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Ueno H, Hase K, Shiomi A, Shiozawa M, Ito M, Sato T, Hashiguchi Y, Kusumi T, Kinugasa Y, Ike H, Matsuda K, Yamada K, Komori K, Takahashi K, Kanemitsu Y, Ozawa H, Ohue M, Masaki T, Takii Y, Ishibe A, Watanabe J, Toiyama Y, Sonoda H, Koda K, Akagi Y, Itabashi M, Nakamura T, Sugihara K. Optimal bowel resection margin in colon cancer surgery: prospective multicentre cohort study with lymph node and feeding artery mapping. Lancet Reg Health West Pac 2023; 33:100680. [PMID: 37181532 PMCID: PMC10166781 DOI: 10.1016/j.lanwpc.2022.100680] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 12/13/2022] [Accepted: 12/21/2022] [Indexed: 01/20/2023]
Abstract
Background There are no standardised criteria for the 'regional' pericolic node in colon cancer, which represents a major cause of the international uncertainty regarding the optimal bowel resection margin. This study aimed to determine 'regional' pericolic nodes based on prospective lymph node (LN) mapping. Methods According to preplanned in vivo measurements of the bowel, the anatomical distributions of the feeding artery and LNs were determined in 2996 stages I-III colon cancer patients who underwent colectomy with resection margin >10 cm at 25 institutions in Japan. Findings The mean number of retrieved pericolic nodes was 20.9 (standard deviation, 10.8) per patient. In all patients except seven (0.2%), the primary feeding artery was distributed within 10 cm of the primary tumour. The metastatic pericolic node most distant from the primary tumour was within 3 cm in 837 patients, 3-5 cm in 130 patients, 5-7 cm in 39 patients and 7-10 cm in 34 patients. Only four patients (0.1%) had pericolic lymphatic spread beyond 10 cm; all of whom had T3/4 tumours accompanying extensive mesenteric lymphatic spread. The location of metastatic pericolic node did not differ by the feeding artery's distribution. Postoperatively, none of the 2996 patients developed recurrence in the remaining pericolic nodes. Interpretation The pericolic nodes designated as 'regional' were those located within 10 cm of the primary tumours, which should be fully considered when determining the bowel resection margin, even in the era of complete mesocolic excision. Funding Japanese Society for Cancer of the Colon and Rectum.
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Affiliation(s)
- Hideki Ueno
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Shiomi
- Division of Colorectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Masaaki Ito
- Colorectal and Pelvic Surgery Division, Department of Surgical Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Toshihiko Sato
- Department of Surgery, Yamagata Prefectural Central Hospital, Yamagata, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Takaya Kusumi
- Department of Surgery, Keiyukai Sappro Hospital, Hokkaido, Japan
| | - Yusuke Kinugasa
- Department of Gastrointestinal Surgery, Tokyo Medical and Dental University, Tokyo, Japan
| | - Hideyuki Ike
- Department of Surgery, Saisei-kai Yokohama-shi Nanbu Hospital, Kanagawa, Japan
| | - Kenji Matsuda
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Kazutaka Yamada
- Department of Gastroenterological Surgery, Coloproctology Center, Takano Hospital, Kumamoto, Japan
| | - Koji Komori
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Aichi, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Centre Hospital, Tokyo, Japan
| | - Heita Ozawa
- Department of Surgery, Tochigi Cancer Centre, Utsunomiya, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University School of Medicine, Tokyo, Japan
| | - Yasumasa Takii
- Department of Surgery, Niigata Cancer Centre Hospital, Niigata, Japan
| | - Atsushi Ishibe
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Jun Watanabe
- Department of Surgery, Gastroenterological Centre, Yokohama City University Medical Centre, Kanagawa, Japan
| | - Yuji Toiyama
- Department of Gastrointestinal and Pediatric Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiromichi Sonoda
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Keiji Koda
- Department of Surgery, Teikyo University Chiba Medical Centre, Chiba, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Fukuoka, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Takahiro Nakamura
- Laboratory for Mathematics, National Defense Medical College, Saitama, Japan
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Watanabe J, Kanemitsu Y, Suwa H, Kakeji Y, Ishihara S, Shinto E, Ozawa H, Suto T, Kawamura J, Fujita F, Itabashi M, Ohue M, Ike H, Sugihara K. A multicenter cohort study on mapping of lymph node metastasis for splenic flexural colon cancer. Ann Gastroenterol Surg 2022; 7:265-271. [PMID: 36998296 PMCID: PMC10043763 DOI: 10.1002/ags3.12620] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 09/01/2022] [Indexed: 04/01/2023] Open
Abstract
Aim There have been no reports of searching for metastases to lymph nodes along the accessory middle colic artery (aMCA). The aim of this study was to investigate the metastasis rate of the aMCA for splenic flexural colon cancer. Methods Patients with histologically proven colon carcinoma located in the splenic flexure, clinically diagnosed as stage I-III were eligible for this study. Patients were retrospectively and prospectively enrolled. The primary endpoint was frequency of lymph node metastasis to the aMCA (station 222-acc and 223-acc). The secondary endpoint was the frequency of lymph node metastasis to the middle colic artery (MCA) (station 222-lt and 223) and left colic artery (LCA) (station 232 and 253). Results Between January 2013 and February 2021, a total of 153 consecutive patients were enrolled. The location of the tumor was 58% in the transverse colon and 42% in the descending colon. Lymph node metastases were observed in 49 cases (32%). The presence of aMCA rate was 41.8% (64 cases). The metastasis rates of stations 221, 222-lt, and 223 were 20.0%, 1.6%, and 0%, and stations 231, 232, and 253 were 21.4%, 1.0%, and 0%, respectively. The metastasis rates of stations 222-acc and 223-acc were 6.3% (95% confidence interval: 1.7%-15.2%) and 3.7% (95% confidence interval: 0.1%-19%), respectively. Conclusions This study identified the distribution of lymph node metastases from splenic flexural colon cancer. If the aMCA is present, this vessel should be targeted for dissection, taking into account the frequency of lymph node metastasis.
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Affiliation(s)
- Jun Watanabe
- Department of Surgery, Gastroenterological CenterYokohama City University Medical CenterYokohamaJapan
| | - Yukihide Kanemitsu
- Department of Colorectal SurgeryNational Cancer Center HospitalTokyoJapan
| | - Hirokazu Suwa
- Department of SurgeryYokosuka Kyosai HospitalYokosukaJapan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of SurgeryKobe University Graduate School of MedicineKobeJapan
| | - Soichiro Ishihara
- Department of Surgical Oncology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Eiji Shinto
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Heita Ozawa
- Department of Colorectal SurgeryTochigi Cancer CenterUtsunomiyaJapan
| | - Takeshi Suto
- Department of Gastroenterological SurgeryYamagata Prefectual Central HospitalYamagataJapan
| | - Junichiro Kawamura
- Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | | | - Michio Itabashi
- Department of SurgeryInstitute of Gastroenterology, Tokyo Women's Medical UniversityTokyoJapan
| | - Masayuki Ohue
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Hideyuki Ike
- Department of SurgeryJCHO Yokohama Hodogaya Central HospitalYokohamaJapan
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Takii Y, Mizusawa J, Kanemitsu Y, Komori K, Shiozawa M, Ohue M, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Ota M, Sunami E, Hamaguchi T, Shida D, Katayama H, Shimada Y, Fukuda H. 414P Long-term follow-up of the randomized trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colon cancer ( JCOG1006). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Shinto E, Ike H, Ito M, Takahashi K, Ohue M, Kanemitsu Y, Suto T, Kinugasa T, Watanabe J, Hida JI, Itabashi M, Ozawa H, Nozawa H, Kobayashi H, Hashiguchi Y, Hase K, Sugihara K. OUP accepted manuscript. BJS Open 2022; 6:6544103. [PMID: 35257141 PMCID: PMC8902341 DOI: 10.1093/bjsopen/zrac006] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 01/13/2022] [Accepted: 01/14/2022] [Indexed: 11/20/2022] Open
Abstract
Background Patients with lateral node metastasis in low rectal cancers have a poor prognosis. However, variability in patient survival in terms of lateral metastatic status has not been thoroughly investigated. This study was conducted to assess the prognostic value of lateral node involvement and to review nodal classification. Methods Patients with stage III low rectal cancers who underwent lateral node dissection were retrospectively reviewed. Two cohorts were set: the first one (1995–2006) was selected using a Japanese multi-institutional database and was used for development of a new nodal system, and the second (2007–2013) was collected from referral institutions for validation of findings. Variables correlated with poor prognosis were investigated. Next, a modified classification of lateral-positive nodal cancers was created. Finally, this new classification was compared with TNM and Japanese classification-based systems according to the Akaike information criterion (AIC) and concordance index (c-index). Results Overall, 742 and 508 patients were selected for cohorts 1 and 2, respectively. Based on the analyses on cohort 1, patients with two or more lateral metastatic nodes partially spreading into regions outside of internal iliac area exhibited poor prognosis; accordingly, a modified N classification was created, where TNM-N1 and N2a cancers with this feature were upgraded, respectively, to N2a and N2b. The modified N classification yielded the most favourable indices (AIC = 2661.08; c-index = 0.6477) compared with the TNM (AIC = 2662.36; c-index = 0.6457) and Japanese classification-based systems (AIC = 2684.06; c-index = 0.6302). All findings were confirmed by analysing cohort 2. Conclusion A modified nodal system is proposed to account for the significance of lateral node metastasis.
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Affiliation(s)
- Eiji Shinto
- Correspondence to: Eiji Shinto, Department of Surgery National Defense Medical College 3-2 Namiki, Tokorozawa, Saitama 359-8513, Japan (e-mail: )
| | - Hideyuki Ike
- Department of Surgery, JCHO Yokohama Hodogaya Central Hospital, Yokohama, Japan
| | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Keiichi Takahashi
- Department of Surgery, Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, Tokyo, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectual Central Hospital, Yamagata, Japan
| | | | - Jun Watanabe
- Department of Surgery, Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Jin-ichi Hida
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Michio Itabashi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Heita Ozawa
- Department of Colorectal Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Hiroaki Nozawa
- Department of Surgical Oncology, The University of Tokyo, Tokyo, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Teikyo University Hospital, Mizonokuchi, Kawasaki, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
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Kanemitsu Y, Shitara K, Mizusawa J, Hamaguchi T, Shida D, Komori K, Ikeda S, Ojima H, Ike H, Shiomi A, Watanabe J, Takii Y, Yamaguchi T, Katsumata K, Ito M, Okuda J, Hyakudomi R, Shimada Y, Katayama H, Fukuda H. Primary Tumor Resection Plus Chemotherapy Versus Chemotherapy Alone for Colorectal Cancer Patients With Asymptomatic, Synchronous Unresectable Metastases (JCOG1007; iPACS): A Randomized Clinical Trial. J Clin Oncol 2021; 39:1098-1107. [PMID: 33560877 PMCID: PMC8078424 DOI: 10.1200/jco.20.02447] [Citation(s) in RCA: 104] [Impact Index Per Article: 34.7] [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] [Indexed: 12/16/2022] Open
Abstract
It remains controversial whether primary tumor resection (PTR) before chemotherapy improves survival in patients with colorectal cancer (CRC) with asymptomatic primary tumor and synchronous unresectable metastases.
