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Sugimura K, Tanaka K, Sugase T, Momose K, Kanemura T, Yamashita K, Makino T, Shiraishi O, Motoori M, Yamasaki M, Miyata H, Fujitani K, Yasuda T, Yano M, Eguchi H, Doki Y. ASO Author Reflections: Clinical Impact of Conversion Surgery After Induction Therapy for Esophageal Cancer with Synchronous Distant Metastasis: A Multi-institutional, Retrospective Study. Ann Surg Oncol 2024; 31:3475-3476. [PMID: 38402269 DOI: 10.1245/s10434-024-15007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 01/18/2024] [Indexed: 02/26/2024]
Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
| | - Koji Tanaka
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takahito Sugase
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kota Momose
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Kanemura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Yamashita
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tomoki Makino
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Makoto Yamasaki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidetoshi Eguchi
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Sugimura K, Tanaka K, Sugase T, Momose K, Kanemura T, Yamashita K, Makino T, Shiraishi O, Motoori M, Yamasaki M, Miyata H, Fujitani K, Yasuda T, Yano M, Eguchi H, Doki Y. Clinical Impact of Conversion Surgery After Induction Therapy for Esophageal Cancer with Synchronous Distant Metastasis: A Multi-institutional Retrospective Study. Ann Surg Oncol 2024; 31:3437-3447. [PMID: 38300405 DOI: 10.1245/s10434-024-14960-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 01/10/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND The standard treatment for advanced esophageal cancer with synchronous distant metastasis is systemic chemotherapy or immunotherapy. Conversion surgery is not established for esophageal cancer with synchronous distant metastasis. This study aimed to investigate the clinical impact of conversion surgery for esophageal cancer with synchronous distant metastasis after induction therapy. METHODS This multi-institutional retrospective study enrolled 66 patients with advanced esophageal cancer, including synchronous distant metastasis, who underwent induction chemotherapy or chemoradiotherapy followed by conversion surgery between 2005 and 2021. Short- and long-term outcomes were investigated. RESULTS Distant lymph node (LN) metastasis occurred in 51 patients (77%). Distant organ metastasis occurred in 15 (23%) patients. There were 41 patients with metastatic para-aortic LNs, and 10 patients with other metastatic LNs. Organs with distant metastasis included the lung in seven patients, liver in seven patients, and liver and lung in one patient. For 61 patients (92%), R0 resection was achieved. The postoperative complication rate was 47%. The in-hospital mortality rate was 1%, and the 3- and 5-year overall survival (OS) rates for all the patients were 32.4% and 24.4%, respectively. The OS rates were similar between the patients with distant LN metastasis and the patients with distant organ metastasis (3-year OS: 34.9% vs. 26.7%; P = 0.435). Multivariate analysis showed that pathologic nodal status is independently associated with a poor prognosis (hazard ratio, 2.43; P = 0.005). CONCLUSIONS Conversion surgery after chemotherapy or chemoradiotherapy for esophageal cancer with synchronous distant metastasis is feasible and promising. It might be effective for improving the long-term prognosis for patients with controlled nodal status.
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Affiliation(s)
- Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan.
- Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan.
| | - Koji Tanaka
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takahito Sugase
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kota Momose
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takashi Kanemura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Yamashita
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Tomoki Makino
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka Sayama, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Makoto Yamasaki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | | | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka Sayama, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hidetoshi Eguchi
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Departments of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Motoori M, Kishi K, Yamamoto K, Takeno A, Hara H, Murakami K, Hamakawa T, Nakahara Y, Masuzawa T, Omori T, Kurokawa Y, Fujitani K, Doki Y. Prognostic factors and significance of postoperative adjuvant chemotherapy in patients with advanced gastric cancer undergoing neoadjuvant chemotherapy followed by gastrectomy. Surg Today 2024:10.1007/s00595-024-02853-7. [PMID: 38678493 DOI: 10.1007/s00595-024-02853-7] [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] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/02/2024] [Indexed: 05/01/2024]
Abstract
PURPOSE In Japan, gastrectomy with D2 lymph node dissection and postoperative adjuvant chemotherapy are the standard treatments for locally advanced gastric cancer. Neoadjuvant chemotherapy (NAC) is not affected by postgastrectomy syndromes or postoperative complications. This multicenter retrospective study investigated the prognostic factors and significance of postoperative adjuvant chemotherapy in patients with advanced gastric cancer who underwent NAC followed by gastrectomy. METHODS Consecutive patients (n = 221) with advanced gastric cancer who underwent NAC followed by curative surgery were enrolled in this study. Prognostic factors including postoperative adjuvant chemotherapy were investigated using univariate and multivariate analyses. RESULTS A multivariate analysis revealed that pathological lymph node metastasis (ypN) status and postoperative adjuvant chemotherapy were independent prognostic factors for the overall and relapse-free survival. Forty-five patients (20.4%) did not receive postoperative adjuvant chemotherapy. There were no significant differences between patients with and without adjuvant chemotherapy for all factors, except age. The most common reason for not undergoing postoperative adjuvant chemotherapy was a poor condition (n = 23). CONCLUSIONS ypN status and postoperative adjuvant chemotherapy were independent prognostic factors in gastric cancer patients who underwent NAC followed by curative gastrectomy. It is important to maintain the patient's condition during NAC and the perioperative period so that they can receive postoperative adjuvant chemotherapy.
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Affiliation(s)
- Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan.
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Kazuyoshi Yamamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Hisashi Hara
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kohei Murakami
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Takeshi Omori
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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Aoyama S, Inoue A, Kagawa Y, Komori T, Ozato Y, Nishizawa Y, Sugimoto T, Komatsu H, Hirota M, Miyazaki Y, Tomokuni A, Motoori M, Fushimi H, Yamamoto G, Akagi K, Iwase K, Fujitani K. Curative resection via right hemicolectomy and regional lymph node dissection for colonic adenomatous polyposis of unknown etiology with adenocarcinomas localized in the right side of the colon: a case report. Surg Case Rep 2024; 10:93. [PMID: 38647838 PMCID: PMC11035501 DOI: 10.1186/s40792-024-01890-1] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/05/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND APC and MUTYH are both well-known colorectal polyposis causative genes. However, 30-50% of colorectal adenomatous polyposis cases are classified as colonic adenomatous polyposis of unknown etiology and lack identifiable pathogenic variants. Although guidelines recommend total proctocolectomy for colonic adenomatous polyposis of unknown etiology with over 100 adenomas, evidence is lacking. This study presents a unique case of localized colonic adenomatous polyposis of unknown etiology with multiple adenocarcinomas, treated with hemicolectomy and regional lymph node dissection. CASE PRESENTATION The patient was a 72-year-old woman whose colonoscopy revealed numerous polyps and two adenocarcinomas localized in the right side of the colon, with no lesions in the left side. The patient had no family history of polyposis or colorectal cancer. No extracolonic lesions, enlarged lymph nodes, or distant metastases were found. Considering the patient's age and lesion localization, laparoscopic right hemicolectomy with regional lymph node dissection was performed. Histopathological diagnosis revealed three adenocarcinoma lesions with no lymph node metastasis. The most advanced pathological stage was T2N0M0 Stage I (UICC 8th edition). The patient was alive 5 years postoperatively, without recurrence of cancer or polyposis in the remaining colon and rectum. To diagnose hereditary colorectal cancer/polyposis, a germline multigene panel testing for APC, EPCAM, MBD4, MLH1, MLH3, MSH2, MSH3, MSH6, MUTYH, NTHL1, PMS2, POLD1, POLE, and TP53 was performed using DNA extracted from blood samples: however, no pathogenic variant was detected. Therefore, the patient was diagnosed with colonic adenomatous polyposis of unknown etiology. CONCLUSIONS In this rare case, colonic adenomatous polyposis of unknown etiology, with numerous adenomatous polyps and multiple adenocarcinomas localized in the right side of the colon, was successfully treated with right hemicolectomy and regional lymph node dissection. Despite genetic analysis, no causative germline variants were identified. Segmental colectomy according to the distribution of polyps might be a curative approach.
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Affiliation(s)
- Shu Aoyama
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan.
