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Etoh T, Ohyama T, Sakuramoto S, Tsuji T, Lee SW, Yoshida K, Koeda K, Hiki N, Kunisaki C, Tokunaga M, Otsubo D, Takagane A, Misawa K, Kinoshita T, Cho H, Doki Y, Nunobe S, Shiraishi N, Kitano S. Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer: The JLSSG0901 Randomized Clinical Trial. JAMA Surg 2023; 158:445-454. [PMID: 36920382 PMCID: PMC10018406 DOI: 10.1001/jamasurg.2023.0096] [Citation(s) in RCA: 25] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 11/17/2022] [Indexed: 03/16/2023]
Abstract
Importance Evidence of implementation of laparoscopic gastrectomy for locally advanced gastric cancer is currently insufficient, as the primary end point in previous prospective studies was evaluated at a median follow-up time of 3 years. More robust evidence is necessary to verify noninferiority of laparoscopic gastrectomy. Objective To compare 5-year survival outcomes between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG) with D2 lymph node dissection for locally advanced gastric cancer. Design, Setting, and Participants This was a multicenter, open-label, noninferiority, prospective randomized clinical trial. Between November 26, 2009, and July 29, 2016, eligible patients with histologically proven gastric carcinoma from 37 institutes in Japan were enrolled. Two interim analyses and final analysis were performed in October 2014, May 2018, and November 2021, respectively. Interventions Patients were randomly assigned (1:1) to either the ODG or LADG group. The procedures were performed exclusively by qualified surgeons. Main Outcomes and Measures The primary end point was 5-year relapse-free survival, and the noninferiority margin for the hazard ratio (HR) was set at 1.31. The secondary end points were 5-year overall survival and safety. Results A total of 502 patients were included in the full-analysis set: 254 (50.6%) in the ODG group and 248 (49.4%) in the LADG group. Patients in the ODG group had a median (IQR) age of 67 (33-80) years and included 168 males (66.1%). Patients in the LADG group had a median (IQR) age of 64 (34-80) years and included 169 males (68.1%). No significant differences were observed in severe postoperative complications between the 2 groups in the safety analysis (ODG, 4.7% [11 of 233] vs LADG, 3.5% [8 of 227]; P = .64). The median (IQR) follow-up for all patients after randomization was 67.9 (60.3-92.0) months. The 5-year relapse-free survival was 73.9% (95% CI, 68.7%-79.5%) and 75.7% (95% CI, 70.5%-81.2%) for the ODG and LADG groups, respectively, and the HR was 0.96 (90% CI, 0.72-1.26; noninferiority 1-sided P = .03). Further, no significant difference was observed in overall survival time between the 2 groups, and the HR was 0.83 (95% CI, 0.57-1.21; P = .34). The pattern of recurrence was similar between the 2 groups. Conclusions and Relevance Results of this study show that on the basis of 5-year follow-up data, LADG with D2 lymph node dissection for locally advanced gastric cancer, when performed by qualified surgeons, was proved noninferior to ODG. This laparoscopic approach could become a standard treatment for locally advanced gastric cancer. Trial Registration UMIN Clinical Trial Registry: UMIN000003420.