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Affiliation(s)
| | - Kohei Shitara
- National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Tetsuya Hamaguchi
- Saitama Medical University International Medical Center, Hidaka, Japan
| | - Dai Shida
- National Cancer Center Hospital, Tokyo, Japan
| | | | | | | | - Hideyuki Ike
- Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | - Akio Shiomi
- Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Jun Watanabe
- Yokohama City University Medical Center, Yokohama, Japan
| | | | | | | | - Masaaki Ito
- National Cancer Center Hospital East, Kashiwa, Japan
| | - Junji Okuda
- Osaka Medical College Hospital, Osaka, Japan
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Shinto E, Ike H, Hida J, Kobayashi H, Hashiguchi Y, Hase K, Kishi Y, Ueno H, Sugihara K. Proposal of a modified subclassification system for stage III colorectal cancer: A multi-institutional retrospective analysis. Ann Gastroenterol Surg 2020; 4:667-675. [PMID: 33319157 PMCID: PMC7726692 DOI: 10.1002/ags3.12375] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 05/28/2020] [Accepted: 06/22/2020] [Indexed: 11/10/2022] Open
Abstract
AIM The prognostic value of the stage III subclassification system based on the Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma has not yet been clarified. This study aimed to develop a modified system with optimal risk stratification and compare its performance with the current staging systems. METHODS Clinicopathological data from 6855 patients with stage III colorectal cancers who underwent D3 dissection were collected from a nationwide multicenter database. After determining patient survival rates across 13 divisions based on pathological N stage (N1, N2a, and N2b/N3) and tumor depth (T1, T2, T3, T4a, and T4b), except for T1N2a and T1N2b/N3 due to the small number, we categorized patients into three groups and developed a trisection staging system according to the Akaike information criterion. We then compared the Akaike information criterion of the developed system with those of the current staging systems. RESULTS The T1N1[rank, 1] division (98.5%) had the most favorable prognosis in terms of 5-year cancer-specific survival, followed by T2N1[2] (93.9%), T2N2a[3] (92.0%), T3N1[4] (87.0%), T3N2a[5] (78.8%), T4aN1[6] (78.7%), T2N2b/N3[7] (77.8%), T4aN2a[8] (75.2%), T4bN1[9] (73.5%), T3N2b/N3[10] (64.7%), T4aN2b/N3[11] (61.5%), T4bN2b/N3[12] (43.0%), and T4bN2a[13] (42.5%). Compared to the categorizations of the Japanese and tumor-node-metastasis systems (Akaike information criterion, 22 684.6 and 22 727.1, respectively), the following stage categorizations were proven to be the most clinically efficacious: T1N1[1 ]-T3N1[4], T3N2a[5 ]-T4bN1[9], and T3N2b/N3[10 ]-T4bN2a[13] (Akaike information criterion, 22 649.2). CONCLUSION The proposed modified system may be useful in the risk stratification of patients with stage III colorectal cancer who had undergone D3 dissection.
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Affiliation(s)
- Eiji Shinto
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Hideyuki Ike
- Department of SurgeryJCHO Yokohama Hodogaya Central HospitalHodogayaJapan
| | - Jin‐ichi Hida
- Department of SurgeryKindai University Nara HospitalIkomaJapan
| | | | | | - Kazuo Hase
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Yoji Kishi
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
| | - Hideki Ueno
- Department of SurgeryNational Defense Medical CollegeTokorozawaJapan
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Ozawa H, Kotake K, Ike H, Sugihara K. Prognostic Impact of the Length of the Distal Resection Margin in Rectosigmoid Cancer: An Analysis of the JSCCR Database between 1995 and 2004. J Anus Rectum Colon 2020; 4:59-66. [PMID: 32346644 PMCID: PMC7186012 DOI: 10.23922/jarc.2019-013] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 01/16/2020] [Indexed: 11/30/2022]
Abstract
Objectives The necessary and sufficient length of the distal resection margin (l-DRM) for rectosigmoid cancer remains controversial. This study evaluated the validity of the 3-cm l-DRM rule for rectosigmoid cancer in the Japanese classification of colorectal cancer. Methods We retrospectively reviewed 1,443 patients with cT3 and cT4 rectosigmoid cancer who underwent R0 resection in Japanese institutions between 1995 and 2004. We identified the optimal cutoff point of the l-DRM affecting overall survival (OS) rate using a multivariate Cox regression analysis model. Using this cutoff point, the patients were divided into two groups after balancing the potential confounding factors of the l-DRM using propensity score matching, and the OS rates of the two groups were compared. Results A multivariate Cox regression analysis model revealed that the l-DRM of 4 cm was the best cutoff point with the greatest impact on OS rate (hazard ratio [HR], 1.37; 95% confidence interval [CI], 1.00-1.84; P = 0.0452) and with the lowest Akaike information criterion value. In the matched cohort study, the OS rate of patients who had l-DRM of 4 cm or more was significantly higher than that of patients who had l-DRM < 4 cm (n = 402; 5-year OS rates, 87.6% vs. 80.3%, respectively; HR, 1.60; 95% CI, 1.09-2.31; P = 0.0136). Conclusions For cT3 and cT4 rectosigmoid cancer, l-DRM of 4 cm may be an appropriate landmark for a curative intent surgery, and we were unable to definitively confirm the validity of the Japanese 3-cm l-DRM rule.
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Affiliation(s)
- Heita Ozawa
- Department of Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Kenjiro Kotake
- Department of Gastroenterological Surgery, Sano City Hospital, Sano, Japan
| | - Hideyuki Ike
- Department of Surgery, Yokohama Hodogaya Central Hospital, Yokohama, Japan
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Shinto E, Ike H, Hida JI, Kobayashi H, Hashiguchi Y, Kajiwara Y, Hase K, Ueno H, Sugihara K. Marked impact of tumor location on the appropriate cutoff values and the prognostic significance of the lymph node ratio in stage III colon cancer: a multi-institutional retrospective analysis. J Gastroenterol 2019; 54:597-607. [PMID: 30607613 DOI: 10.1007/s00535-018-01539-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 12/18/2018] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prognostic significance of lymph node ratio (LNR) is not constant among studies. Exploration of appropriate location-specific cutoffs might be necessary because the number of lymph nodes harvested is generally higher in right than in left colon cancer. We aimed to determine appropriate cutoff values of LNR in right and left colon cancer and to clarify its clinical significance. METHODS The clinicopathologic data of 5463 patients with stage III colon cancer were collected. The best cutoff for LNR as a prognostic indicator for patients with right and left colon cancer was studied separately. We compared the prognostic impact between LNR and the number of lymph node metastasis using the Akaike information criterion (AIC), and evaluated the prognostic significance of LNR in each stage III subcategory. RESULTS The best performance was noted when LNR was categorized by cutoffs of 0.16 and 0.22 for right and left colon cancer, respectively. AIC scores were better with these categorizations than with subgrouping by number of positive nodes. LNR-low right colon cancer patients showed better cancer-specific survival than LNR-high in stage IIIA (95.7% vs. 89.3%), IIIB (86.7% vs. 77.2%), and IIIC (71.2% vs. 58.7%). The same results were obtained in left colon cancer patients with stage IIIB (88.3% vs. 80.7%) and IIIC (79.8% vs. 68.4%). CONCLUSIONS We demonstrated the difference in the appropriate cutoffs of LNR between right and left colon cancer. Categorization by location-specific cutoff of LNR may be useful for risk stratification of patients with stage III cancer.
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Affiliation(s)
- Eiji Shinto
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan.
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, 3-2-10 Konandai, Konan-ku, Yokohama, Kanagawa, 234-0054, Japan
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University School of Medicine, 3-4-1 Kowakae, Higashiosaka, Osaka, 577-8502, Japan
| | - Hirotoshi Kobayashi
- Department of Surgery, Tokyo Metropolitan Hiroo Hospital, 2-34-10 Ebisu, Shibuya-ku, Tokyo, 150-0013, Japan
| | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-8605, Japan
| | - Yoshiki Kajiwara
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, 3-2 Namiki, Tokorozawa, Saitama, 359-8513, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan
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Takii Y, Mizusawa J, Kanemitsu Y, Komori K, Shiozawa M, Ohue M, Nishimura Y, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Ota M, Masaki T. A randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colon cancer: Primary analysis of Japan Clinical Oncology Group study JCOG1006. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.3515] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
3515 Background: The no-touch isolation technique (NTIT) aims to reduce cancer cells flowing from the primary tumor site to the liver and other organs by first ligation of blood vessels that feed the primary tumor. The efficacy of NTIT has not been proved in previous studies. To acquire the answer of an unsolved problem more than 60 years, we conducted a phase III trial to confirm the superiority of NTIT in patients with cT3/T4 colon cancer. This is the primary analysis of the disease-free survival (DFS) as the primary endpoint. Methods: Eligibility criteria included histologically proven colon cancer; tumor located in the cecum, ascending, transverse, descending, sigmoid or rectosigmoid colon; clinical T3 or T4, N0-2, M0; patients age 20-80 years. Patients were randomized preoperatively to either conventional technique (CoT) arm or NTIT arm. Operation was performed in open surgery. Patients with pathological stage III received adjuvant chemotherapy with capecitabine. The primary endpoint was DFS. Planned sample size was 850 to detect a hazard ratio (HR) of 0.732 in DFS with one-sided alpha of 5% and power of 80%. Results: A total of 853 patients were randomized (CoT: 427, NTIT: 426) between January 2011 and November 2015. The 3-year DFS were 77.3% and 76.2% in the CoT arm and NTIT arm,respectively. The HR was 1.029(95% CI 0.800-1.324); thus the superiority of NTIT was not confirmed (p = 0.59). The 3-year overall survival (OS), 3-year recurrence-free survival (RFS) and 3-year liver-recurrence-free survival (LRFS) are shown in the Table. Conclusions: The superiority of NTIT to CoT was not confirmed. NTIT does not improve the DFS or OS, RFS, LRFS in the patents with stage II and III colon cancer. Clinical trial information: UMIN000004957. [Table: see text]
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Affiliation(s)
- Yasumasa Takii
- Department of Gastroenterological Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yukihide Kanemitsu
- Department of Colorectal Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Masayuki Ohue
- Department of Gastroenterological Surgery, Osaka International Cancer Institite, Osaka, Japan
| | - Yoji Nishimura
- Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | | | - Nobuhiro Takiguchi
- Department of Gastroenterological Surgery, Chiba Cancer Center, Chiba, Japan
| | - Takaya Kobatake
- Department of Gastroenterological Surgery, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohama City Nanbu Hospital,, Yokohama, Japan
| | | | - Naohiro Tomita
- Division of Lower GI Surgery, Department of Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Mitsuyoshi Ota
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Tadahiko Masaki
- Department of Surgery, Kyorin University, Mitaka City,Tokyo, Japan
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10
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Yasui M, Takii Y, Ohue M, Komori K, Shiozawa M, Nishimura Y, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Fujii S, Yatsuoka T, Shingai T, Shimada Y, Katayama H, Kanemitsu Y. Central monitoring as surgical quality assurance in a randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colorectal cancer (Japan clinical oncology group study / JCOG1006). Eur J Surg Oncol 2019. [DOI: 10.1016/j.ejso.2018.10.196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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11
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Hashimoto I, Hasegawa S, Ikeda T, Sugawara Y, Takagawa R, Inagaki D, Murakami H, Osaragi T, Ueda M, Ike H, Fukushima T, Imada T, Rino Y, Masuda M. [A Case of Neuroendocrine Tumor G1 of the Ileum with Multiple Liver Metastases]. Gan To Kagaku Ryoho 2018; 45:1964-1966. [PMID: 30692412] [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: 06/09/2023]
Abstract
A 74-year-old man was admitted to our hospital with multiple liver tumors detected by routine ultrasonography. Colonoscopy showed a type 2 tumor measuring approximately 25mm in diameter at the terminal ileum. The biopsy specimen showed neuroendocrine tumor(NET)G1. The patient was diagnosed with NET G1 of the ileum with multiple liver metastases. Thus, he underwent ileocecal resection with lymph node dissection and liver(S2)biopsy. A tumor was observed at the terminal ileum with serosal invasion, and the mesenteric lymph nodes were enlarged. Multiple liver metastatic tumors were observed in S2, S5, and S8. The patient was diagnosed with NET G1 of the ileum, T4N1M1, Stage Ⅳ. He is receiving octreotide therapy and has maintained stable disease for about 24 months.