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Takamichi Komori
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | - Yuki Ozato
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Yujiro Nishizawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Tomoki Sugimoto
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Masashi Hirota
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Akira Tomokuni
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Hiroaki Fushimi
- Department of Pathology, Osaka General Medical Center, Osaka, Japan
| | - Gou Yamamoto
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Kitaadachi-gun, Japan
| | - Kiwamu Akagi
- Division of Molecular Diagnosis and Cancer Prevention, Saitama Cancer Center, Kitaadachi-gun, Japan
| | - Kazuhiro Iwase
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
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Saito T, Kurokawa Y, Fujitani K, Kawabata R, Takeno A, Mikami J, Endo S, Matsuyama J, Akamaru Y, Hirota M, Kishi K, Urakawa S, Yamamoto K, Tanaka K, Takahashi T, Oka M, Wada H, Eguchi H, Doki Y. Serum NY-ESO-1 antibody as a predictive biomarker for postoperative recurrence of gastric cancer: a multicenter prospective observational study. Br J Cancer 2024; 130:1157-1165. [PMID: 38326601 PMCID: PMC10991393 DOI: 10.1038/s41416-023-02540-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 11/18/2023] [Accepted: 12/01/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND No reliable marker has been identified to predict postoperative recurrence of gastric cancer. We designed a clinical trial to investigate the utility of serum NY-ESO-1 antibody responses as a predictive marker for postoperative recurrence in gastric cancer. METHODS A multicenter prospective study was conducted between 2012 and 2021. Patients with resectable cT3-4 gastric cancer were included. Postoperative NY-ESO-1 and p53 antibody responses were serially evaluated every 3 months for 1 year in patients with positive preoperative antibody responses. The recurrence rate was assessed by the positivity of antibody responses at 3 and 12 months postoperatively. RESULTS Among 1001 patients, preoperative NY-ESO-1 and p53 antibody responses were positive in 12.6% and 18.1% of patients, respectively. NY-ESO-1 antibody responses became negative postoperatively in non-recurrent patients (negativity rates; 45% and 78% at 3 and 12 months, respectively), but remained positive in recurrent patients (negativity rates; 9% and 8%, respectively). p53 antibody responses remained positive in non-recurrent patients. In multivariate analysis, NY-ESO-1 antibody positivity at 3 months (P < 0.03) and 12 months (P < 0.001) were independent prognostic factors for a shorter recurrence-free interval. CONCLUSIONS Serum NY-ESO-1 antibodies may be a useful predictive marker for postoperative recurrence in gastric cancer. CLINICAL TRIAL REGISTRATION UMIN000007925.
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Affiliation(s)
- Takuro Saito
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan.
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | | | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | - Jota Mikami
- Department of Surgery, Sakai City Medical Center, Sakai, Japan
| | - Shunji Endo
- Department of Surgery, Higashi-Osaka Medical Center, Higashi-Osaka, Japan
| | - Jin Matsuyama
- Department of Surgery, Yao Municipal Hospital, Yao, Japan
| | - Yusuke Akamaru
- Department of Surgery, Ikeda City Hospital, Osaka, Japan
| | - Masashi Hirota
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Kentaro Kishi
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Shinya Urakawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kei Yamamoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Mikio Oka
- Department of Immuno-Oncology, Kawasaki Medical School, Okayama, Japan
| | - Hisashi Wada
- Department of Clinical Research in Tumor Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Hayashi Y, Motoori M, Miyazaki Y, Maekawa S, Nishizawa Y, Komatsu H, Inoue A, Kagawa Y, Tomokuni A, Fujitani K. Impact of the perioperative assessment of deglutition on postoperative respiratory complications in elderly patients undergoing gastrectomy for gastric cancer. Surg Today 2024; 54:258-265. [PMID: 37458836 DOI: 10.1007/s00595-023-02728-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/26/2023] [Indexed: 02/20/2024]
Abstract
PURPOSE To investigate the association between perioperative deglutition screening and postoperative respiratory complications (PRCs) in elderly patients undergoing gastrectomy for gastric cancer. METHODS We analyzed data from 86 patients with gastric cancer (aged ≥ 70 years) who underwent gastrectomy between October, 2016 and November, 2018. Videofluoroscopic swallowing examinations (VFSEs) were performed before and after surgery. We examined the association of these results with postoperative respiratory complications, as well as the relationships between demographic, operative, and swallowing function assessment data. RESULTS PRCs were identified in 16 patients. The results of pre- and postoperative VFSE showed abnormalities in 28 and 32 patients, respectively. Multivariate analysis revealed that abnormalities in the postoperative VFSEs were strongly associated with the development of PRCs (P = 0.002). The findings of this analysis suggests that ventilatory impairment, a Charlson comorbidity index score ≥ 3, and an open surgical approach are independent risk factors for PRCs. CONCLUSION This is the first study to demonstrate the efficacy of perioperative assessment of swallowing function using VFSE for predicting PRCs in elderly patients undergoing gastrectomy for gastric cancer.
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Affiliation(s)
- Yoshinori Hayashi
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan.
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Shizuka Maekawa
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Japan
| | - Yujiro Nishizawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Akira Tomokuni
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-Ku, Osaka, 558-8558, Japan
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7
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Aoyama S, Miyazaki Y, Motoori M, Hirota M, Itami T, Matsumoto S, Hirano M, Aomatsu M, Goto T, Kitahara M, Ozato Y, Nishizawa Y, Komatsu H, Inoue A, Kagawa Y, Tomokuni A, Iwase K, Nishi H, Fujitani K. Cardiac tamponade complicating esophagectomy and retrosternal gastric tube reconstitution in a patient with an abnormal ascending aorta position: a case report. Surg Case Rep 2024; 10:48. [PMID: 38416299 PMCID: PMC10899980 DOI: 10.1186/s40792-024-01850-9] [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] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/19/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND Cardiac tamponade is a rare postoperative complication of esophageal cancer surgery, which leads to rapid hemodynamic changes and can be fatal if not treated properly and promptly. Herein, we report a case of cardiac tamponade after thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution for esophageal cancer that was successfully treated with surgical drainage. CASE PRESENTATION An 86-year-old man with lower thoracic esophageal cancer underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution. No intra-operative complications were observed. On the first postoperative day, tachycardia and hypotension were observed, and pericardial effusion was identified on computed tomography images. The patient was diagnosed with obstructive shock secondary to cardiac tamponade. As percutaneous puncture drainage was not possible due to the presence of a retrosternal gastric tube, pericardiotomy with a small left anterior thoracotomy was performed, and a large amount of hematogenous fluid was drained, which instantly improved circulation. On the second postoperative day, the patient showed decreased pulse pressure, and computed tomography revealed a residual and enlarged hematoma around the right ventricle. The patient underwent surgical drainage and another pericardiotomy with a small right anterior thoracotomy was performed to drain the hematoma. At this time, multiple injuries to the fatty tissue, epicardium, and myocardium with active bleeding were observed on the anterior surface of the right ventricle near the root of the pulmonary artery. In this patient, the ascending aorta ran further to the right and dorsal sides than usual, causing the anterior wall of the right ventricle near the root of the pulmonary artery to be closer to the back of the sternum. This abnormality may have contributed to injury during the creation of the retrosternal pathway, leading to cardiac tamponade. CONCLUSIONS Cardiac tamponade after esophagectomy can occur because of manipulation during creation of the retrosternal route, with an anomaly in the aortic position being present in this case. Gentle manipulation and selection of the reconstruction route according to the patient's condition are necessary in cases with such anatomical abnormalities.
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Affiliation(s)
- Shu Aoyama
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan.
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Masashi Hirota
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Takefumi Itami
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Sayaka Matsumoto
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Masataka Hirano
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Michihiro Aomatsu
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Takasumi Goto
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
- Department of Cardiovascular Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Mutsunori Kitahara
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
- Department of Cardiovascular Surgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Yuki Ozato
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Yujiro Nishizawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Akira Tomokuni
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Kazuhiro Iwase
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
| | - Hiroyuki Nishi
- Department of Cardiovascular Surgery, Osaka General Medical Center, Osaka, Japan
- Department of Cardiovascular Surgery, Osaka National Hospital, National Hospital Organization, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, Japan
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8
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Hayashi N, Nishizawa Y, Kagawa Y, Inoue A, Kawabe Y, Sindo M, Suzuki K, Nakanishi M, Komatsu H, Hirota M, Miyazaki Y, Tomokuni A, Motoori M, Iwase K, Fujitani K. [A Case of Single Hole Ileal Resection for Ascendiry Colon Cancer with Ureterocutaneous Fistula in the Right Lower Abdomen]. Gan To Kagaku Ryoho 2023; 50:1903-1905. [PMID: 38303247] [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: 02/03/2024]
Abstract
The patient is a 70s woman. She underwent cystectomy for bladder cancer 6 years ago and had a ureterocutaneous fistula in the right lower abdomen. After colonoscopy for positive fecal occult blood, a type 1 elevated lesion was found in the ascending colon, which was diagnosed as a well-differentiated adenocarcinoma on biopsy. Surgery was performed with a single hole. The approach from the right lower abdomen, where the ureterocutaneous fistula and ureter are located, was avoided, and the approach from the hepatic flexure of the transverse colon was used first. After the right colon was mobilized, the large mesh adhesions around the ureter were carefully dissected, and the right ureter was identified and preserved, extending from the lateral ascending colon to the abdominal wall. The ileal artery was dissected at the root and after dissection of the D3 lymph node, the intestine was dissected and anastomosed extracorporeally. The operative time was 246 minutes with small amount of blood loss. The patient was discharged on the 6th postoperative day without any postoperative complications. The pathology result was pT3N0M0, pStage Ⅱa, and radical resection had been performed. The patient is currently undergoing recurrence-free follow-up.