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Affiliation(s)
- Tsuyoshi Etoh
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Japan
| | | | - Shinichi Sakuramoto
- Department of Upper Gastrointestinal Surgery, Saitama Medical University International Medical Center, Hidaka, Japan
| | - Toshikatsu Tsuji
- Department of Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterology and Pediatric Surgery, Gifu University, Gifu, Japan
| | - Keisuke Koeda
- Department of Medical Safety Science, Iwate Medical University School of Medicine, Shiwa, Japan
| | - Naoki Hiki
- Department of Upper Gastrointestinal Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Chikara Kunisaki
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan
| | - Masanori Tokunaga
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Yushima, Japan
| | - Dai Otsubo
- Department of Gastrointestinal Surgery, Hyogo Cancer Center, Akashi, Japan
| | - Akinori Takagane
- Department of Surgery, Hakodate Goryoukaku Hospital, Hakodate, Japan
| | - Kazunari Misawa
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Takahiro Kinoshita
- Department of Gastric Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Haruhiko Cho
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Honkomagome, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University, Suita, Japan
| | - Souya Nunobe
- Department of Gastric Surgery, Cancer Institute Hospital, Ariake, Japan
| | - Norio Shiraishi
- Department of Comprehensive Surgery for Community Medicine, Oita University Faculty of Medicine, Yufu, Japan
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Yoshida T, Tanaka M, Mohri K, Akiyama S, Yamagishi T, Murata K, Otsubo D, Furutani A, Yamane H, Sawa H, Suzuki S, Kajimoto K, Tominaga M, Fujino Y. [Long-Term Survival of a Patient with Hepatocellular Carcinoma after Surgical Resection of Metachronous Hilar Lymph Node Metastases]. Gan To Kagaku Ryoho 2022; 49:1414-1416. [PMID: 36733086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The recurrence of hepatocellular carcinoma(HCC)is primarily due to intrahepatic metastases. Additionally, extrahepatic HCC metastases most commonly occurs in the lungs, lymph nodes, adrenal glands, and bones. Systemic chemotherapy is the standard treatment for extrahepatic metastases. Although several reports on surgical resection of lymph node metastases (LNM) in patients with HCC have been published, its clinical benefits remain controversial. We report a case in which surgical resection of LNM was performed in a patient with HCC. The patient was a 74-year-old woman diagnosed with HCC and non-B non-C chronic hepatitis, for which she underwent a laparoscopic partial hepatectomy. The pathological diagnosis was St-A, 1.6×1.4 cm, confluent multinodular type, pT1N0M0, fStage Ⅰ. Nine months later, 2 LNM on the liver hilum were detected and managed with sorafenib. Sorafenib was discontinued after 2 months due to the development of Grade 3 hand-foot syndrome. Since no new lesions were detected on follow-up, lymph node resection was performed. The patient remains disease-free 4.5 years postoperatively.
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Kitahama T, Yamane H, Mohri K, Fukuoka E, Yoshida T, Yamagishi T, Goto H, Furutani A, Otsubo D, Matsumoto T, Tanaka M, Fujino Y, Tominaga M. A case of intraductal papillary neoplasm of the bile duct accompanied by intraductal papillary mucinous neoplasm of the pancreas and hepatocellular carcinoma. Clin J Gastroenterol 2021; 14:1536-1543. [PMID: 34106396 DOI: 10.1007/s12328-021-01461-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 06/03/2021] [Indexed: 12/20/2022]
Abstract
A 73-year-old man with mixed-type intraductal papillary mucinous neoplasm of the pancreas body was followed up for 14 years. Based on imaging findings, the intraductal papillary mucinous neoplasm of the pancreas met the high-risk stigmata, and new hepatic masses were suspected to be intraductal papillary neoplasms of the bile duct. With a diagnosis of intraductal papillary mucinous neoplasm of the pancreas and intraductal papillary neoplasm of the bile duct, the patient had undergone left lateral hepatectomy and distal pancreatectomy. Based on pathology, the pancreatic specimen was diagnosed as a high-grade intraductal papillary mucinous neoplasm of the pancreas, and the hepatic specimen was diagnosed as an intraductal papillary neoplasm of the bile duct and hepatocellular carcinoma. The intraductal papillary neoplasms of the bile duct and hepatocellular carcinoma were adjacent to each other. Fifteen months after surgery, recurrence in the remnant pancreas was detected. The patient had undergone residual total pancreatectomy, with no recurrence thirty months after the second resection. This case demonstrates that second surgery for metachronous high-risk lesions in the remnant pancreas of patients with intraductal papillary mucinous neoplasm of the pancreas and intraductal papillary neoplasm of the bile duct may also be considered to improve survival.