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12
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Shinto E, Hida JI, Ike H, Kobayashi H, Hashiguchi Y, Hase K, Ueno H, Sugihara K. A New N Staging System for Colorectal Cancer in the Era of Extended Lymphadenectomy. Ann Surg Oncol 2018; 25:3891-3897. [PMID: 30276642 DOI: 10.1245/s10434-018-6786-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Indexed: 01/14/2023]
Abstract
BACKGROUND Complete mesocolic excision is becoming popular in colon cancer surgery in Western countries, and in the tumor-node-metastasis (TNM) classification of rectal cancer, a part of the lateral pelvic lymph nodes is classified as regional. However, the appropriateness of TNM staging according to the assessment of nodal status exclusively by extended lymphadenectomy remains unclear. PATIENTS AND METHODS Using a nationwide multicenter database in Japan, we retrospectively analyzed 6866 patients with stage III colorectal cancer (CRC) treated with extended (D3) dissection. First, the best cutoff values for the number of metastatic nodes were explored. Second, the utility of the metastatic status of the main lymph nodes (i.e., at the origin of the feeding artery) and the lateral pelvic lymph nodes ("jN3" category in the Japanese staging system) as N staging criteria was evaluated. The modified N staging system that had the best risk stratification power was determined according to the Akaike information criterion (AIC). RESULTS Excellent performance was noted when the number of metastatic nodes was categorized by cutoff values of "3/4" and "6/7." Categorization of nodal metastasis was proven the most clinically efficacious when classified as modified-N1 (N1 and jN3-negative), modified-N2a (N2a and jN3-negative), and modified-N2b (N2b and/or jN3-positive; AIC, 22,810.8), rather than the classification based on the TNM (AIC, 22,849.2) or Japanese staging system (AIC, 22,811.1). CONCLUSIONS We structured a modified N staging system according to the number and extent of lymph node metastases. The modified system may be used in stage III cases for precise risk stratification.
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Affiliation(s)
- Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan.
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University School of Medicine, Osaka, Japan
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital, Yokohama, Japan
| | | | - Yojiro Hashiguchi
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Kazuo Hase
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
| | - Hideki Ueno
- Department of Surgery, National Defense Medical College, Tokorozawa, Saitama, Japan
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13
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Ota M, Fujita S, Mizusawa J, Kanemitsu Y, Ito M, Shiomi A, Ohue M, Fujii S, Saito S, Shiozawa M, Yamaguchi T, Bando H, Katsumata K, Okamura S, Akagi Y, Takiguchi N, Yamaguchi S, Ike H, Akasu T, Moriya Y. Mesorectal excision with or without lateral lymph node dissection for clinical stage II, III lower rectal cancer: Long-term follow-up data of Japan Clinical Oncology Group study JCOG0212. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.3607] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Mitsuyoshi Ota
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Junki Mizusawa
- JCOG Data Center/ Operation Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Masaaki Ito
- Department of Colorectal Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Akio Shiomi
- Division of Colon and Rectal Surgery, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | | | - Shoichi Fujii
- Department of Gastroenterological Surgery, Chemotherapy Research Institute Hospital, International University of Health and Welfare, Chiba, Japan
| | - Shuji Saito
- Depatment of Surgery, Yokohama Shin-Midori General Hospital, Yokohama, Japan
| | - Manabu Shiozawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | | | - Hiroyuki Bando
- Gastroenterological Surgery, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Kenji Katsumata
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Shu Okamura
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University, Kurume, Japan
| | - Nobuhiro Takiguchi
- Department of Gastrointestinal Surgery, Chiba Cancer Center, Chiba, Japan
| | - Shigeki Yamaguchi
- Gastroenterological Surgery, Saitama Medical University International Medical Center, Hidaka-Shi, Japan
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohama City Nanbu Hospital,, Yokohama, Japan
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Sudo Y, Takagawa R, Kohagura K, Hashimoto I, Yokoi H, Sugawara Y, Arisaka H, Segami K, Hayashi T, Shimada K, Murakami H, Hirakawa S, Hasegawa S, Fukushima T, Ike H, Imada T. [Gallbladder Malignant Lymphoma Diagnosed after Surgery for Acute Cholecystitis - A Case Report]. Gan To Kagaku Ryoho 2018; 45:85-87. [PMID: 29362316] [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: 06/07/2023]
Abstract
An 84-year-old man visited our hospital with epigastralgia.Levels of hepatic and biliary enzymes and CRP were elevated, as detected by a blood test.On a CT scan, a swollen gallbladder with stones was detected.The patient was admitted to the hospital with a diagnosis of Grade I acute cholecystitis.Conservative treatment was continued with antibiotic administration and the patient was discharged from the hospital with improvement on day 6 after admission.Three months later, the patient underwent laparoscopic cholecystectomy.In the gallbladder, a 45×45 mm tumor was found.Upon pathological examination, diffuse proliferation of lymphocyte-like heterotypic cells and subserosal invasion were observed.Immunohistochemistry results were negative for MUM1 and positive for CD10 and Bcl6 markers.A malignant diffuse large B-cell lymphoma was diagnosed.We experienced a case of malignant lymphoma of the gallbladder diagnosed after surgery for acute cholecystitis, which we herein report with literature consideration.
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Affiliation(s)
- Yuna Sudo
- Dept. of Surgery, Saiseikai Yokohama City Nanbu Hospital
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15
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Hashimoto I, Murakami H, Arisaka S, Sugawara Y, Segami K, Takagawa R, Hayashi T, Shimada K, Hirakawa S, Hasegawa S, Fukushima T, Ike H, Imada T, Rino Y, Masuda M. [The Case of HER2 Positive Advanced Gastric Cancer with Para-Aorta Lymph Node Recurrence Responding to Capecitabine plus CDDP plus Trastuzumab Chemotherapy]. Gan To Kagaku Ryoho 2017; 44:1455-1457. [PMID: 29394666] [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: 06/07/2023]
Abstract
We report the case of a 69-year-old man diagnosed with gastric cancer.The patient underwent distal gastrectomy(D2) and Billroth I reconstruction in March, 2010. Postoperative histopathological examination indicated M, Ant, Type 5, 100×50 mm, pap>por2>sig, T4aN3M0, pStage III C.We performed S-1 therapy as adjuvant chemotherapy.Abdominal CT showed para-aortic lymph node recurrence in February, 2015. Since HER2 protein was overexpressed in primary tumor immunostaining, he was treated with capecitabine plus CDDP plus trastuzumab therapy.After the chemotherapy, CEA levels decreased to the normal range and the enlarged lymph node was remarkably decreased in size in May, 2015.T he patient is alive 24 months after the chemotherapy with no evidence of recurrence.
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16
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Takii Y, Komori K, Shiozawa M, Ohue M, Nishimura Y, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Tomita N, Mizusawa J, Katayama H, Shimada Y, Kanemitsu Y. Short-term clinical outcome from a randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colon cancer: Japan Clinical Oncology Group study JCOG1006. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Hamaguchi T, Shimada Y, Mizusawa J, Sato T, Kato T, Takahashi K, Sugihara K, Saida Y, Ike H, Hase K, Masaki T, Shiozawa M, Sugita A, Nishimura J, Munakata Y, Ikeda S, Nakamura K, Fukuda H. Randomized phase III study of adjuvant chemotherapy with S-1 versus capecitabine in patients with stage III colorectal cancer: Updated results of Japan Clinical Oncology Group study (JCOG0910). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx393.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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18
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Suto T, Ishiguro M, Hamada C, Kunieda K, Masuko H, Kondo K, Ishida H, Nishimura G, Sasaki K, Morita T, Hazama S, Maeda K, Mishima H, Ike H, Sadahiro S, Sugihara K, Okajima M, Saji S, Sakamoto J, Tomita N. Erratum to: Preplanned safety analysis of the JFMC37-0801 trial: a randomized phase III study of six months versus twelve months of capecitabine as adjuvant chemotherapy for stage III colon cancer. Int J Clin Oncol 2017; 22:805-806. [PMID: 28608229 DOI: 10.1007/s10147-017-1146-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata-shi, Yamagata, 990-2214, Japan
| | - Megumi Ishiguro
- Department of Translational Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Chikuma Hamada
- Graduate School of Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585, Japan
| | - Katsuyuki Kunieda
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu-shi, Gifu, 500-8717, Japan
| | - Hiroyuki Masuko
- Department of Surgery, Nikko Memorial Hospital, 1-5-13 Shintomi-cho, Muroran-shi, Hokkaido, 051-8501, Japan
| | - Ken Kondo
- Department of Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan
| | - Genichi Nishimura
- Department of Surgery, Kanazawa Red Cross Hospital, 2-251 Mimma, Kanazawa-shi, Ishikawa, 921-8162, Japan
| | - Kazuaki Sasaki
- Department of Surgery, Otaru Ekisaikai Hospital, 1-10-17 Ironai, Otaru-shi, Hokkaido, 047-0031, Japan
| | - Takayuki Morita
- Department of Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori-shi, Aomori, 030-8553, Japan
| | - Shoichi Hazama
- Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube-shi, Yamaguchi, 755-8505, Japan
| | - Koutarou Maeda
- Department of Lower Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake-shi, Aichi, 470-1192, Japan
| | - Hideyuki Mishima
- Cancer Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, 480-1195, Japan
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohama Southern Hospital, 3-2-10 Konandai, Konan-ku, Yokohama-shi, Kanagawa, 234-8503, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masazumi Okajima
- The Second Department of Surgery, Hiroshima University School of Medicine, 7-33 Motomachi, Naka-ku, Hiroshima-shi, Hiroshima, 730-8518, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, 1-28-6 Kameido, Koto-ku, Tokyo, 136-0071, Japan
| | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, 1-28-6 Kameido, Koto-ku, Tokyo, 136-0071, Japan
| | - Naohiro Tomita
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan.