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9
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Komatsu H, Tomokuni A, Ozato Y, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Motoori M, Fujitani K, Iwase K. [A Case of Hepatic Encephalopathy Caused by Portal Vein Thrombosis after Surgery for Perihilar Cholangiocarcinoma]. Gan To Kagaku Ryoho 2023; 50:1878-1880. [PMID: 38303238] [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: 02/03/2024]
Abstract
A female in her 70s underwent right hepatectomy with resection of caudate lobe and extrahepatic bile duct for perihilar cholangiocarcinoma(T2aN0M0, Stage Ⅱ: Biliary Cancer Treatment Regulations, 7th edition). On the 4th postoperative day, the patient had impaired consciousness, which worsened to almost coma on the 5th postoperative day. On the same day, a blood test showed high ammonia level, thus the state was thought to be hepatic encephalopathy. Contrast -enhanced CT on the same day showed thrombus from the main trunk of the portal vein to the remnant left branch, narrowing of the lumen of the vessel. Simultaneously, enlarged portosystemic shunt in the pelvic floor due to portal hypertension induced by the thrombosis. Plasmapheresis was performed, and anticoagulation with sodium heparin and antithrombin Ⅲ were started. Then, the portal vein thrombus was reduced, and encephalopathy was improved. She was discharged from the hospital on postoperative day 48. She was treated with edoxaban as an outpatient, and anticoagulation therapy was terminated after a CT scan 6 months after surgery, which confirmed no recurrence of thrombus. She is now alive without recurrence of thrombus or tumor for about 2 years after the surgery.
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Affiliation(s)
- Hisateru Komatsu
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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10
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Kawabe Y, Inoue A, Kagawa Y, Nishizawa Y, Ozato Y, Hayashi N, Shindo M, Suzuki K, Komatsu H, Hirota M, Miyazaki Y, Tomokuni A, Motoori M, Iwase K, Fujitani K. [A Case of Conversion Surgery after Chemotherapy for Locally Advanced Unresectable Rectal Cancer]. Gan To Kagaku Ryoho 2023; 50:1768-1770. [PMID: 38303201] [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: 02/03/2024]
Abstract
We report a case of locally advanced rectal cancer that could not be curatively resected, in which the patient underwent conversion surgery after chemotherapy. The patient is a 70-year-old woman. She came to our hospital with a chief complaint of lower abdominal pain, and a close examination revealed rectal cancer with invasion of the external iliac artery and pelvic wall. She was treated with mFOLFOX6 plus cetuximab for locally advanced rectal cancer that was not amenable to surgical resection. After 11 courses of chemotherapy, significant shrinkage of the tumor was observed, and robot assisted laparoscopic high-anterior resection was performed. The patient didn't relapse at 12 months after surgery without adjuvant chemotherapy.
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Affiliation(s)
- Yusuke Kawabe
- Dept. of Gastrointestinal Surgery, Osaka General Medical Center
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11
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Nishizawa Y, Kagawa Y, Inoue A, Ozato Y, Kumode A, Ueda Y, Takahashi M, Fukui A, Komatsu H, Hirota M, Miyazaki Y, Tomokuni A, Motoori M, Iwase K, Fujitani K. [A Case of Pathological Complete Response for MSI-High Locally Advanced Unresectable Transverse Colon Cancer Treated with Nivolumab plus Ipilimumab Combination Therapy]. Gan To Kagaku Ryoho 2023; 50:1968-1970. [PMID: 38303267] [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: 02/03/2024]
Abstract
74-year-old woman was diagnosed with locally advanced unresectable transverse colon cancer. She started CAPOX therapy as first-line therapy after ileostomy. After second course, MSI-high was detected, so nivolumab plus ipilimumab combination therapy was started as second-line therapy. After 4 courses of combination therapy, she was judged to be in partial response and surgery was performed. Histopathological diagnosis of the surgical specimen showed complete response, and she is still alive without recurrence 15 months after surgery.
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Affiliation(s)
- Yujiro Nishizawa
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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12
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Nishikawa K, Kawakami H, Shimokawa T, Fujitani K, Tamura S, Endo S, Kobayashi M, Kawada J, Kurokawa Y, Tsuburaya A, Yoshikawa T, Sakamoto J, Satoh T. Meta-analysis of three randomized trials of capecitabine plus cisplatin (XP) versus S-1 plus cisplatin (SP) as first-line treatment for advanced gastric cancer. Int J Clin Oncol 2023; 28:1501-1510. [PMID: 37634209 DOI: 10.1007/s10147-023-02402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 08/07/2023] [Indexed: 08/29/2023]
Abstract
BACKGROUND S-1 plus cisplatin (SP) and capecitabine plus cisplatin (XP) are standard first-line regimens for advanced gastric cancer (AGC) worldwide. We conducted a meta-analysis using individual participant data (IPD) to investigate which is more suitable. METHODS IPD from three randomized trials were collected. In these trials, patients with AGC were randomly allocated to SP (S-1 80-120 mg for 21 days plus cisplatin 60 mg/m2 (q5w)) or XP (capecitabine 2000 mg/m2 for 14 days plus cisplatin 80 mg/m2 (q3w)). RESULTS In 211 eligible patients, median overall survival (OS) for SP versus XP was 13.5 and 11.7 months (hazard ratio [HR], 0.787; p = 0.114), progression-free survival (PFS) was 6.2 and 5.1 months (HR, 0.767; P = 0.076), and TTF was 5.1 and 4.0 months (HR, 0.611; P = 0.001). The most common grade ≥ 3 adverse events with SP or XP were neutropenia (18% vs. 29%) and anorexia (16% vs.18%). Subgroup analysis demonstrated significant interaction between treatment effect and performance status > 1 (HR, 0.685; P = 0.036), measurable lesion (HR, 0.709; P = 0.049), primary upper third tumor (HR, 0.539; P = 0.040), and differentiated type (HR, 0.549; interaction, 0.236; P = 0.019). For the differentiated type, OS was significantly longer in the SP group (13.2 months) than in the XP group (11.1 months) (HR, 0.549; P = 0.019). For the undifferentiated type, OS was similar in the SP group (14.2 months) and in the XP group (12.4 months) (HR, 0.868; P = 0.476). CONCLUSIONS SP and XP were both effective and well tolerated. SP might be suitable for the pathological differentiated subtype of AGC. CLINICAL TRIAL REGISTRATION The HERBIS-2, HERBIS-4A, and XParTS II trials were registered with UMIN-CTR as UMIN000006105, UMIN000006755, and UMIN000006045, respectively.
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Affiliation(s)
- Kazuhiro Nishikawa
- Cancer Treatment Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennoji-ku, Osaka, 543-0035, Japan.
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | | | - Shunji Endo
- Department of Digestive Surgery, Kawasaki Medical School Hospital, Kurashiki, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nankoku, Japan
| | - Junji Kawada
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Akira Tsuburaya
- Department of Surgery, AOI Nanasawa Rehabilitation Hospital, Atsugi, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo, Japan
| | | | - Taroh Satoh
- Palliative Care Center, Osaka University Hospital, Suita, Japan
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13
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Terashima M, Fujitani K, Yang H, Mizusawa J, Tsujinaka T, Nakamura K, Katayama H, Lee H, Lee JH, An J, Takagane A, Park Y, Choi SH, Song KY, Ito S, Park DJ, Jin S, Boku N, Yoshikawa T, Sasako M. Role of reduction gastrectomy in patients with gastric cancer with a single non-curable factor: Supplementary analysis of REGATTA trial. Ann Gastroenterol Surg 2023; 7:741-749. [PMID: 37663970 PMCID: PMC10472355 DOI: 10.1002/ags3.12674] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 09/05/2023] Open
Abstract
Background REGATTA trial failed to demonstrate the survival benefit of reduction gastrectomy in patients with advanced gastric cancer with a single non-curable factor. However, a significant interaction was found between the treatment effect and tumor location in the subset analysis. Additionally, the treatment effect appeared to be different between Japan and Korea. This supplementary analysis aimed to elucidate the effect of reduction surgery based on tumor location and country. Methods Multivariable Cox regression analyses in each subgroup were performed to estimate the hazard ratio (HRadj), including the following variables as explanatory variables: country, age, sex, incurable factor, cT, cN, primary tumor, performance status, histological type, and macroscopic type. Results Patients (95 in Japan and 80 in Korea) were randomized to chemotherapy alone (86 patients) or gastrectomy plus chemotherapy (89 patients). The subgroup analysis according to the country revealed a worse overall survival in gastrectomy plus chemotherapy arm in Japan (hazard ratio: 1.32, 95% confidence interval: 0.85-2.05), but not in Korea (hazard ratio: 0.85.95% confidence interval: 0.52-1.40). Overall survival was better in distal gastrectomy plus chemotherapy compared with chemotherapy alone (hazard ratio = 0.69, 95% confidence interval: 0.42-1.13), and worse in total gastrectomy plus chemotherapy compared with chemotherapy alone (hazard ratio = 1.34, 95% CI: 0.93-1.94), which was more remarkable in Korea than in Japan. Conclusions Primary chemotherapy is a standard of care for advanced gastric cancer; however, the survival benefits from reduction by distal gastrectomy remained controversial.