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Affiliation(s)
- Takumi Kitahama
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan.
| | - Hisoka Yamane
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Koichi Mohri
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Eiji Fukuoka
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Toshihiko Yoshida
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Takashi Yamagishi
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Hironobu Goto
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Akinobu Furutani
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Dai Otsubo
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Taku Matsumoto
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Motofumi Tanaka
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Yasuhiro Fujino
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
| | - Masahiro Tominaga
- Division of Gastroenterological Surgery, Hyogo Cancer Center, 13-70 Kitaoji-cho, Akashi, Hyogo, 673-8558, Japan
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Matsumoto T, Yoshida T, Yamagishi T, Goto H, Otsubo D, Furutani A, Yamane H, Fujino Y, Tominaga M. Hepatocellular carcinoma recurrence in the extrahepatic bile duct wall: A case report. Clin Case Rep 2021; 9:1561-1565. [PMID: 33768889 PMCID: PMC7981687 DOI: 10.1002/ccr3.3828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 12/19/2020] [Accepted: 01/06/2021] [Indexed: 11/07/2022] Open
Abstract
We should know that hepatocellular carcinoma can progress as if it replaces the bile duct wall itself.
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Affiliation(s)
- Taku Matsumoto
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Toshihiko Yoshida
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Takashi Yamagishi
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Hironobu Goto
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Dai Otsubo
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Akinobu Furutani
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Hisoka Yamane
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Yasuhiro Fujino
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
| | - Masahiro Tominaga
- Department of Gastroenterological SurgeryHyogo Cancer CenterAkashiJapan
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Yoshida T, Yamane H, Kitahama T, Mohri K, Fukuoka E, Kozuki R, Yamagishi T, Goto H, Otsubo D, Furutani A, Matsumoto T, Hirose T, Fujino Y. [A Case of Complete Resection Using the Liver-First Approach after Systemic Chemotherapy in a Patient with Synchronous Colorectal Liver and Lung Metastases]. Gan To Kagaku Ryoho 2021; 48:416-418. [PMID: 33790173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Conversion surgery for patients with initially unresectable colorectal liver metastases is increasingly being performed because of effective systemic chemotherapy. Additionally, many studies have reported the benefit of the liver-first approach for advanced liver metastasis. We report a case of an initially unresectable advanced colon cancer with multiple liver and lung metastases that was successfully treated with the liver-first approach following chemotherapy. The patient was a 36-year- old woman who was diagnosed with advanced rectal cancer, cT4aN2aM1b, cStage Ⅳb. After a temporary transverse colostomy, she was administered systemic chemotherapy for 9 months. The primary tumor and liver metastases showed partial response while the lung metastases showed complete response. Since it was considered that liver metastases were the main prognostic factors, we performed a right hemihepatectomy plus S3 partial hepatectomy, followed by laparoscopic high anterior resection. A partial pneumonectomy was also performed because of the regrowth of the lung metastases, and we succeeded in complete resection. The liver-first approach was a beneficial treatment option for this patient with unresectable colorectal liver metastases.
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Furutani A, Yoshida S, Yoshida T, Nishi M, Yamagishi T, Goto H, Otsubo D, Yamane H, Matsumoto T, Fujino Y, Tominaga M. A case of laparoscopic anterior resection for rectal cancer with duplication of the inferior vena cava using preoperative 3D computed tomography angiography. J Surg Case Rep 2020; 2020:rjaa223. [PMID: 32983404 PMCID: PMC7502290 DOI: 10.1093/jscr/rjaa223] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/09/2020] [Indexed: 11/25/2022] Open
Abstract
We report the case of a patient with duplication of the inferior vena cava (DIVC) who underwent anterior laparoscopic resection for rectal cancer. A 66-year-old woman presented with abnormal lung shadows on a chest x-ray during a routine health checkup. She was diagnosed with rectal cancer and lung metastasis using colonoscopy and thoracoabdominal computed tomography (CT). In addition, a 3D CT angiography revealed double inferior vena cava, one on either side of the aorta. The preoperative diagnosis was rectal cancer cT3N0M1a(Lung) cStage IVA with DIVC, and a two-stage surgery was planned. The first stage was high anterior laparoscopic resection. This was safely performed because the pre-hypogastric nerve fascia was preserved and the left inferior vena cava was not visualized during the surgery. During the second stage of the surgery, video-assisted thoracoscopic left lower lobectomy was performed and no recurrence was observed for >6 months after the second surgery.