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Suto T, Ishiguro M, Hamada C, Kunieda K, Masuko H, Kondo K, Ishida H, Nishimura G, Sasaki K, Morita T, Hazama S, Maeda K, Mishima H, Ike H, Sadahiro S, Sugihara K, Okajima M, Saji S, Sakamoto J, Tomita N. Preplanned safety analysis of the JFMC37-0801 trial: a randomized phase III study of six months versus twelve months of capecitabine as adjuvant chemotherapy for stage III colon cancer. Int J Clin Oncol 2017; 22:494-504. [PMID: 28078540 PMCID: PMC5486458 DOI: 10.1007/s10147-016-1083-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/02/2016] [Accepted: 12/23/2016] [Indexed: 12/01/2022]
Abstract
Background Six months of adjuvant chemotherapy is regarded as the standard of care for patients with stage III colon cancer. However, whether longer treatment can improve prognosis has not been fully investigated. We conducted a phase III study comparing 6 and 12 months of adjuvant capecitabine chemotherapy for stage III colon cancer, and report here the results of our preplanned safety analysis. Methods Patients aged 20–79 years with curatively resected stage III colon cancer were randomly assigned to receive 8 cycles (6 months) or 16 cycles (12 months) of capecitabine (2500 mg/m2/day on days 1–14 of each 21-day cycle). Treatment exposure and adverse events (AEs) were evaluated. Results A total of 1304 patients (642 and 636 in the 6-month and 12-month groups, respectively) were analyzed. The most common AE was hand-foot syndrome (HFS). HFS, leukocytopenia, neutropenia, and hyperbilirubinemia (any grade) occurred more frequently in the 12-month group than in the 6-month group. HFS was the only grade ≥3 AE to have a significantly higher incidence in the 12-month group (23 vs 17%, p = 0.011). The completion rate for 8 cycles was 72% in both groups, while that for 16 cycles was 46% in the 12-month group. HFS was the most common AE requiring dose reduction and treatment discontinuation. Conclusions Twelve months of adjuvant capecitabine demonstrated a higher cumulative incidence of HFS compared to the standard 6-month treatment period, while toxicities after 12 months of capecitabine were clinically acceptable. Trial registration UMIN-CTR, UMIN000001367.
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Affiliation(s)
- Takeshi Suto
- Department of Gastroenterological Surgery, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata-shi, Yamagata, 990-2214, Japan
| | - Megumi Ishiguro
- Department of Translational Oncology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Chikuma Hamada
- Graduate School of Engineering, Tokyo University of Science, 6-3-1 Niijuku, Katsushika-ku, Tokyo, 125-8585, Japan
| | - Katsuyuki Kunieda
- Department of Surgery, Gifu Prefectural General Medical Center, 4-6-1 Noishiki, Gifu-shi, Gifu, 500-8717, Japan
| | - Hiroyuki Masuko
- Department of Surgery, Nikko Memorial Hospital, 1-5-13 Shintomi-cho, Muroran-shi, Hokkaido, 051-8501, Japan
| | - Ken Kondo
- Department of Surgery, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya-shi, Aichi, 460-0001, Japan
| | - Hideyuki Ishida
- Department of Digestive Tract and General Surgery, Saitama Medical Center, Saitama Medical University, 1981 Kamoda, Kawagoe-shi, Saitama, 350-8550, Japan
| | - Genichi Nishimura
- Department of Surgery, Kanazawa Red Cross Hospital, 2-251 Mimma, Kanazawa-shi, Ishikawa, 921-8162, Japan
| | - Kazuaki Sasaki
- Department of Surgery, Otaru Ekisaikai Hospital, 1-10-17 Ironai, Otaru-shi, Hokkaido, 047-0031, Japan
| | - Takayuki Morita
- Department of Surgery, Aomori Prefectural Central Hospital, 2-1-1 Higashitsukurimichi, Aomori-shi, Aomori, 030-8553, Japan
| | - Shoichi Hazama
- Department of Digestive Surgery and Surgical Oncology, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube-shi, Yamaguchi, 755-8505, Japan
| | - Koutarou Maeda
- Department of Lower Gastrointestinal Surgery, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake-shi, Aichi, 470-1192, Japan
| | - Hideyuki Mishima
- Cancer Center, Aichi Medical University, 1-1 Yazakokarimata, Nagakute-shi, Aichi, 480-1195, Japan
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohama Southern Hospital, 3-2-10 Konandai, Konan-ku, Yokohama-shi, Kanagawa, 234-8503, Japan
| | - Sotaro Sadahiro
- Department of Surgery, Tokai University School of Medicine, 143 Shimokasuya, Isehara-shi, Kanagawa, 259-1193, Japan
| | - Kenichi Sugihara
- Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan
| | - Masazumi Okajima
- The Second Department of Surgery, Hiroshima University School of Medicine, 7-33 Motomachi, Naka-ku, Hiroshima-shi, Hiroshima, 730-8518, Japan
| | - Shigetoyo Saji
- Japanese Foundation for Multidisciplinary Treatment of Cancer, 1-28-6 Kameido, Koto-ku, Tokyo, 136-0071, Japan
| | - Junichi Sakamoto
- Japanese Foundation for Multidisciplinary Treatment of Cancer, 1-28-6 Kameido, Koto-ku, Tokyo, 136-0071, Japan
| | - Naohiro Tomita
- Division of Lower Gastrointestinal Surgery, Department of Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya-shi, Hyogo, 663-8501, Japan.
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Stefl M, Lundergan W, Heckmann N, McKnight B, Ike H, Murgai R, Dorr LD. Spinopelvic mobility and acetabular component position for total hip arthroplasty. Bone Joint J 2017; 99-B:37-45. [DOI: 10.1302/0301-620x.99b1.bjj-2016-0415.r1] [Citation(s) in RCA: 155] [Impact Index Per Article: 22.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 07/27/2016] [Indexed: 12/17/2022]
Abstract
Aims Posterior tilt of the pelvis with sitting provides biological acetabular opening. Our goal was to study the post-operative interaction of skeletal mobility and sagittal acetabular component position. Materials and Methods This was a radiographic study of 160 hips (151 patients) who prospectively had lateral spinopelvic hip radiographs for skeletal and implant measurements. Intra-operative acetabular component position was determined according to the pre-operative spinal mobility. Sagittal implant measurements of ante-inclination and sacral acetabular angle were used as surrogate measurements for the risk of impingement, and intra-operative acetabular component angles were compared with these. Results Post-operatively, ante-inclination and sacral acetabular angles were within normal range in 133 hips (83.1%). A total of seven hips (4.4%) had pathological imbalance and were biologically or surgically fused hips. In all, 23 of 24 hips had pre-operative dangerous spinal imbalance corrected. Conclusions In all, 145 of 160 hips (90%) were considered safe from impingement. Patients with highest risk are those with biological or surgical spinal fusion; patients with dangerous spinal imbalance can be safe with correct acetabular component position. The clinical relevance of the study is that it correlates acetabular component position to spinal pelvic mobility which provides guidelines for total hip arthroplasty. Cite this article: Bone Joint J 2017;99-B(1 Supple A):37–45.
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Affiliation(s)
- M. Stefl
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - W. Lundergan
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - N. Heckmann
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - B. McKnight
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - H. Ike
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - R. Murgai
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
| | - L. D. Dorr
- Keck Medical Centre of USC, 1520
San Pablo Street, Suite 2000, Los
Angeles, CA 90033, USA
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21
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Shimada Y, Hayashi T, Minamizawa K, Shibuya T, Nemoto D, Yokoi H, Wada T, Watanabe T, Takagawa R, Murakami H, Hasegawa S, Fukushima T, Ike H, Rino Y, Masuda M. [A Case of Stage IV Gastric Cancer Successfully Treated Using Salvage Surgery after S-1/CDDP Therapy]. Gan To Kagaku Ryoho 2016; 43:1908-1910. [PMID: 28133172] [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: 06/06/2023]
Abstract
A 75-year-old man admitted for left lateral abdominal pain was found to have advanced poorly differentiated gastric adenocarcinoma with abdominal para-aortic and Virchow's lymph node metastases, which was diagnosed to be clinical Stage IV (T3N3H0M1[LYM]). As curative surgery was not deemed possible, we started chemotherapy administration using S-1 (120mg/day)administered orally for 3 weeks and cisplatin(CDDP 100mg/body)administered intravenously on day 8. After 6 courses of chemotherapy, a CT scan showed that all lymph nodes metastases had disappeared, resulting in downstaging to clinical Stage II (T3[SE]N0H0P0M0). Thus, we performed total gastrectomy, lymph node dissection(D2), and splenectomy. Histological findings showed no residual tumor cells in any of the lymph nodes. However, cancer cells remained in the primary gastric lesion. The pathological response to chemotherapy was judged to be Grade 2. The patient has been recurrence-free for 5 years after surgery.