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Affiliation(s)
| | - Kazumasa Fujitani
- Osaka General HospitalOsakaJapan
- Osaka Prefectural General Medical CenterOsakaJapan
| | | | - Junki Mizusawa
- Japan Clinical Oncology Group Data CenterNational Cancer Center HospitalTokyoJapan
| | | | - Kenichi Nakamura
- Japan Clinical Oncology Group Operations OfficeNational Cancer Center HospitalTokyoJapan
| | - Hiroshi Katayama
- Japan Clinical Oncology Group Operations OfficeNational Cancer Center HospitalTokyoJapan
| | | | - Jun Ho Lee
- National Cancer CenterGoyangSouth Korea
- Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Ji‐Yeong An
- Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
- Yonsei University Severance HospitalSeoulSouth Korea
| | | | - Young‐Kyu Park
- Chonnam National University Medical SchoolGwangjuSouth Korea
| | - Seung Ho Choi
- Yonsei University Kangnam Severance HospitalSeoulSouth Korea
| | - Kyo Young Song
- Catholic University Seoul St. Mary's HospitalSeoulSouth Korea
| | - Seiji Ito
- Aichi Cancer Center HospitalNagoyaJapan
| | - Do Joong Park
- Seoul National University HospitalSeoulSouth Korea
- Seoul National University Bundang HospitalSeongnamSouth Korea
| | - Sung‐Ho Jin
- Korea Cancer Center HospitalKorea Institute of Radiological and Medical SciencesSeoulSouth Korea
| | - Narikazu Boku
- National Cancer Center HospitalTokyoJapan
- IMSUT HospitalThe Institute of Medical Science, The University of TokyoTokyoJapan
| | - Takaki Yoshikawa
- National Cancer Center HospitalTokyoJapan
- Kanagawa Cancer CenterYokohamaJapan
| | - Mitsuru Sasako
- Yodogawa Christian HospitalOsakaJapan
- Hyogo Medical UniversityNishinomiyaJapan
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14
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Kimura Y, Kawakami H, Tamura S, Fujitani K, Matsuyama J, Imamura H, Iijima S, Sakai D, Kurokawa Y, Shimokawa T, Tsujinaka T, Furukawa H, Satoh T. Effect of the number of cycles of docetaxel + S-1 therapy on long-term survival in adjuvant chemotherapy for stage III gastric cancer. A pooled analysis of the OGSG0604 and OGSG1002 trials. Gastric Cancer 2023; 26:788-797. [PMID: 37335367 DOI: 10.1007/s10120-023-01408-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 06/04/2023] [Indexed: 06/21/2023]
Abstract
BACKGROUND S-1 plus docetaxel (DS) therapy followed by S-1 is the standard of care in Japan in postoperative adjuvant chemotherapy for stage III gastric cancer, but long-term survival and the number of DS cycles required are unclear. The purpose of this study was to investigate the impact of the number of cycles of DS therapy on the 5-year survival in stage III gastric cancer in a pooled analysis of two phase II trials (OGSG0604 and OGSG1002). PATIENTS AND METHODS Patients with histologically confirmed stage III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were enrolled in this pooled analysis. They received DS therapy for four or eight cycles, followed by S-1 until 1 year postgastrectomy. The 5-year overall survival (OS) and the 5-year disease free survival (DFS) by the landmark analysis was evaluated. RESULTS In total, 113 patients from the OGSG0604 and OGSG1002 trials were enrolled in this study. The landmark analysis showed a 5-year OS that was better with four to eight cycles of DS therapy than with one to three cycles of DS therapy, with the best 5-year OS of 77.4% (95% confidence interval, 66.5-90.1%) for eight cycles. The 5-year DFS was approximately 66% when four or eight cycles of DS therapy were given. CONCLUSION Although eight cycles of DS therapy may prolong prognosis, the present study did not provide a clear conclusion as to how many DS therapy cycles are needed to improve prognosis after D2 gastrectomy for stage III gastric cancer. TRIAL REGISTRATION Registration number: UMIN00000714 and UMIN000004440.
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Affiliation(s)
- Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, 1248-1 Otoda-Cho, Ikoma, Nara, 630-0293, Japan.
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University, Faculty of Medicine, Osaka-Sayama, Japan
| | | | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Jin Matsuyama
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Shohei Iijima
- Department of Nutritional Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Daisuke Sakai
- Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | | | - Hiroshi Furukawa
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka-Sayama, Japan
| | - Taroh Satoh
- Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan
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15
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Kubo Y, Makino T, Yamasaki M, Tanaka K, Yamashita K, Shiraishi O, Sugimura K, Miyata H, Motoori M, Fujitani K, Takeno A, Hirao M, Kimura Y, Satoh T, Yano M, Eguchi H, Yasuda T, Doki Y. ASO Visual Abstract: Three-Course Neoadjuvant Chemotherapy Associated with Unfavorable Survival in Non-responders to the First Two Courses for Locally Advanced Esophageal Cancer. Ann Surg Oncol 2023; 30:5910-5911. [PMID: 37266810 DOI: 10.1245/s10434-023-13668-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Yuto Kubo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Keijiro Sugimura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | | | - Atsushi Takeno
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, Nara, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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16
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Kubo Y, Makino T, Yamasaki M, Tanaka K, Yamashita K, Shiraishi O, Sugimura K, Miyata H, Motoori M, Fujitani K, Takeno A, Hirao M, Kimura Y, Satoh T, Yano M, Eguchi H, Yasuda T, Doki Y. Three-Course Neoadjuvant Chemotherapy Associated with Unfavorable Survival of Non-responders to the First Two Courses for Locally Advanced Esophageal Cancer. Ann Surg Oncol 2023; 30:5899-5907. [PMID: 37316744 DOI: 10.1245/s10434-023-13548-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/27/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Three-course neoadjuvant chemotherapy (NAC) followed by surgery has become a standard of care for locally advanced esophageal cancer (EC). However, some patients occasionally experience a poor tumor response to the third course and have a poor clinical outcome. METHODS An exploratory analysis of data from the authors' recent multicenter randomized phase 2 trial compared patients with locally advanced EC who received two courses (n = 78) and those who received three courses (n = 68) of NAC. The association between tumor response and clinico-pathologic factors, including survival, was evaluated to identify risk factors in the three-course group. RESULTS Of 68 patients who received three courses of NAC, 28 (41.2%) had a tumor reduction rate lower than 10% during the third course. This rate was associated with unfavorable overall survival (OS) and progression-free survival (PFS) compared with a tumor reduction rate of 10% or higher (2-year OS rate: 63.5% vs. 89.3%, P = 0.007; 2-year PFS rate: 52.6% vs. 79.7%, P = 0.020). The independent prognostic factors for OS were tumor reduction rate lower than 10% during the third course (hazard ratio [HR], 2.735; 95% confidence interval [CI] 1.041-7.188; P = 0.041) and age of 65 years or older (HR, 9.557, 95% CI 1.240-73.63; P = 0.030). Receiver operating characteristic curve and multivariable logistic regression analyses identified a tumor reduction rate lower than 50% after the first two courses as an independent predictor of a tumor reduction rate lower than 10% during the third course of NAC (HR, 4.315; 95% CI 1.329-14.02; P = 0.015). CONCLUSION Continuing NAC through a third course may worsen survival for patients who do not experience a response to the first two courses in locally advanced EC.
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Affiliation(s)
- Yuto Kubo
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Keijiro Sugimura
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | | | - Atsushi Takeno
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, Nara, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Japan
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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17
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Yamasaki M, Miyata H, Yamashita K, Hamakawa T, Tanaka K, Sugimura K, Makino T, Takeno A, Shiraishi O, Motoori M, Kimura Y, Hirao M, Fujitani K, Yasuda T, Yano M, Eguchi H, Doki Y. Chemoradiotherapy versus triplet chemotherapy as initial therapy for T4b esophageal cancer: survival results from a multicenter randomized Phase 2 trial. Br J Cancer 2023:10.1038/s41416-023-02286-y. [PMID: 37142731 DOI: 10.1038/s41416-023-02286-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 04/08/2023] [Accepted: 04/17/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND We report the long-term results as primary endpoint in a multicentre randomized prospective Phase 2 trial which compared chemoradiotherapy (CRT) and triplet chemotherapy (CT) as the initial therapy for conversion surgery (CS) in T4b esophageal cancer (EC). METHODS Patients with T4b EC were randomly assigned to the CRT group or CT group as initial treatment. CS was performed if resectable after initial or secondary treatment. The primary endpoint was 2-year overall survival, analysed by intention-to-treat. RESULTS The median follow-up period was 43.8 months. The 2-year survival rate was higher in the CRT group (55.1%; 95% CI: 41.1-68.3%) compared to the CT group (34.7%; 95% CI: 22.8-48.9%), although the difference was not significant (P = 0.11). Local and regional lymph node recurrence in patients undergoing R0 resection was significantly higher in the CT group compared to the CRT group (local: 30% versus 8%, respectively, P = 0.03; regional: 37% versus 8%, respectively, P = 0.002). CONCLUSIONS Upfront CT was not superior to upfront CRT as induction therapy for T4b EC in terms of 2-year survival and was significantly inferior to upfront CRT in terms of local and regional control. REGISTRATION The Japan Registry of Clinical Trials (s051180164).