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Affiliation(s)
- Akinobu Furutani
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Sachiko Yoshida
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Toshihiko Yoshida
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Masayasu Nishi
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Takashi Yamagishi
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Hironobu Goto
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Dai Otsubo
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Hisoka Yamane
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Taku Matsumoto
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Yasuhiro Fujino
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
| | - Masahiro Tominaga
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo 673-8558, Japan
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Oshikiri T, Takiguchi G, Miura S, Goto H, Otsubo D, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Fujino Y, Tominaga M, Nakamura T, Suzuki S, Kakeji Y. Correction to: Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study. Ann Surg Oncol 2020; 27:970-971. [PMID: 32350716 DOI: 10.1245/s10434-020-08506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the original article, there are errors in Fig. 1. Following is the corrected figure.
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Affiliation(s)
- Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Susumu Miura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Hironobu Goto
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Dai Otsubo
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Yasuhiro Fujino
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Masahiro Tominaga
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Satoshi Suzuki
- Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
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Goto H, Kanaji S, Otsubo D, Oshikiri T, Yamamoto M, Nakamura T, Suzuki S, Fujino Y, Tominaga M, Kakeji Y. Comparison of total versus subtotal gastrectomy for remnant gastric cancer. Langenbecks Arch Surg 2019; 404:753-760. [DOI: 10.1007/s00423-019-01821-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
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Yamane H, Yoshida S, Yoshida T, Nishi M, Yamagishi T, Goto H, Otsubo D, Furutani A, Matsumoto T, Fujino Y, Tominaga M. Laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma accompanied by hypoplasia of the right hepatic lobe. J Surg Case Rep 2019; 2019:rjz213. [PMID: 31308931 PMCID: PMC6619407 DOI: 10.1093/jscr/rjz213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 06/16/2019] [Indexed: 11/12/2022] Open
Abstract
We report a case of laparoscopic anatomical segment 3 segmentectomy for hepatocellular carcinoma (HCC) accompanied by hypoplasia of the right hepatic lobe. An 80-year-old man was admitted with a suspicion of HCC diagnosed by computed tomography during follow-up for thyroid cancer. Dynamic computed tomography showed 40-mm HCC in segment 3 and hypoplasia of the right hepatic lobe with the Chilaiditi sign. We performed laparoscopic anatomical segment 3 segmentectomy. There were no postoperative complications, and the patient was discharged 6 days postoperatively. This procedure can be performed safely and is technically feasible, but special attention should be paid to anatomical alterations to avoid fatal surgical complications.