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Affiliation(s)
- Yuko Shimada
- Dept. of Surgery, Saiseikai Yokohamashi Nanbu Hospital
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Oba M, Inaba Y, Kobayashi N, Ike H, Tezuka T, Saito T. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem. Bone Joint Res 2016; 5:362-9. [PMID: 27601435 PMCID: PMC5017138 DOI: 10.1302/2046-3758.59.2000525] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Accepted: 06/23/2016] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES In total hip arthroplasty (THA), the cementless, tapered-wedge stem design contributes to achieving initial stability and providing optimal load transfer in the proximal femur. However, loading conditions on the femur following THA are also influenced by femoral structure. Therefore, we determined the effects of tapered-wedge stems on the load distribution of the femur using subject-specific finite element models of femurs with various canal shapes. PATIENTS AND METHODS We studied 20 femurs, including seven champagne flute-type femurs, five stovepipe-type femurs, and eight intermediate-type femurs, in patients who had undergone cementless THA using the Accolade TMZF stem at our institution. Subject-specific finite element (FE) models of pre- and post-operative femurs with stems were constructed and used to perform FE analyses (FEAs) to simulate single-leg stance. FEA predictions were compared with changes in bone mineral density (BMD) measured for each patient during the first post-operative year. RESULTS Stovepipe models implanted with large-size stems had significantly lower equivalent stress on the proximal-medial area of the femur compared with champagne-flute and intermediate models, with a significant loss of BMD in the corresponding area at one year post-operatively. CONCLUSIONS The stovepipe femurs required a large-size stem to obtain an optimal fit of the stem. The FEA result and post-operative BMD change of the femur suggest that the combination of a large-size Accolade TMZF stem and stovepipe femur may be associated with proximal stress shielding.Cite this article: M. Oba, Y. Inaba, N. Kobayashi, H. Ike, T. Tezuka, T. Saito. Effect of femoral canal shape on mechanical stress distribution and adaptive bone remodelling around a cementless tapered-wedge stem. Bone Joint Res 2016;5:362-369. DOI: 10.1302/2046-3758.59.2000525.
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Affiliation(s)
- M Oba
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - Y Inaba
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - N Kobayashi
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - H Ike
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - T Tezuka
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
| | - T Saito
- Department of Orthopaedic Surgery, Yokohama City University, s3-9, Fukuura, Kanazawa-ku, Yokohama-city, Kanagawa, 236-0004, Japan
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Takii Y, Komori K, Shiozawa M, Ohue M, Nshimura Y, Ikeda S, Takiguchi N, Kobatake T, Ike H, Sato T, Yatsuoka T, Shingai T, Fujii S, Tomita N, Shimada Y, Katayama H, Kanemitsu Y. 114. Surgical quality assurance in a randomized controlled trial of the conventional technique versus the no-touch isolation technique for primary tumor resection in patients with colorectal cancer: Japan Clinical Oncology Group Study JCOG1006. Eur J Surg Oncol 2016. [DOI: 10.1016/j.ejso.2016.06.120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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24
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Ogawa S, Hida JI, Ike H, Kinugasa T, Ota M, Shinto E, Itabashi M, Kameoka S, Sugihara K. Selection of Lymph Node-Positive Cases Based on Perirectal and Lateral Pelvic Lymph Nodes Using Magnetic Resonance Imaging: Study of the Japanese Society for Cancer of the Colon and Rectum. Ann Surg Oncol 2015; 23:1187-94. [PMID: 26671038 DOI: 10.1245/s10434-015-5021-2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Indexed: 12/28/2022]
Abstract
PURPOSE To investigate the optimum cutoff for lymph node size to identify cases positive for perirectal lymph node (PRLN) and lateral lymph node (LPLN) metastasis of lower rectal cancer on magnetic resonance imaging (MRI). METHODS The subjects were 449 patients who underwent preoperative MRI. Mesorectal excision was performed in all patients (combined with lateral pelvic lymph node [LN] dissection in 324) between 2004 and 2013 at 6 institutes. Cases were classified as cN positive and cN negative on the basis of the short axis of the largest LN being greater than or equal to a cutoff or less than a cutoff, respectively. PRLN and LPLN diagnoses using 5 and 10 mm cutoffs were compared with histologic diagnoses. Of the 449 patients, 55 received preoperative chemoradiotherapy. MRI was only performed after this therapy in all of these patients. RESULTS For PRLNs, 5 and 10 mm cutoffs gave area under the curve (AUC) values of 0.6364 and 0.5794, respectively. The 5 mm cutoff gave a significantly higher AUC value (P = 0.0152), with an accuracy of 63.7 %, sensitivity of 72.6 %, and specificity of 54.7 %. For right LPLNs, the respective AUC values were 0.7418 and 0.6326 (P = 0.0034), and the variables (5 mm cutoff) were 77.6, 68.6, and 79.7 %. For left LPLNs, AUC values were 0.7593 and 0.6559, respectively (P = 0.0057), and the variables (5 mm cutoff) were 79.3, 70.8, and 81.0 %. CONCLUSIONS Identification of LN-positive cases on the basis of PRLN and LPLN sizes was superior at a short-axis 5 mm cutoff. Size-based diagnosis of LN metastasis is simple and useful, but further investigation is needed to clarify whether it is superior to diagnosis based on morphology, such as shape, border, and signal intensity.
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Affiliation(s)
- Shimpei Ogawa
- Department of Surgery II, Tokyo Women's Medical University School of Medicine, Tokyo, Japan.
| | - Jin-Ichi Hida
- Department of Surgery, Kindai University School of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan
| | - Tetsushi Kinugasa
- Department of Surgery, Kurume University School of Medicine, Kurume, Japan
| | - Mitsuyoshi Ota
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Eiji Shinto
- Department of Surgery, National Defense Medical College, Tokorozawa, Japan
| | - Michio Itabashi
- Department of Surgery II, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Shingo Kameoka
- Department of Surgery II, Tokyo Women's Medical University School of Medicine, Tokyo, Japan
| | - Kenichi Sugihara
- Department of Surgical Oncology, Graduate School, Tokyo Medical and Dental University, Tokyo, Japan
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Fujikawa Y, Hasegawa S, Doi Y, Shibuya T, Mori K, Yabushita Y, Mikayama Y, Watanabe T, Tsuchida K, Murakami H, Mushiake H, Fukushima T, Ike H, Imada T, Masuda M. [The Outcomes of Laparoscopy-Assisted Surgery in Elderly Patients with Colorectal Carcinoma]. Gan To Kagaku Ryoho 2015; 42:2142-2144. [PMID: 26805291] [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: 06/05/2023]
Abstract
AIM To evaluate short-term outcomes of laparoscopy-assisted colectomy (LAC) in elderly patients with colorectal carcinoma. METHODS A total of 289 colorectal cancer patients underwent LAC between 2008 and 2013. They were divided into an elderly group (<80 years of age, group E), and a younger group (<80 years of age, group Y). The treatment results, including the surgery-related factors, the perioperative course, and the pre- and postoperative complications, were retrospectively analyzed. RESULTS There were 49 patients in group E, and 240 patients in group Y. There was no significant difference between the 2 groups considering the operative time, blood loss, rate of transfusion, post-operative hospital stay, rate of conversion to open surgery, or rate of complications, except for the number of patients with an ASA classification of greater than Grade 2 and the degree of lymph node dissection. CONCLUSIONS LAC in elderly patients was found to be relatively safe because it was associated with a reduction in damage to the abdominal wall, and with an early recovery from surgery. These results suggest that the indications of LAC could be expanded for elderly patients.
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Harada S, Tsuchida K, Shibuya T, Doi Y, Kikuchi A, Mori K, Yabushita Y, Watanabe T, Murakami H, Hasegawa S, Fukushima T, Ike H, Nakayama T. [Experience of the Pharmacotherapy against Appendix and Sigmoid Colon Signet Ring Cell Carcinoma with the Peritoneal Dissemination]. Gan To Kagaku Ryoho 2015; 42:1268-1270. [PMID: 26489568] [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: 06/05/2023]
Abstract
We report 2 cases of signet ring cell carcinoma of the appendix and colon. Case 1: A 61-year-old man was admitted for lower abdominal pain. Colonoscopy revealed an elevated lesion in the orifice of the appendix. Signet ring cell carcinoma was diagnosed on biopsy. The surgical findings showed multiple peritoneal dissemination nodules, while the primary tumor was unresectable owing to extensive invasion into the retroperitoneum. The histopathological findings were signet ring cell carcinoma, T4b (retroperitoneum), NX, P3, Stage Ⅳ. Although the patient received 14 courses of treatment with S-1 as postoperative chemotherapy, he died of his illness at 32 postoperative months. Case 2: A 76-year-old man was admitted for abdominal pain. Perforation of the lower gastrointestinal tract was diagnosed on abdominal CT, and an emergency operation was performed. The surgical findings demonstrated a large number of peritoneal dissemination nodules, cecal invasion of a sigmoid tumor, and perforation of the ascending colon. The primary tumor was thought to be unresectable, and the perforated segment was resected. The histopathological findings were signet ring cell carcinoma, T4b (cecum), NX, P3, Stage Ⅳ. Although 11 courses of treatment using FOLFIRI+Bev were administered as postoperative chemotherapy, the patient died of his illness at 26 postoperative months.
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Affiliation(s)
- Shingo Harada
- Dept. of Surgery, Saiseikai Yokohamashi Nanbu Hospital
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Tsuchida K, Murakami H, Doi Y, Kikuchi A, Mori K, Harada S, Yabushita Y, Watanabe T, Hasegawa S, Fukushima T, Ike H, Nakayama T, Rino Y, Imada T, Masuda M. [Clinicopathological Features and Outcomes of Treatment for HER2 Positive Gastric Cancer]. Gan To Kagaku Ryoho 2015; 42:1289-1291. [PMID: 26489575] [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: 06/05/2023]
Abstract
In March 2011, trastuzumab was approved for treating human epidermal growth factor receptor 2 (HER2) positive advanced gastric cancer (AGC) in Japan. Therefore, all patients with AGC should be evaluated for HER2 status. In this study, we analyzed the clinicopathological features and current status of treatment in HER2 positive gastric cancer. One hundred 6 gastric cancer patients were examined for HER2 expression in our hospital between March 2011 and August 2014. Sixteen patients (15.1%) were HER2 positive. There was no correlation between HER2 status and age, sex, and location of tumor; however, HER2 positivity was significantly more frequent in patients with intestinal type tumors and had a tendency towards being more frequent in patients with macroscopic types 0, 1 or 2. Trastuzumab was administered to 10 patients with HER2 positive AGC. The total number of doses of trastuzumab was 1 to 44 (median 7.5), and the therapeutic effect of trastuzumab combination chemotherapy was 1 patient with a complete response and 4 with a partial response. Adverse events due to trastuzumab were not observed. The incidence of HER2 over-expression was 15.1%, and trastuzumab combination chemotherapy was relatively safe and effective.