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Affiliation(s)
- Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan.
| | - Hiroshi Miyata
- Department of Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | | | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Osamu Shiraishi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | - Takusi Yasuda
- Department of Surgery, Kindai University Faculty of Medicine, Osaka Sayama, Osaka, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
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18
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Ura T, Hironaka S, Tsubosa Y, Mizusawa J, Kato K, Tsushima T, Fushiki K, Chin K, Tomori A, Okuno T, Matsushita H, Kojima T, Doki Y, Kusaba H, Fujitani K, Seki S, Kitagawa Y. Early tumor shrinkage and depth of response in patients with metastatic esophageal cancer treated with 2-weekly docetaxel combined with cisplatin plus fluorouracil: an exploratory analysis of the JCOG0807. Esophagus 2023; 20:272-280. [PMID: 36427158 DOI: 10.1007/s10388-022-00968-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 10/29/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND We herein investigated the association between early tumor shrinkage (ETS) and depth of response (DpR) and clinical outcomes in patients with metastatic esophageal cancer treated with 2-weekly docetaxel combined with cisplatin plus fluorouracil (bDCF) using data from the JCOG0807, a phase I/II trial of bDCF as first-line chemotherapy for metastatic esophageal cancer. METHODS ETS was defined as a percent decrease in the sum of the target lesions' longest diameter after 8 weeks, whereas DpR was defined as a percentage of the maximal tumor shrinkage during the treatment course. Multivariable analyses were conducted to identify significant prognostic variables in progression-free survival (PFS) and overall survival (OS): one for ETS and covariates, and another for DpR and covariates. RESULTS Among 53 patients, 35 patients with ETS ≥ 20% (66.0%) had longer PFS (7.5 vs. 3.4 months, hazard ratio [HR]: 0.26, 95% confidence interval [95% CI] 0.14-0.49), OS (13.8 vs. 6.1 months, HR 0.20, 95% CI 0.11-0.39), and PPS (6.4 vs. 2.8 months, HR 0.38, 95% CI 0.20-0.72) than those with ETS < 20%. In addition, 37 patients with DpR ≥ 30% (69.8%) had longer PFS (7.5 vs. 2.9 months, HR 0.17, 95% CI 0.08-0.34), OS (13.8 vs. 6.0 months, HR 0.14, 95% CI 0.07-0.27), and PPS (6.8 vs. 2.8 months, HR 0.30, 95% CI 0.15-0.58) than those with DpR < 30%. Multivariable analyses revealed that each ETS and DpR was an independent factor of longer PFS and OS. CONCLUSIONS ETS and DpR might be associated with clinical outcomes in patients with metastatic esophageal cancer treated with bDCF.
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Affiliation(s)
- Takashi Ura
- Department of Medical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Shuichi Hironaka
- Department of Medical Oncology, Gastroenterological Oncology, Saitama Medical University International Medical Center, 1397-1, Yamane, Hidaka-Shi, Saitama, 350-1298, Japan.
| | - Yasuhiro Tsubosa
- Division of Esophageal Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Junki Mizusawa
- JCOG Data Center, National Cancer Center Hospital, Tokyo, Japan
| | - Ken Kato
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Takahiro Tsushima
- Department of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Kunihiro Fushiki
- Department of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keisho Chin
- Department of Gastroenterology, Cancer Institute Hospital, Tokyo, Japan
| | - Akihisa Tomori
- Department of Gastroenterology, Saku Central Hospital, Saku, Japan
| | - Tatsuya Okuno
- Division of Gastroenterology, Department of Internal Medicine, Kobe University Graduate School of Medicine, Kobe, Japan
| | | | - Takashi Kojima
- Gastrointestinal Oncology Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Yuichiro Doki
- Gastroenterological Surgery, Osaka University, Suita, Japan
| | - Hitoshi Kusaba
- Department of Medicine and Biosystemic Science, Kyushu University, Fukuoka, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan
| | - Shiko Seki
- Department of Gastroenterological Surgery, Tokyo Medical Center, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
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19
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Aoyama S, Motoori M, Yamasaki M, Shiraishi O, Miyata H, Hirao M, Takeno A, Sugimura K, Makino T, Tanaka K, Hamakawa T, Yamashita K, Kimura Y, Fujitani K, Yasuda T, Yano M, Doki Y. The impact of weight loss during neoadjuvant chemotherapy on postoperative infectious complications and prognosis in patients with esophageal cancer: exploratory analysis of OGSG1003. Esophagus 2023; 20:225-233. [PMID: 36494496 DOI: 10.1007/s10388-022-00975-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2022] [Accepted: 11/28/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Neoadjuvant therapy followed by surgery is the standard treatment for locally advanced esophageal cancers. During neoadjuvant therapy, tumor-induced esophageal stenosis or adverse events often cause weight loss. However, little is known about the effects of weight loss during neoadjuvant therapy on postoperative complications or prognosis. We investigated the association between weight loss during neoadjuvant chemotherapy, postoperative infectious complications, and prognosis. METHODS Data from OGSG1003, a randomized phase-II trial comparing two regimens of neoadjuvant chemotherapy, cisplatin and fluorouracil plus Adriamycin and cisplatin and fluorouracil plus docetaxel, for locally advanced esophageal squamous cell carcinoma were used. Body weight was measured before neoadjuvant chemotherapy and esophagectomy. Multivariate analysis for infectious complications and prognosis was performed. RESULTS The study included 134 patients. The median weight loss during neoadjuvant chemotherapy was 2.83% (-2.07% to 6.29%). Postoperative infectious complications were observed in 37 patients who had a significantly higher weight loss during neoadjuvant chemotherapy (5.18% vs. 1.90%, P = 0.002). Multivariate analysis revealed that > 5% of weight loss during neoadjuvant chemotherapy was the only independent factor associated with postoperative infectious complications (odds ratio 2.69, 95% confidence interval 1.12-6.46, P = 0.027). Weight loss during neoadjuvant chemotherapy was significantly associated with worse recurrence-free survival in the univariate analysis (log-rank test, P = 0.002), but this association was marginal in the multivariate analysis (hazard ratio 1.73, 95% confidence interval 0.98-3.08, P = 0.058). CONCLUSIONS Severe weight loss during neoadjuvant chemotherapy was an independent risk factor for postoperative infectious complications. Weight maintenance during neoadjuvant chemotherapy may reduce the incidence of postoperative infectious complications.
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Affiliation(s)
- Shu Aoyama
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan.
| | - Makoto Yamasaki
- Department of Surgery, Kansai Medical University, Hirakata, Japan
| | - Osamu Shiraishi
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Hiroshi Miyata
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | - Tomoki Makino
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Takuya Hamakawa
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yutaka Kimura
- Department of Surgery, Kindai University Nara Hospital, Ikoma, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi, Sumiyoshi-Ku, Osaka, Japan
| | - Takushi Yasuda
- Department of Surgery, Faculty of Medicine, Kindai University, Osakasayama, Japan
| | - Masahiko Yano
- Department of Surgery, Suita Municipal Hospital, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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20
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Tomita H, Kagawa T, Inoue A, Nishizawa Y, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Ueda Y, Kumode A, Fukui A, Murayama H, Goto M, Iwase K, Fujitani K. [A Case of Rectal Cancer with Enlarged Lateral Lymph Nodes Treated with Total Neoadjuvant Therapy and Robotic Surgery]. Gan To Kagaku Ryoho 2023; 50:215-217. [PMID: 36807176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
A 70s woman with advanced rectal cancer(AV 3 cm, type 2)was diagnosed as cT3N2M1a, Stage Ⅳ(UICC, TNM 8th) and underwent total neoadjuvant therapy(TNT)consisted of preoperative 5 Gy×5 short course RT followed by 5 courses of CAPOX plus BEV and CAPOX. Post-treatment endoscopy revealed nearCR, MRI failed to identify the primary tumor, and the mesenteric and lateral lymph node enlargement had disappeared. The patient underwent robot-assisted low anterior resection, bilateral lymph node dissection, and temporary ileal colostomy. Postoperative pathological findings were ypT0N0M0, Stage 0, and the efficacy evaluation was TRG 0(AJCC)with no residual tumor including lateral lymph nodes. The patient was discharged on the 16th day without any postoperative complications and is currently alive 6 months postoperatively without recurrence.