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Affiliation(s)
- Hisoka Yamane
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Sachiko Yoshida
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Toshihiko Yoshida
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Masayasu Nishi
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Takashi Yamagishi
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Hironobu Goto
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Dai Otsubo
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Akinobu Furutani
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Taku Matsumoto
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Yasuhiro Fujino
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
| | - Masahiro Tominaga
- Division of Gastroenterological Surgery, Hyogo Cancer Center, Hyogo, Japan
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Oshikiri T, Takiguchi G, Miura S, Goto H, Otsubo D, Hasegawa H, Yamamoto M, Kanaji S, Yamashita K, Matsuda T, Fujino Y, Tominaga M, Nakamura T, Suzuki S, Kakeji Y. Thoracic Duct Resection During Esophagectomy Does Not Contribute to Improved Prognosis in Esophageal Squamous Cell Carcinoma: A Propensity Score Matched-Cohort Study. Ann Surg Oncol 2019; 26:4053-4061. [PMID: 31313045 DOI: 10.1245/s10434-019-07627-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE Esophagectomy with extended lymphadenectomy remains the mainstay of treatment for localized esophageal squamous cell carcinoma (ESCC). Thoracic duct (TD) resection has been recommended as part of extended lymphadenectomy, although its merits are unclear. The aim of this two-institutional, matched-cohort study is to clarify whether TD resection improves prognosis in esophagectomy for ESCC. PATIENTS AND METHODS In this two-institutional, matched-cohort study of 399 patients with ESCC who underwent McKeown esophagectomy between 2010 and 2014, the primary outcomes were overall survival (OS), disease-free survival (DFS), and cause-specific survival (CSS). Secondary outcomes were perioperative results and recurrence patterns. RESULTS Based on a propensity score, 122 TD-resected or 122 TD-preserved patients in all stages were selected (median follow-up 4.5 years). The 5-year OS, DFS, and CSS rates in the TD-resected versus TD-preserved groups were 49% versus 60%, 53% versus 57%, and 58% versus 70%, respectively, without any significant differences. Operative time for the thoracic procedure was significantly longer and the number of retrieved mediastinal nodes was significantly higher in the TD-resected group (P = 0.009 and 0.005, respectively). The rates of chylothorax and left recurrent laryngeal nerve (RLN) palsy were significantly higher in the TD-resected group (P = 0.041 and 0.018, respectively). There were no significant differences in rates of local or distant metastases between the two groups. CONCLUSIONS TD resection does not contribute to improve OS, DFS, or CSS in ESCC but increases incidence of chylothorax and left RLN palsy. Prophylactic TD resection should be avoided in esophagectomy for ESCC.
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Affiliation(s)
- Taro Oshikiri
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan.
| | - Gosuke Takiguchi
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Susumu Miura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Hironobu Goto
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Dai Otsubo
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Hiroshi Hasegawa
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Masashi Yamamoto
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Shingo Kanaji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Kimihiro Yamashita
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Takeru Matsuda
- Division of Minimally Invasive Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Yasuhiro Fujino
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Masahiro Tominaga
- Department of Gastroenterological Surgery, Hyogo Cancer Center, Akashi, Hyogo, Japan
| | - Tetsu Nakamura
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Satoshi Suzuki
- Division of Community Medicine and Medical Network, Department of Social Community Medicine and Health Science, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Hyogo, Japan
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Hasegawa H, Yamashita K, Otsubo D, Kakeji Y. Liver Injury After Invariant NKT Cell Activation by Free Alpha-galactosylceramide and Alpha-galactosylceramide-loaded Dendritic Cells. Anticancer Res 2016; 36:3667-3672. [PMID: 27354638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/17/2016] [Indexed: 06/06/2023]
Abstract
BACKGROUND/AIM Both free alpha-galactosylceramide (αGalCer) and αGalCer-loaded dendritic cells (DCG) activate invariant natural killer T (iNKT) cells to varying degrees, with αGalCer inducing liver injury. We sought to evaluate liver injury by these two pathways. MATERIALS AND METHODS Mice were injected with αGalCer or DCG followed by analysis of serum alanine transaminase (ALT) activity levels, mortality and liver function. RESULTS While ALT levels were elevated after DCG in a tumor necrosis factor (TNF)-α-dependent manner, DCG did not cause lethal injury. More serious injury of liver CD31-positive endothelial cells (CD31(+) EC) was observed in mice treated with αGalCer than with DCG. Furthermore, liver CD31(+) EC of αGalCer-treated mice induced naïve liver lymphocytes to produce TNF-α. CONCLUSION DCG treatment did not induce lethal liver injury. CD31(+) EC may play an antigen-presenting role to iNKT cells after αGalCer treatment and may be a cause of lethal injury.