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28
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Ike H, Inaba Y, Kobayashi N, Yukizawa Y, Hirata Y, Tomioka M, Saito T. Effects of rotational acetabular osteotomy on the mechanical stress within the hip joint in patients with developmental dysplasia of the hip. Bone Joint J 2015; 97-B:492-7. [DOI: 10.1302/0301-620x.97b4.33736] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
In this study we used subject-specific finite element analysis to investigate the mechanical effects of rotational acetabular osteotomy (RAO) on the hip joint and analysed the correlation between various radiological measurements and mechanical stress in the hip joint. We evaluated 13 hips in 12 patients (two men and ten women, mean age at surgery 32.0 years; 19 to 46) with developmental dysplasia of the hip (DDH) who were treated by RAO. Subject-specific finite element models were constructed from CT data. The centre–edge (CE) angle, acetabular head index (AHI), acetabular angle and acetabular roof angle (ARA) were measured on anteroposterior pelvic radiographs taken before and after RAO. The relationship between equivalent stress in the hip joint and radiological measurements was analysed. The equivalent stress in the acetabulum decreased from 4.1 MPa (2.7 to 6.5) pre-operatively to 2.8 MPa (1.8 to 3.6) post-operatively (p < 0.01). There was a moderate correlation between equivalent stress in the acetabulum and the radiological measurements: CE angle (R = –0.645, p < 0.01); AHI (R = –0.603, p < 0.01); acetabular angle (R = 0.484, p = 0.02); and ARA (R = 0.572, p < 0.01). The equivalent stress in the acetabulum of patients with DDH decreased after RAO. Correction of the CE angle, AHI and ARA was considered to be important in reducing the mechanical stress in the hip joint. Cite this article: Bone Joint J 2015;97-B:492–7.
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Affiliation(s)
- H. Ike
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Y. Inaba
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - N. Kobayashi
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Y. Yukizawa
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Y. Hirata
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - M. Tomioka
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - T. Saito
- Yokohama City University, 3-9
Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Narui K, Ichikawa Y, Ike H, Ota M, Saito S, Fujii S, Sasaki T, Nozawa A, Shimada H, Endo I. Optimizing the selection of patients with low rectal cancer for intersphincteric resection by evaluating vertical invasion to the levator and external sphincter. Colorectal Dis 2015; 17:133-40. [PMID: 25204386 DOI: 10.1111/codi.12769] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2014] [Accepted: 07/15/2014] [Indexed: 02/08/2023]
Abstract
AIM The indications for intersphincteric (ISR) anterior resection are not clearly defined. The aim of this study was to evaluate vertical extension of T2 or T3 low rectal cancer treated by rectal amputation to optimize patient selection for ISR. METHOD The abdominoperineal excision specimens of T2 or T3 low rectal cancer from 53 patients treated between 1992 and 2004 were retrospectively reviewed. Vertical invasion was quantified by measuring the shortest distance between the tumour and the striated muscle (T-SM), assuming that this represented the surgical margin that would have be achieved had an ISR been performed. RESULTS Involvement of the dentate line (DL) and intramural distal spread were independent risk factors for T-SM ≤ 2 mm. The T-SM was less when the inferior border of the tumour was on the distal side of the DL (r = 0.572, P < 0.001). The probability of involvement of the DL, intramural distal spread or either one of these being associated with T-SM ≤ 2 mm was 43, 46 and 43%, respectively. All patients without both intramural distal spread and involvement of the DL had T-SM > 2. CONCLUSION We recommend that ISR should only be performed for patients with T2 or T3 low rectal cancer in whom the lowest edge of the tumour is above the DL and there is no intramural distal spread. Such patients are relatively unlikely to have a T-SM ≤ 2 mm.
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Affiliation(s)
- K Narui
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Y Ichikawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - H Ike
- Department of Surgery, Saiseikai Yokohama City Nanbu Hospital, Yokohama, Japan
| | - M Ota
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan.,Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - S Saito
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - S Fujii
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - T Sasaki
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - A Nozawa
- Department of Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - H Shimada
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - I Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Yokohama, Japan
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Watanabe T, Ike H, Mikayama Y, Tsuchida K, Mushiake H, Hasegawa S, Fukushima T, Kyo R, Tokoro C, Hishiki S, Kawana I, Rino Y, Masuda M, Imada T. [Outcomes of laparoscopic surgery after preoperative metallic stent placement for obstructive colorectal cancer]. Gan To Kagaku Ryoho 2014; 41:1482-1484. [PMID: 25731226] [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
AIM To assess the outcomes of preoperative colonic stent placement for obstructive colorectal cancer. PATIENTS AND METHODS A total of 30 patients with colorectal cancer were treated after preoperative colonic metallic stent placement between July 2012 and March 2014. We reviewed their medical records to assess the usefulness of stent placement and the clinical course. The effects of various clinicopathological variables on post-operative complications were analyzed statistically. RESULTS Stent insertion was effective in 93% of the 30 patients with obstructive colorectal cancer. Preoperative colonoscopy or enema for proximal colonic survey was possible in 70% of the patients after stent placement; colonic lesions requiring simultaneous resection were noted in 5 patients (24%). The mean interval between stent insertion and operation was 19 days, and 23%of the patients underwent laparoscopic surgery. Statistical analysis revealed that the occurrence of complications was associated with laparoscopic surgery and the amount of operative blood loss. CONCLUSION Preoperative stent placement in patients with obstructive colorectal cancer is feasible and laparoscopic surgery can be selected after stent placement.
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31
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Higuchi A, Saito S, Ike H, Mikayama H, Harada H, Minabe D, Imada T, Yamamoto N, Yukawa N, Rino Y, Masuda M. Anatomical Variations of Mesenteric Arteries Visualized by 3D-CT Angiography. ACTA ACUST UNITED AC 2014. [DOI: 10.3862/jcoloproctology.67.68] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hasegawa S, Higuchi A, Shino K, Sugimasa N, Shimanaka M, Narasaki M, Mikayama H, Ike H. Analysis of the Breast Cancer Cases Aged More Than 85 Who Didn'T Undergo Surgery. Ann Oncol 2013. [DOI: 10.1093/annonc/mdt460.54] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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33
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Iida J, Kudo T, Shimada K, Yatsuno Y, Yamagishi S, Hasegawa S, Ike H, Sato T, Kagaya H, Ito K. Investigation of the Safety of Topical Metronidazole from a Pharmacokinetic Perspective. Biol Pharm Bull 2013; 36:89-95. [DOI: 10.1248/bpb.b12-00687] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Junichi Iida
- Research Institute of Pharmaceutical Sciences, Musashino University
- Department of Pharmacy, Saiseikai Yokohamashi Nanbu Hospital
| | - Toshiyuki Kudo
- Research Institute of Pharmaceutical Sciences, Musashino University
| | - Kento Shimada
- Research Institute of Pharmaceutical Sciences, Musashino University
| | | | - Saori Yamagishi
- Research Institute of Pharmaceutical Sciences, Musashino University
| | | | - Hideyuki Ike
- Department of Surgery, Saiseikai Yokohamashi Nanbu Hospital
| | - Toru Sato
- Department of Pharmacy, Saiseikai Yokohamashi Nanbu Hospital
| | - Hajime Kagaya
- Department of Pharmacy, Saiseikai Yokohamashi Nanbu Hospital
| | - Kiyomi Ito
- Research Institute of Pharmaceutical Sciences, Musashino University
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Fujii S, Watanabe K, Ota M, Yamagishi S, Kunisaki C, Osada S, Ike H, Ichikawa Y, Endo I, Shimada H. Solo surgery in laparoscopic colectomy: a case-matched study comparing robotic and human scopist. Hepatogastroenterology 2011; 58:406-410. [PMID: 21661404] [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] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
BACKGROUND/AIMS Recent technical developments have enabled solo surgery in laparoscopic surgery. Our experience of solo surgery using the voice-guided robotic arm in laparoscopic colectomy for colorectal cancer was analyzed. METHODOLOGY The colon-lifting method was used in this study. The laparoscope was handled by AESOP3000. The colon was retracted anteriorly by the thread that passed through the mesocolon. This method enables lymphadenectomy by stretching of feeding vessels and obviates the need for an assistant. The short-term outcomes and survival between robotic arm and human scopist in a series of laparoscopic colectomies were compared with a case-matched control study. RESULTS The numbers of both group patients were 11 respectively. There was no conversion to open surgery in both groups. The operation time (Robotic vs. Human=269 min. vs. 265) and laparoscopic time (209 vs. 212) were not significant differences. There were also no significant differences in the bleeding, the morbidity rate and the numbers of dissected lymph nodes between the two groups. The five-year overall (81.8% vs. 72.7%) and disease-free (72.7% vs. 62.3%) survivals showed no significant differences. CONCLUSIONS Laparoscopic solo-surgery in colectomy is safe and feasible, without any deterioration of the curative potential of the procedure.
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Affiliation(s)
- Shoichi Fujii
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
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35
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Ichikawa Y, Miyagi Y, Fujii S, Ota M, Yamagishi S, Hasegawa S, Saito S, Ike H, Ohki S, Nakano A, Matsumura N, Ishikawa T, Kunizaki C, Shimada H. Gastrointestinal stromal tumor with two genetic abnormalities on different alleles: report of a case. Surg Today 2010; 40:262-6. [PMID: 20180082 DOI: 10.1007/s00595-008-4029-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2007] [Accepted: 07/03/2008] [Indexed: 11/29/2022]
Abstract
We report a case of a gastrointestinal stromal tumor (GIST) with strong and faint KIT protein staining, respectively, at two different sites. A single point mutation (c1727 T>C) was detected in DNA extracted from both sites, and a further deletion mutation (c1678_1680 del GTT) was detected in DNA from the site with strong KIT protein staining. Cloning analysis indicated that the point mutation and the deletion were present on different alleles.
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Affiliation(s)
- Yasushi Ichikawa
- Department of Gastroenterological Surgery, Yokohama City University Postgraduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
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Matsuzu K, Ike H, Cho H, Ashida A, Fujikawa H, Saito B, Hayashi T, Fujii K, Kojima Y, Narui K, Fujii Y, Makino T, Wada N, Rino Y, Masuda M. [Long survival of a case of unresected duodenal cancer treated by S-1 before and after duodenojejunostomy]. Gan To Kagaku Ryoho 2009; 36:1573-1576. [PMID: 19755837] [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: 05/28/2023]
Abstract
A 52-year-old woman visited our hospital with epigastralgia. Detailed examination revealed a duodenal cancer of the ascending limbs. Since she refused the resection, the administration of S-1 alone was commenced. After one course of this treatment, oral intake became impossible. Duodenography and endoscopy showed duodenal obstruction, and she underwent surgery. The tumor proved to be unresectable due to direct invasion of the inferior vena cava. Duodenojejunostomy was performed. After surgery, she was treated by S-1 and survived 2 years and 11 months, which resulted in 3 years and 2 months' long survival from her first visit. The intervals of the intake and home stay, after the operation, were 2 years and 8 months and 2 years and 5 months, respectively. The combination of S-1 administration and bypass operation provides a useful alternative for the treatment of unresectable duodenal cancer with stenosis.