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Affiliation(s)
- Hikari Tomita
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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21
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Hayashi N, Kagawa Y, Inoue A, Nishizawa Y, Komatsu H, Miyazaki Y, Tomokuni A, Takahashi A, Hotta N, Fukui A, Murayama H, Goto M, Motoori M, Iwase K, Fujitani K. [A Case of Rectal Cancer in Which Total Pelvic Organ Excision Could Be Avoided by TNT Therapy and Robotic Surgery]. Gan To Kagaku Ryoho 2023; 50:200-202. [PMID: 36807171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
The patient is a 50s year old man. He visited his local doctor with complaints of anal pain and bloody stools, and a rectal examination revealed a tumor on the anterior wall of the rectal canal. CT imaging showed tumors invading the prostate, urethra, and anorectal muscles, and a 3 mm-sized nodule was found in the lungs. The patient was diagnosed as cT4bN1M1a, Stage Ⅳ, and total neoadjuvant chemotherapy was planned as preoperative treatment. The 5 Gy×5 times radiation therapy followed by 5 courses of CAPOX plus BEV as preoperative chemotherapy and CAPOX. CAPOX was administered. After completion of treatment, the colonoscopy showed PR, and MRI showed clear boundary between the prostate and tumor but invasion into the anorectal muscles; CT showed no lung metastasis, and preoperative diagnosis was ycT4bN0M0, ycStage Ⅱ. Robotic-assisted rectal amputation and left lateral lymph node dissection were performed under general anesthesia. Pathologically, the patient was diagnosed as ycT4bN0M0, Stage Ⅱ, and the efficacy was determined as TRG 1(AJCC). Vertical dissection was negative and radical resection was possible.
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22
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Kitabayashi K, Kagawa Y, Inoue A, Nishizawa Y, Komatsu H, Miyazaki Y, Tomokuni A, Takahashi A, Ueda Y, Kumode A, Fukui A, Ozawa Y, Motoori M, Iwase K, Fujitani K. [A Case of Locally Advanced Sigmoid Colon Cancer Invading the Urinary Bladder Treated with Neoadjuvant Chemotherapy and Robot Assisted Urinary Bladder-Conserving Surgery]. Gan To Kagaku Ryoho 2023; 50:218-220. [PMID: 36807177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report a case of 72s male with locally advanced sigmoid colon cancer. Colonoscopy revealed an advanced sigmoid colon cancer(AV 15 cm, type 2, semi-peripheral, deeper than T3). He was diagnosed as cT4bN2M0, cStage Ⅲc(Japanese Classification of Colorectal, appendiceal, and, Carcinoma, 9th edition), and was given chemotherapy as preoperative treatment. He was treated with CAPOX plus BEV as neoadjuvant chemotherapy. Preoperative diagnosis was ycT4bN0M0, ycStage Ⅱc. The robot assisted high anterior resection and partial bladder resection were performed. The bladder was sutured under robotic assistance. The residual bladder capacity was 100 mL. Postoperative diagnosis was ypT0N0M0, ypStage 0, TRG 0 (AJCC). We experienced a case of neoadjuvant chemotherapy for rectosigmoid colon cancer with bladder invasion, which resulted in pCR.
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Affiliation(s)
- Kai Kitabayashi
- Dept. of Gastrointestinal Surgery, Osaka General Medical Center
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23
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Sugimoto T, Inoue A, Komori T, Nishizawa Y, Kagawa Y, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Iwase K, Fujitani K. [Investigation of the Short-Term Outcome of Perioperative Heparinization in Laparoscopic Surgery for Colorectal Cancer]. Gan To Kagaku Ryoho 2022; 49:1603-1605. [PMID: 36733149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In aging society, the number of colorectal cancer patients who take antithrombotic drugs is increasing. However, there are not established guidelines for perioperative management for antithrombotic drugs in laparoscopic surgery. Here, we investigated the clinical outcomes of antithrombotic drugs withdrawal and perioperative heparinization in laparoscopic surgery for colorectal cancer patients taking antithrombotic drugs. From January 2015 to December 2017 in our center, patients who took antithrombotic drugs and underwent laparoscopic surgery for colorectal cancer were reviewed retrospectively. The association between postoperative complications and heparinizations was analyzed. Among 79 patients taking antithrombotic drugs, heparinization was performed in 40 patients(50.6%). The total length of hospital stay in heparinization group was 21 days and significantly longer than 13 days in the non-heparinization group. There were no significant differences in the operation time, intraoperative blood loss, and postoperative complications between the 2 groups. The antithrombotic drugs withdrawal and perioperative heparinization were suggested to be safe and feasible in laparoscopic surgery for patients with colorectal cancer.
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Affiliation(s)
- Tomoki Sugimoto
- Dept. of Gastroenterological Surgery and Oncology, Osaka General Medical Center
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24
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Endo S, Terazawa T, Goto M, Tanaka R, Kato T, Fujitani K, Kawakami H, Sakai D, Kurokawa Y, Tsujinaka T, Shimokawa T, Satoh T. Neoadjuvant docetaxel, oxaliplatin and S-1 therapy for the patients with large type 3 or type 4 gastric cancer (OGSG1902): protocol of a multi-center, phase II study. BMC Cancer 2022; 22:811. [PMID: 35870893 PMCID: PMC9308238 DOI: 10.1186/s12885-022-09890-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 07/13/2022] [Indexed: 11/26/2022] Open
Abstract
Background Large type 3 and type 4 gastric cancers have extremely poor prognoses. To address this, neoadjuvant chemotherapy may be a promising approach. The phase III JCOG0501 study, conducted to confirm the superiority of neoadjuvant S-1 plus cisplatin followed by D2 gastrectomy over upfront surgery, showed no survival benefit for neoadjuvant S-1 plus cisplatin. In Korea, the PRODIGY study, which was a phase III study of neoadjuvant docetaxel plus oxaliplatin plus S-1 (DOS) followed by surgery and adjuvant S-1 versus surgery and adjuvant S-1 for gastric cancer of T2-3N+ or T4Nany, showed that progression-free survival (PFS) was significantly superior in the neoadjuvant DOS arm. Therefore, DOS therapy may be a promising candidate for preoperative chemotherapy for large type 3 or type 4 gastric cancer. Methods Preoperative docetaxel 40 mg/m2 and oxaliplatin 100 mg/m2 will be intravenously administered on day1 every three weeks. S-1 will be orally administered 80 mg/m2 on days 1–14 of a 21-day cycle. Patients will receive three courses of treatment and gastrectomy with ≥D2 lymph node dissection. Postoperative S-1 plus docetaxel therapy (DS) will be administered according to the JACCRO GC-07 (START-2) study. The primary endpoint is the 3-year PFS rate. Secondary endpoints include PFS time, overall survival time, pathological response rate, response rate according to RECIST version1.1, proportion of completion of neoadjuvant chemotherapy, R0 resection rate, proportion of completion of surgery, proportion of completion of protocol treatment, proportion of negative conversion of CY, adverse event occurrence rate, and nutritional evaluation. The null hypothesis for the 3-year PFS rate is 45% and the expected value is 60%. The total sample size is 46 considering that the registration period and follow-up period are two and three years, respectively. Discussion This is a prospective, multicenter, single-arm, open-label, phase II trial assessing the efficacy and safety of preoperative DOS and postoperative DS for large type 3 or type 4 gastric cancer. The results will inform future phase III trials and are expected to lead to new treatment strategies for large type 3 or type 4 gastric cancer. Trial registration Registered with Japan Registry of Clinical Trials on October 11, 2019 (jRCTs051190060).
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Kawakami H, Nishikawa K, Shimokawa T, Fujitani K, Tamura S, Endo S, Kobayashi M, Kawada J, Kurokawa Y, Tsuburaya A, Yoshikawa T, Sakamoto J, Satoh T. Histology Classification Highlights Differences in Efficacy of S-1 versus Capecitabine, in Combination with Cisplatin, for HER2-Negative Unresectable Advanced or Recurrent Gastric Cancer with Measurable Disease. Cancers (Basel) 2022; 14:cancers14225673. [PMID: 36428770 PMCID: PMC9688851 DOI: 10.3390/cancers14225673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/14/2022] [Accepted: 11/16/2022] [Indexed: 11/22/2022] Open
Abstract
It has been suggested that the therapeutic efficacy of S-1 + cisplatin (SP) and capecitabine + cisplatin (XP) may differ depending on the histology of the tumor, but no clear evidence exists. Individual participant data were obtained from three randomized phase II trials in which such patients received either SP (S-1 [40-60 mg twice daily for 21 days] plus cisplatin [60 mg/m2 on day 8], every 5 weeks) or XP (capecitabine [1000 mg/m2 twice daily for 14 days] plus cisplatin [80 mg/m2 on day 1], every 3 weeks). A total of 162 patients were included, with 79 patients in the SP arm and 83 patients in the XP arm. Although there was also no difference between arms in ORR according to histological classification, differentiated tumors showed a significantly better OS (but not PFS) for SP versus XP that was associated with a deeper tumor shrinkage. Undifferentiated tumors showed a consistently better OS, and PFS for SP versus XP, likely because cases without tumor shrinkage tended to be fewer for SP. Our data thus showed that SP was superior to XP in this setting, but there were qualitative differences in therapeutic efficacy dependent on tumor histology.