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Affiliation(s)
- Hiroshi Hasegawa
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimihiro Yamashita
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Dai Otsubo
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Otsubo D, Yamashita K, Fujita M, Nishi M, Kimura Y, Hasegawa H, Suzuki S, Kakeji Y. Early-phase Treatment by Low-dose 5-Fluorouracil or Primary Tumor Resection Inhibits MDSC-mediated Lung Metastasis Formation. Anticancer Res 2015; 35:4425-4431. [PMID: 26168482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM The outcome of patients with malignant tumors is poor if they suffer from lung metastases. Myeloid-derived suppressor cells (MDSCs), a major player for tumor-induced immunosuppression, can be suppressed by certain chemotherapeutic agents, such as low-dose 5-fluorouracil (5-FU) or surgical treatment. Based on these findings, we hypothesized that early-phase treatment by low-dose 5-FU or surgical resection of primary tumors would prevent lung metastasis formation by inhibiting MDSCs. MATERIALS AND METHODS B16F10 melanoma-bearing C57BL/5 mice with lung metastases were treated with low-dose 5-FU or surgical resection of primary tumors. RESULTS Low-dose 5-FU chemotherapy inhibited systemic and lung-accumulating MDSCs in tumor-bearing mice. The therapy inhibited lung metastasis formation and prolonged the survival of the animals. Consistently, early-phase resection of primary tumors improved survival, which was concomitant with a reduction of lung-accumulating MDSCs and lung metastases. CONCLUSION Early-phase treatment may provide therapeutic values to prevent MDSC-mediated lung metastasis formation in tumor-bearing hosts.
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Affiliation(s)
- Dai Otsubo
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kimihiro Yamashita
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mitsugu Fujita
- Departments of Microbiology and Acute Medicine, Kindai University Graduate School of Medical Sciences, Osaka, Japan
| | - Masayasu Nishi
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yutaka Kimura
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hiroshi Hasegawa
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Suzuki
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshihiro Kakeji
- Department of Surgery, Division of Gastrointestinal Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Mii Y, Fukuoka E, Murata K, Otsubo D, Sawa H, Oka S, Iwatani Y, Kuroda D. [A case of erythema multiforme induced by regorafenib therapy for metastatic colon cancer]. Gan To Kagaku Ryoho 2014; 41:1841-1843. [PMID: 25731348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A 47-year-old woman underwent colectomy for advanced colon cancer and thereafter received regorafenib therapy as fourth-line chemotherapy. On treatment day 12, the patient developed erythema multiforme (EM) induced by the regorafenib therapy. Immediately after regorafenib was withdrawn, the patient was treated with oral bepotastine and steroid ointment, which relieved the EM without progressing to Stevens-Johnson syndrome (SJS). Regorafenib is used for third- or fourth-line chemotherapy. Progression of regorafenib-induced EM to SJS may cause critical dysfunction among patients. Before administering regorafenib therapy, the patient should be made aware of this potential adverse effect and be advised to withdraw the treatment and visit the hospital immediately if symptoms of EM are observed.
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Otsubo D, Sawa H, Fukuoka E, Murata K, Mii Y, Oka S, Iwatani Y, Kuroda D. [Pathological complete response in a large gastric GIST that became resectable after neoadjuvant chemotherapy with imatinib mesylate]. Gan To Kagaku Ryoho 2014; 41:2402-2404. [PMID: 25731537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
We report a case of a large gastric gastrointestinal stromal tumor (GIST), which became resectable and achieved pathological complete response after neoadjuvant chemotherapy with imatinib mesylate. A 59-year-old man presented with left hypochondrial pain. Abdominal computed tomography (CT) revealed gastric GIST invading the spleen and the diaphragm. Administration of imatinib mesylate was initiated as neoadjuvant chemotherapy. Six months after neoadjuvant chemotherapy with imatinib mesylate, abdominal CT revealed a reduction in tumor size. We judged the tumor resectable and performed partial gastrectomy and splenectomy. Histologically, number of myofibroblasts increased, but no viable tumor cells were observed. Pathological complete response was obtained.
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Affiliation(s)
- Dai Otsubo
- Dept. of Surgery, Kita-Harima Medical Center
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