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Yoneda K, Iida H, Endo H, Hosono K, Akiyama T, Takahashi H, Inamori M, Abe Y, Yoneda M, Fujita K, Kato S, Nozaki Y, Ichikawa Y, Uozaki H, Fukayama M, Shimamura T, Kodama T, Aburatani H, Miyazawa C, Ishii K, Hosomi N, Sagara M, Takahashi M, Ike H, Saito H, Kusakabe A, Nakajima A. Identification of Cystatin SN as a novel tumor marker for colorectal cancer. Int J Oncol 2009; 35:33-40. [PMID: 19513549] [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: 05/27/2023] Open
Abstract
The goal of this study was to investigate Cystatin SN, a cysteine protease inhibitor, as a novel tumor marker for colorectal cancer (CRC). Gene expression profiles of mRNA from normal tissues and cancer cell lines were performed. Twenty-eight monoclonal antibodies for Cystatin SN were generated and serum Cystatin SN was quantified using ELISA in sera from 159 patients with CRC and 40 healthy controls. Cystatin SN was highly expressed in colon cancer cells. Employing a receiver-operating characteristic curve, we obtained an area under the curve of 0.708 for Cystatin SN, 0.819 for carcinoembryonic antigen (CEA) and 0.703 for carbohydrate antigen 19-9 (CA19-9). The combination assay of Cystatin SN, CEA and CA19-9 showed 62.9% sensitivity and 90.0% specificity. Especially, the sensitivity of the combination assay in stages I and II detection, in which stages curative operation would be possible, was improved over that of the assay testing only for CEA and CA19-9 (from 37.5 to 42.5% in stage I, from 49.0 to 60.8% in stage II). Furthermore, Western blot analysis revealed that Cystatin SN was increased in the urine from patients with CRC. Our results suggest the possibility of utilizing this novel tumor marker that can be tested in urine samples. These observations suggest that Cystatin SN in combination with CEA and CA19-9 is a useful tumor marker for detecting early stage CRC and that it is a unique urinary excretory protein, suggesting that Cystatin SN might be a novel candidate for use in mass screening for CRC.
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Affiliation(s)
- Kyoko Yoneda
- Gastroenterology Division, Yokohama City University Graduate School of Medicine, Kanazawa-ku, Yokohama 236-0004, Japan
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Fujii S, Shimada H, Ike H, Kunisaki C, Ohki S, Ichikawa Y, Ohta M, Yamagishi S, Osada S. Reduction of postoperative abdominal adhesion and ileus by a bioresorbable membrane. Hepatogastroenterology 2009; 56:725-728. [PMID: 19621691] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS This study examines the efficacy of a bioresorbable sodium hyaluronate-carboxy-methylcellulose-based membrane (HA/CMC membrane) in reducing postoperative abdominal adhesion and ileus after intestinal resection. Also, this study attempts to identify the possible factors that influence effectiveness through qualitative analysis of an individual patient case. METHODOLOGY Bioresorable membranes were applied just prior to abdominal closure in 121 patients who underwent abdominal surgery. The incidence of adhesion-related postoperative ileus was compared between the treatment and control group. Severity and extent of adhesions were also examined in 27 patients who underwent follow-up laparotomy. RESULTS The incidence of postoperative ileus was low in the treatment group. For the partial colectomies with lymph node dissection for colorectal cancers, there was no difference between the treatment and control group in the incidence of postoperative ileus. In patients who underwent a second operation, the incidence and severity of adhesions were significantly lower for the treated area compared with the untreated area. CONCLUSIONS HA/CMC membrane was effective in reducing postoperative abdominal adhesions. The incidence of adhesion-related postoperative ileus after colorectal cancer surgery was unchanged. The results of qualitative analysis imply that further improvement of application may allow HA/CMC membrane to be more effective in reducing postoperative ileus.
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Affiliation(s)
- Shoichi Fujii
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
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Fujii S, Shimada H, Yamagishi S, Ota M, Ichikawa Y, Kunisaki C, Ike H, Ohki S. Surgical strategy for local recurrence after resection of rectal cancer. Hepatogastroenterology 2009; 56:667-671. [PMID: 19621677] [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] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
BACKGROUND/AIMS To evaluate surgery for local recurrence after rectal cancer resection. METHODOLOGY In total, 76 patients with local recurrence after rectal cancer resection were enrolled between 1978 and 1998. Of these, 61 underwent curative resection. Outcomes were assessed according to treatment. Recurrence was classified as visceral or parietal based on preoperative computed tomography or magnetic resonance imaging. RESULTS The 5-year survival rates were 17.8%, 25.9%, and 36.9% for patients who underwent total pelvic exenteration, abdomino-perineal resection, and local resection, respectively. Of the 61 patients who underwent curative resection, 18 (29.5%) showed visceral recurrence and 43 (70.5%) showed parietal recurrence. Among patients with visceral recurrence, 9 (50%) underwent total pelvic exenteration, 6 (33.3%) underwent abdomino-perineal resection, and 3 (16.7%) underwent local resection. Among patients with parietal recurrence, 27 (62.8%) underwent total pelvic exenteration, 4 (9.3%) underwent abdomino-perineal resection, and 12 (27.9%) underwent local resection. Mucinous adenocarcinomas were most common among patients with parietal recurrence. Overall 5-year survival rates were 64.9% and 14.0% for patients with visceral and parietal recurrence, respectively. CONCLUSIONS Curative resection was effective in rectal cancer patients with visceral recurrence. Novel systemic chemical radiotherapy should be considered for patients with parietal recurrence.
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Affiliation(s)
- Shoichi Fujii
- Department of Surgery, Gastroenterological Center, Yokohama City University, Yokohama, Japan.
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Oda K, Ando M, Amemiya T, Fukata S, Yasui A, Ike H, Kuroiwa K, Kitagawa Y, Ookawa Y, Kawamura T, Shimada H, Nimura Y, Nagino M. Disease-operation specific QOL decline after elective radical surgery for gastroentelogial malignancies in elderly. Crit Rev Oncol Hematol 2008. [DOI: 10.1016/s1040-8428(08)70094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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41
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Amemiya T, Oda K, Ando M, Kawamura T, Kitagawa Y, Okawa Y, Yasui A, Ike H, Shimada H, Kuroiwa K, Nimura Y, Fukata S. Activities of daily living and quality of life of elderly patients after elective surgery for gastric and colorectal cancers. Ann Surg 2007; 246:222-8. [PMID: 17667500 PMCID: PMC1933572 DOI: 10.1097/sla.0b013e3180caa3fb] [Citation(s) in RCA: 117] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE To establish reliable standards for surgical application to elderly patients 75 years old or older with gastric or colorectal cancer with special reference to the postoperative recovery of activities of daily living (ADL) and quality of life (QOL). SUMMARY BACKGROUND DATA ADL and QOL are important outcomes of surgery for the elderly. However, there has been only limited evidence on the natural course of recovery of functional independence. METHODS Two hundred twenty-three patients 75 years old or older with gastric or colorectal cancer were prospectively examined. Physical conditions, ADL, and QOL were evaluated preoperatively and at the first, third, and sixth postoperative month. RESULTS The mortality and morbidity rates were 0.4% and 28%, respectively. Twenty-four percent of patients showed a decrease in ADL at 1 month postoperatively, but most patients recovered from this transient reduction, with only 3% showing a decline at the sixth postoperative month (6POM). ADL of these patients was likely to decrease after discharge from the hospital. QOL of the patients showed a recovery to an extent equal to or better than their average preoperative scores. CONCLUSIONS Of the patients 75 years old or older who underwent elective surgery for gastric or colorectal cancer, only a few showed a protracted decline in ADL and most exhibited better QOL after surgery. This indicates that surgical treatment should be considered, whenever needed, for elderly patients 75 years old or older with gastric or colorectal cancer. Estimation of Physical Ability and Surgical Stress is useful for predicting postoperative declines in ADL and protracted disability; this could aid in establishing a directed rehabilitation program for preventing protracted disability in elderly patients.
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Affiliation(s)
- Takeshi Amemiya
- Division of Surgical Oncology, Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Kimura H, Shimada H, Ike H, Yamaguchi S, Ichikawa Y, Kikuchi M, Fujii S, Ohki S. Colonic J-pouch decreases bowel frequency by improving the evacuation ratio. Hepatogastroenterology 2006; 53:854-7. [PMID: 17153440] [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] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND/AIMS To compare the functional outcome of ultra-low anterior resection for rectal cancer with colonic J-pouch reconstruction with that of straight reconstruction. METHODOLOGY Twenty-three patients who underwent ultra-low anterior resection with or without J-pouch reconstruction underwent bowel transit study, videodefecography, and answered a questionnaire survey 4 months and 1 year after surgery. Eleven healthy subjects underwent similar testing as controls. RESULTS Patients with a J-pouch had less frequent stools than patients with straight reconstruction 4 months after surgery (p<0.05), but the two groups were similar at 1 year. Bowel transit time was similar at both study points. The evacuation ratio was higher after J-pouch than straight reconstruction 4 months after surgery (p<0.05). However, the ratio improved in the straight group, and no difference existed at 1 year. Colonic contraction was seen only near the anastomosis 4 months after surgery, but the contraction proximal to the anastomosis improved over the next 8 months. CONCLUSIONS J-pouch reconstruction facilitates evacuation by improving the evacuation ratio. Although straight anastomosis caused excessive stool frequency 4 months after surgery, colonic function continued to improve and was comparable with J-pouch and straight reconstruction 1 year after surgery because the contraction ratio proximal to the anastomosis improved.
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Affiliation(s)
- H Kimura
- Second Department of Surgery, Yokohama City University School of Medicine, Yokohama, Japan.
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Narui K, Ike H, Fujii S, Nojiri K, Tatsumi K, Yamagishi S, Saito S, Kunisaki C, Imada T, Nozawa A, Ohki S, Ota M, Ichikawa Y, Shimada H. [A case of radiation-induced rectal cancer]. Nihon Shokakibyo Gakkai Zasshi 2006; 103:551-7. [PMID: 16734262] [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] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
We report a case of radiation-induced rectal cancer, which is thought to originate from dysplasia due to radiation colitis. The patient is a 73 year-old woman, who underwent radical hysterectomy and radiotherapy for uterine cervical cancer 31 years ago. She visited to our hospital complaining of hematochezia. Colonoscopy in January 2004 disclosed redness of the rectal mucosa accompanied with contact bleeding and pathological study of the biopsy specimen revealed severe dysplasia. However, colonoscopy showed an ulcerative lesion of the rectum in December 2004, and pathological findings of the biopsy specimen disclosed moderately differentiated adenocarcinoma. She underwent a rectal resection in January 2005. Pathological study of resected specimen revealed fibrous change induced by radiation. Predominant histological type of the tumor was moderately differentiated carcinoma followed by well differentiated type. However, multiple dysplasias were found around the main tumor or in the mucosa which was treated with radiotherapy.