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Affiliation(s)
- Hisato Kawakami
- Department of Medical Oncology, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka 589-8511, Japan
- Correspondence:
| | - Kazuhiro Nishikawa
- Department of Surgery, Sakai City Medical Center, Sakai, Osaka 593-8304, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Wakayama 641-0012, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Osaka 558-8558, Japan
| | - Shigeyuki Tamura
- Department of Surgery, Yao Municipal Hospital, Yao, Osaka 581-0069, Japan
| | - Shunji Endo
- Department of Digestive Surgery, Kawasaki Medical School Hospital, Kurashiki, Okayama 701-0192, Japan
| | - Michiya Kobayashi
- Cancer Treatment Center, Kochi Medical School Hospital, Nangoku, Kochi 783-8505, Japan
| | - Junji Kawada
- Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Osaka 558-8558, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Osaka 565-0871, Japan
| | - Akira Tsuburaya
- Department of Surgery, Ozawa Hospital, Odawara, Kanagawa 250-0012, Japan
| | - Takaki Yoshikawa
- Department of Gastric Surgery, National Cancer Center Hospital, Tokyo 104-0045, Japan
| | | | - Taroh Satoh
- Palliative and Supportive Care Center, Osaka University Hospital, Suita, Osaka 565-0871, Japan
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Matsuyama J, Terazawa T, Goto M, Kawabata R, Endo S, Imano M, Fujita S, Akamaru Y, Taniguchi H, Tatsumi M, Lee SW, Kawakami H, Kurokawa Y, Shimokawa T, Sakai D, Kato T, Fujitani K, Satoh T. Three-Year Outcomes of a Phase II Study of Perioperative Capecitabine Plus Oxaliplatin Therapy for Clinical SS/SE N1-3 M0 Gastric Cancer (OGSG 1601). Oncologist 2022; 27:251-e304. [PMID: 35380725 PMCID: PMC8982391 DOI: 10.1093/oncolo/oyab061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 09/17/2021] [Indexed: 12/24/2022] Open
Abstract
Background We previously reported the good feasibility and favorable efficacy of perioperative capecitabine plus oxaliplatin (CapeOx) in patients (pts) with clinical T3(SS)/T4a(SE) N1-3 M0 gastric cancer (GC) in a phase II study in which the pathological response rate, the primary endpoint, of 54.1% was demonstrated. Here, we report 3-year follow-up data. Methods The eligibility criteria included clinical T3(SS)/T4a(SE) N1-3 M0 GC according to the Japanese Classification of Gastric Carcinoma-3rd English Edition (JCGC). Three cycles of neoadjuvant CapeOx (capecitabine, 2000mg/m2 for 14 days; oxaliplatin, 130mg/m2 on day 1, every 3 weeks) were administered, followed by 5 cycles of adjuvant CapeOx after D2 gastrectomy. Three-year overall survival and relapse-free survival are presented here, and analyzed by cohorts based on pathologic response rate (pRR). Results Thirty-seven pts were enrolled from July 2016 to May 2017, and fully evaluated for efficacy and toxicity. Thirty-three pts (89.2%) completed the planned three cycles of neoadjuvant CapeOx and underwent gastrectomy, with an R0 resection rate of 78.4% (n = 29). The overall survival (OS) rate and relapse-free survival (RFS) rate at 3 years was 83.8% (95% CI, 72.7-96.5%) and 73.0% (95% CI, 60.0-88.8%), respectively. Further, the 3-year OS rate in pts with pathological response of grade 1a (n = 13) and grade 1b or higher (n = 20) was 69.2% (95% CI: 48.2-99.5%) and 100.0%, respectively, based on JCGC. Pathological response rate was classified according to JCGC as follows: grade 0, the tumor was not affected; grade 1a, less than one-third of the tumor was affected; grade 1b, one to two thirds of the tumor was affected; grade 2, greater than or equal to two thirds was affected; and grade 3, no residual tumor. A pathological response was defined as grade 1b or greater. Conclusion Perioperative CapeOx showed good feasibility and favorable prognosis, especially in pts with pathological response of grade 1b or higher and was found to be useful in predicting prognosis. The data obtained using this novel approach warrant further investigation (Trial ID: UMIN000021641, jRCTs051180109).
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Affiliation(s)
- Jin Matsuyama
- Department of Gastroenterological Surgery, Higashiosaka City Medical Center, Higashiosaka, Japan
| | - Tetsuji Terazawa
- Department of Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Masahiro Goto
- Department of Cancer Chemotherapy Center, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | | | - Shunji Endo
- Department of Surgery, Yao Municipal Hospital, Yao, Japan
| | - Motohiro Imano
- Department of Surgery, Kindai University School of Medicine, Sayama, Japan
| | | | - Yusuke Akamaru
- Department of Surgery, Ikeda City Hospital, Ikeda, Japan
| | | | | | - Sang-Woong Lee
- Department of General and Gastroenterological Surgery, Osaka Medical and Pharmaceutical University, Takatsuki, Japan
| | - Hisato Kawakami
- Department of Medical Oncology, Kindai University School of Medicine, Sayama, Japan
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Toshio Shimokawa
- Department of Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Daisuke Sakai
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takeshi Kato
- Department of Gastroenterological Surgery, Osaka National Hospital, Osaka, Japan
| | | | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Japan
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27
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Motoori M, Sugimura K, Tanaka K, Shiraishi O, Kimura Y, Miyata H, Yamasaki M, Makino T, Miyazaki Y, Iwama M, Yamashita K, Niikura M, Sugimoto T, Asahara T, Fujitani K, Yasuda T, Doki Y, Yano M. Comparison of Synbiotics Combined with Enteral Nutrition and Prophylactic Antibiotics as Supportive Care in Patients with Esophageal Cancer Undergoing Neoadjuvant Chemotherapy: A Multicenter Randomized Study. Clin Nutr 2022; 41:1112-1121. [DOI: 10.1016/j.clnu.2022.03.023] [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] [Received: 09/24/2021] [Revised: 03/03/2022] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
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Aoyama T, Yoshikawa T, Ida S, Cho H, Sakamaki K, Ito Y, Fujitani K, Takiguchi N, Kawashima Y, Nishikawa K, Nunobe S, Hiki N. Effects of perioperative eicosapentaenoic acid‑enriched oral nutritional supplement on the long‑term oncological outcomes after total gastrectomy for gastric cancer. Oncol Lett 2022; 23:151. [PMID: 35836480 PMCID: PMC9258592 DOI: 10.3892/ol.2022.13272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022] Open
Abstract
Basic and clinical reports have suggested that eicosapentaenoic acid (EPA) exhibits anti-tumor activity. The present study evaluated whether perioperative EPA could improve the survival of patients with localized gastric cancer as a key secondary endpoint of a randomized clinical study. The present study was designed as multicenter, open-label, superiority, randomized trial to confirm the preventive effect of EPA on body weight loss after total gastrectomy for gastric cancer. Eligible patients were randomized to either the standard-diet group (EPA-off group) or EPA-on group by a centralized dynamic method. An EPA-enriched supplement (ProSure®) was given to the EPA-on group in addition to their standard diet. This supplement included 600 kcal with 2.2 g/day of EPA. Among the 126 patients who were randomized, 123 patients (EPA-off group, n=60; EPA-on group, n=63) were examined in the survival analyses. All background factors were well balanced between the two groups. The 3-year and 5-year overall survival rates were 74.6 and 67.8%, respectively, in the EPA-off group, and 77.8 and 76.2% in the EPA-on group. There was no significant difference between the EPA-off and EPA-on groups (hazard ratio, 0.77; P=0.424). In the subgroup analysis, the hazard ratio was 0.39 in patients who received neoadjuvant chemotherapy and 0.57 in patients with nodal metastasis. In conclusion, a clear survival benefit of perioperative EPA was not observed in localized gastric cancer. The value of EPA should be further tested in a future study in patients with unfavorable advanced gastric cancer. Clinical trial number: UMIN000006380; date of registration, September 21, 2011.