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Affiliation(s)
- Kazutaka Narui
- Gastroenterological Center, Yokohama City University Medical Center
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Nagano Y, Matsuo K, Gorai K, Sugimori K, Kunisaki C, Ike H, Tanaka K, Imada T, Shimada H. Bile duct hamartomas (von Mayenburg complexes) mimicking liver metastases from bile duct cancer: MRC findings. World J Gastroenterol 2006; 12:1321-3. [PMID: 16534895 PMCID: PMC4124453 DOI: 10.3748/wjg.v12.i8.1321] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We present a case of a 72-year-old man with a common bile duct cancer, who was initially believed to have multiple liver metastases based on computed tomography findings, and in whom magnetic resonance cholangiography (MRC) revealed a diagnosis of bile duct hamartomas. At exploration for pancreaticoduodenectomy, liver palpation revealed disseminated nodules at the surface of the liver. These nodules showed gray-white nodular lesions of about 0.5 cm in diameter scattered on the surface of both liver lobes, which were looked like multiple liver metastases from bile duct cancer. Frozen section of the liver biopsy disclosed multiple bile ducts with slightly dilated lumens embedded in the collagenous stroma characteristics of multiple bile duct hamartomas (BDHs). Only two reports have described the MRC features of bile duct hamartomas. Of all imaging procedures, MRC provides the most relevant features for the imaging diagnosis of bile duct hamartomas.
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Affiliation(s)
- Yasuhiko Nagano
- Yokohama City University Medical Center, Gastroenterological Center, 232-0024 4-57 Urafunecho, Minami-ku, Yokohama City, Japan.
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Ichikawa Y, Ishikawa T, Momiyama N, Kamiyama M, Sakurada H, Matsuyama R, Hasegawa S, Chishima T, Hamaguchi Y, Fujii S, Saito S, Kubota K, Hasegawa S, Ike H, Oki S, Shimada H. Matrilysin (MMP-7) degrades VE-cadherin and accelerates accumulation of beta-catenin in the nucleus of human umbilical vein endothelial cells. Oncol Rep 2006. [DOI: 10.3892/or.15.2.311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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46
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Ichikawa Y, Ishikawa T, Momiyama N, Kamiyama M, Sakurada H, Matsuyama R, Hasegawa S, Chishima T, Hamaguchi Y, Fujii S, Saito S, Kubota K, Hasegawa S, Ike H, Oki S, Shimada H. Matrilysin (MMP-7) degrades VE-cadherin and accelerates accumulation of beta-catenin in the nucleus of human umbilical vein endothelial cells. Oncol Rep 2006; 15:311-5. [PMID: 16391847] [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: 05/06/2023] Open
Abstract
Matrilysin, MMP-7, is an important target for anti-metastasis therapy of colorectal cancer because it is a strong proteolytic factor secreted from the cancer cell itself and it induces tumor angiogenesis. In a previous report, we showed that matrilysin accelerated human umbilical vein endothelial cell (HUVEC) proliferation in low serum conditioned medium. In the present study, we show that matrilysin stimulation decreased VE-cadherin expression, induced accumulation of beta-catenin in the nucleus of the HUVEC, and up-regulated matrilysin mRNA expression. These results compel a hypothesis that matrilysin cleaves VE-cadherin and releases beta-catenin from the VE-cadherin/catenin complex; the free beta-catenin can activate T-cell factor (Tcf) DNA binding protein, which accelerates cell proliferation and matrilysin expression.
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Affiliation(s)
- Yasushi Ichikawa
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Japan.
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Nagano Y, Nojiri K, Matsuo K, Tanaka K, Togo S, Ike H, Shimada H. The impact of advanced age on hepatic resection of colorectal liver metastases. J Am Coll Surg 2005; 201:511-6. [PMID: 16183488 DOI: 10.1016/j.jamcollsurg.2005.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.5] [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: 01/09/2005] [Revised: 05/09/2005] [Accepted: 05/10/2005] [Indexed: 01/04/2023]
Abstract
BACKGROUND The aim of this study was to evaluate the impact of patient age on surgical therapy for colorectal liver metastases. STUDY DESIGN Between 1992 and 2004, 212 consecutive patients underwent potentially curative hepatic resection. Sixty-two patients were 70 years or older at the time of resection (older group) and 150 patients were less than 70 years at the time of resection (younger group). RESULTS A proportion of older patients had a history of severe cardiopulmonary disease (32.3%) and respiratory insufficiency (6.5%). Intraoperative variables, such as resected liver volume, operation time, estimated blood loss, and blood transfusion, were not notably different between older and younger patients. Postoperative complications after resection occurred in 19.7% of older patients and at a similar rate (23.3%) in the younger group. Resection mortality was 0% in older patients and 0.49% in younger patients. The 5-year survival rates of older and younger patients were 34.1% and 53.1%, respectively. Compared with younger patients, the overall survival rate of older patients was markedly lower (p<0.01). CONCLUSIONS Advanced chronologic age cannot be regarded as a medical contraindication for hepatic resection of colorectal liver metastases in patients who are more than 70 years of age.
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Affiliation(s)
- Yasuhiko Nagano
- Department of Gastroenterological Surgery, Yokohama City University, Graduate School of Medicine, Yokohama, Japan
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Nagano Y, Matsuo K, Kunisaki C, Ike H, Imada T, Tanaka K, Togo S, Shimada H. Practical usefulness of ultrasonic surgical aspirator with argon beam coagulation for hepatic parenchymal transection. World J Surg 2005; 29:899-902. [PMID: 15951928 DOI: 10.1007/s00268-005-7784-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
The objective of this study was to evaluate the effectiveness and feasibility of using the Cavitron ultrasonic surgical aspirator (CUSA) with argon beam coagulation (ABC) during hepatic resection, in comparison with a conventional method using CUSA with bipolar cautery. Between April 2003 and March 2004, a series of 14 consecutive patients underwent hepatic resection of normal liver. Hepatectomies were performed using CUSA and bipolar irrigation electrocautery (BP) in eight patients between April 2003 and December 2003. CUSA and an ABC were used in six patients between January 2004 and March 2004. There were no differences in patient characteristics between the two groups. Blood loss per area of transected liver surface was significantly lower for CUSA with ABC than for CUSA with BP (2.9 +/- 1.44 vs. 6.33 +/- 3.14 ml/cm2). Furthermore, the speed of resection, defined as resection time per area of transected liver surface, was significantly greater for CUSA with ABC than for CUSA with BP (0.53 +/- 0.14 vs. 2.18 +/- 1.73 min/cm2). This new technique of combining CUSA with ABC can decrease blood loss during hepatic parenchymal transection and shorten the resection time.
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Affiliation(s)
- Yasuhiko Nagano
- Gastroenterological Center, Yokohama City University Medical Center, Minami-ku, Yokohama, Japan.
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Togo S, Nagano Y, Masui H, Tanaka K, Miura Y, Morioka D, Endo I, Sekido H, Ike H, Shimada H. Two-stage hepatectomy for multiple bilobular liver metastases from colorectal cancer. Hepatogastroenterology 2005; 52:913-9. [PMID: 15966231] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND/AIMS To determine an appropriate surgical treatment for patients with multiple liver metastases, we evaluated the efficacy of two-stage hepatectomy in patients with multiple bilobular liver metastases from colorectal carcinoma. METHODOLOGY Some patients with multiple liver metastases are not candidates for a complete resection by a single hepatectomy, even when downstaged by chemotherapy, after portal embolization. In two-stage hepatectomy, the highest possible number of tumors is resected in a first, noncurative intervention, and the remaining tumors are resected after a period of liver regeneration. Two-stage hepatectomy was performed in 11 patients. RESULTS Two-stage hepatectomy was feasible in all of the 11 patients. In 3 of them, the first stage was a major resection (more extensive than a lobectomy). This first hepatectomy was uneventful in all patients. The second hepatectomy was also uneventful in nine patients, but in one of the other two, a perihepatic fluid infection occurred, and in the other, postoperative liver failure developed due to a right subphrenic abscess. However, all patients were discharged. The percentage of the expected resection volume at one time, calculated from CT volumetry, was 75.5+/-1.2% and the prognostic score as surgical risk was 56.6+/-4.5. In two-stage hepatectomy cases, the percentage of the resected volume and the prognostic score in the first hepatectomy were 25.4+/-6.4% and 6.7+/-7.3, and in the second, 45.7+/-4.5% and 28.5+/-5.8. During the follow-up procedures, a residual hepatic recurrence was observed in 6 patients, and pulmonary recurrence in 9. The 1- and 3-year survival rates after the first hepatectomy were 90% and 45%, with median survivals of 18 months from the first hepatectomy. CONCLUSIONS Two-stage hepatectomy is a surgical modality intended for patients with initial unresectable metastases. However, following such surgery, protective treatment against residual liver recurrence and lung metastasis will be a most important issue.
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Affiliation(s)
- Shinji Togo
- Department of Surgery II, Yokohama City University, Yokohama, Japan.
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Nagano Y, Sekido H, Matsuoi K, Ohtsuki K, Gorai K, Kunisaki C, Ike H, Imada T, Shimada H. Successful pancreatoduodenectomy for carcinoma of the ampulla of vater after esophagectomy with remnant gastrectomy. Hepatogastroenterology 2005; 52:933-5. [PMID: 15966235] [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] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
A 59-year-old man was admitted to our hospital because his serum hepatobiliary enzymes were elevated on the medical check-up in September 2003. In his past history, he had undergone distal gastrectomy for a gastric adenoma 17 years before. Furthermore, he had undergone subtotal esophagectomy with remnant gastrectomy, the right colon and ileum were used for the reconstruction, and a cervical esophago-ileostomy and an abdominal colo-duodenostomy were made in the fashion of an interposition. Duodenoscopy was performed and showed the protruded lesion of the ampulla of Vater, biopsied specimens from this tumor revealed adenocarcinomas. Accordingly, we performed pancreaticoduodenectomy with regional lymph nodes dissection. The problem in this case was that the rt middle colic artery (MCA), and the middle colic vein (MCV) tend to be injured because these vessels are situated near the caudal region of the pancreas. We were able to identify the superior mesenteric vein (SMV) safely due to approaching this vein from the flank and mobilizing the duodenum, dissecting behind the mesenteric trunk from right to left. Double cancer of the ampulla of Vater and the esophagus are extremely rare, with only 4 cases reported. And we recommended the use of the dorsal approach to the SMV to avoid injuring the MCV such as in this case.
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Affiliation(s)
- Yasuhiko Nagano
- Yokohama City University Medical Center, Gastroenterological Center, Yokohama City Graduate University School of Medicine, Yokohama, Japan.
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