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Affiliation(s)
- Toru Aoyama
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Satoshi Ida
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135‑0063, Japan
| | - Haruhiko Cho
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa 241‑8515, Japan
| | - Kentaro Sakamaki
- Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Kanagawa 232‑0024, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center, Nagoya, Aichi 464‑8681, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka General Medical Center, Osaka 558‑8558, Japan
| | - Nobuhiro Takiguchi
- Division of Gastroenterological Surgery, Chiba Cancer Center, Chuo-ku, Chiba 260‑8781, Japan
| | - Yoshiyuki Kawashima
- Department of Gastroenterological Surgery, Saitama Cancer Center, Kitaadachi, Saitama 362‑0806, Japan
| | | | - Soya Nunobe
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135‑0063, Japan
| | - Naoki Hiki
- Department of Gastroenterological Surgery, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo 135‑0063, Japan
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Kawabata R, Fujitani K, Sakamaki K, Ando M, Ito Y, Tanizawa Y, Yamada T, Hirao M, Yamada M, Hihara J, Ryoji, Fukushima, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M, Yoshida K. Survival analysis of a prospective multicenter observational study on surgical palliation among patients with malignant bowel obstruction caused by peritoneal dissemination of gastric cancer. Gastric Cancer 2022; 25:422-429. [PMID: 34550490 DOI: 10.1007/s10120-021-01251-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 07/02/2021] [Accepted: 09/13/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Our previous report showed that surgical palliation maintained quality of life (QOL), improved solid food intake, and had an acceptable surgical safety among patients with malignant bowel obstruction (MBO) caused by advanced gastric cancer. This study performed a survival analysis stratified by the patients' QOL to elucidate its impact on survival. METHODS Patients who underwent resection or bypass of the small intestine/colon or ileostomy/colostomy for bowel obstruction caused by peritoneal dissemination of gastric cancer were included. Validated instruments (EuroQoL-5 Dimensions) were used to assess QOL at baseline and 2 weeks, 1 month, and 3 months following surgical palliation. Postoperative improvement in oral intake was also evaluated using the Gastric Outlet Obstruction Scoring System (GOOSS). Univariate and multivariate survival analyses were performed using baseline characteristics and changes in QOL and GOOSS scores 2 weeks after surgery to determine prognostic factors. RESULTS We enrolled 60 patients with a median survival time of 6.64 (95% CI 4.76-10.28) months. Patients who received postoperative chemotherapy and had lower baseline C-reactive protein (CRP) levels, higher baseline albumin levels, better baseline EuroQoL-5 Dimensions (EQ-5D) scores, and improved oral intake after palliative surgery exhibited significantly better survival. Multivariate analysis identified postoperative chemotherapy, lower baseline CRP levels, and improved oral intake as independent prognostic factors. CONCLUSIONS The current study revealed that baseline QOL and postoperative QOL changes did not affect survival. Moreover, improved oral intake, lower baseline CRP levels, and postoperative chemotherapy were significant prognostic factors in patients who underwent palliative surgery for advanced gastric cancer with MBO.
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Affiliation(s)
- Ryohei Kawabata
- Department of Surgery, Osaka Rosai Hospital, 1179-3, Nagasone-cho, Kita-ku, Sakai-city, , Osaka, 5918025, Japan. .,Department of Surgery, Sakai City Medical Center, Sakai, Japan.
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | - Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Nagaizumi, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | - Fukushima
- Department of Surgery, Teikyo University School of Medicine, Itabashi City, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Gifu University Graduate School of Medicine, Gifu, Japan
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30
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Yokono Y, Komatsu H, Sugimoto T, Hirano M, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Tomokuni A, Fushimi H, Motoori M, Fujitani K, Iwase K. [A Case of Signet-Ring Cell Carcinoma of the Ampulla of Vater in a Young Male]. Gan To Kagaku Ryoho 2022; 49:192-194. [PMID: 35249058] [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: 06/14/2023]
Abstract
A male in his twentieth was referred to our hospital for jaundice. Computed tomography(CT)showed dilation of the intrahepatic and extrahepatic bile ducts and showed a lesion at the ampulla of Vater, which caused obstructive jaundice. Upper gastrointestinal endoscopy revealed a tumor of protruded-predominant type with raised margins at the ampulla of Vater, and biopsy from the lesion indicated malignancy. With no apparent distant metastasis, radical resection was assumed to be possible, thus we performed subtotal stomach preserved pancreatoduodenectomy. Before the operation, endoscopic retrograde biliary drainage(ERBD)was unsuccessful because of the existence of the tumor, so percutaneous transhepatic cholangio drainage(PTCD)was conducted. After the operation, although pancreatic fistula(ISGPF Grade B)occurred, it improved with conservative treatment, and he discharged at 30 postoperative days. Histopathological examination revealed signet-ring cell carcinoma among the tumor at the ampulla of Vater, which was infiltrating into the pancreas. Final diagnosis was pT3, pN0, M0, pStage ⅡA. Now he is alive without recurrence for 3 and a half years.
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Affiliation(s)
- Yoshinori Yokono
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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31
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Matsumoto S, Komatsu H, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Tomokuni A, Fushimi H, Motoori M, Fujitani K, Iwase K. [A Case of Metastatic Liver Tumor from Colon Cancer with Preoperative Diagnosis Obtained by Immunohistochemical Analysis of Cytologic Specimen]. Gan To Kagaku Ryoho 2022; 49:183-185. [PMID: 35249055] [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: 06/14/2023]
Abstract
A woman in her 50s underwent sigmoid colectomy and D3 lymph node dissection for sigmoid cancer(pT3, N0, M0, Stage Ⅱ: Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma 9th). She received adjuvant chemotherapy with capecitabine. Seven months after surgery, contrast-enhanced computed tomography( CECT) scan revealed a small mass in the segment 2 (S2) of the liver with dilation of peripheral intrahepatic bile duct, and the size of this mass and the bile duct dilatation were gradually increased. FDG positron emission tomography(FDG-PET)/CT showed abnormal FDG uptakes in the lesion of S2, and EOB-MRI detected other small lesions in the S6 and S7. Considering the results of image examinations, multiple lesions intrahepatic cholangiocarcinoma was firstly assumed. However, immunohistochemistry of the tumor obtained by endoscopic retrograde cholangiopancreatography (ERCP) showed cytokeratin 7-negative. Based on preoperative diagnosis of liver metastasis from colon cancer rather than intrahepatic cholangiocarcinoma, we performed left lobectomy, partial hepatectomy of S6 and S7 and cholecystectomy. In the resected specimen, the tumor was macroscopically located in the intrahepatic bile ducts. Microscopically, there existed atypical epithelial cells with glandular duct-like structure, and the lesions was histopathologically diagnosed as metastasis from colon cancer. She was discharged on the 10th postoperative day, and she is alive without recurrence one year after surgery.
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Affiliation(s)
- Sayaka Matsumoto
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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32
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Sumimoto S, Inoue A, Kagawa Y, Komori T, Nishizawa Y, Hirano M, Song X, Matsumoto S, Itami T, Nakai S, Yokono Y, Komatsu H, Miyazaki Y, Tomokuni A, Matsuoka K, Motoori M, Iwase K, Fujitani K. Intra-abdominal desmoid-type fibromatosis successfully resected using laparoscopic fluorescence imaging with indocyanine green after intersphincteric resection for rectal cancer. Asian J Endosc Surg 2022; 15:192-196. [PMID: 34302433 DOI: 10.1111/ases.12968] [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: 12/21/2020] [Accepted: 07/05/2021] [Indexed: 11/29/2022]
Abstract
Successful resection of intra-abdominal tumors using indocyanine green (ICG) fluorescence imaging has not been reported. Here, we report a rare case of an intra-abdominal desmoid-type fibromatosis successfully resected using this technique after intersphincteric resection (ISR) for rectal cancer. One year after ISR for rectal cancer in a 47-year-old man, computed tomography showed a 50-mm intra-abdominal tumor near the left common iliac vein. Surgical resection was performed. The tumor was located in the mesentery of the remnant rectum after ISR. ICG fluorescence imaging confirmed the blood supply to the mesentery of the distal remnant rectum after tumor excision. The anal canal was successfully preserved without creating a permanent colostomy. The tumor was safely resected with resection margins, diagnosed as desmoid-type fibromatosis. No tumor recurrence was observed 6 months post-resection. This was the first case report to demonstrate the utility of this technique for an intra-abdominal tumor resection.
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Affiliation(s)
- Satoko Sumimoto
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Akira Inoue
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yoshinori Kagawa
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takamichi Komori
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yujiro Nishizawa
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Masataka Hirano
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Xiuyu Song
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Sayaka Matsumoto
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Takefumi Itami
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Shigeto Nakai
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yoshinori Yokono
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Hisateru Komatsu
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Yasuhiro Miyazaki
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Akira Tomokuni
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Keiko Matsuoka
- Department of Pathology, Osaka General Medical Center, Osaka, Japan
| | - Masaaki Motoori
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazuhiro Iwase
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Gastrointestinal Surgery, Osaka General Medical Center, Osaka, Japan
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Hirano M, Komatsu H, Aomatsu M, Tsuji Y, Takeuchi T, Yokono Y, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Tomokuni A, Fushimi H, Motoori M, Fujitani K, Iwase K. [A Case of Metastasis to the Pancreas from Colorectal Cancer Which Was Difficult to Distinguish from Primary Pancreatic Cancer]. Gan To Kagaku Ryoho 2021; 48:1789-1791. [PMID: 35046331] [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: 06/14/2023]
Abstract
A man in his 50s underwent laparoscopic sigmoid colectomy for sigmoid colon cancer with liver metastasis(cT4aN1M1a, cStage Ⅳa), followed by partial liver resection(S4, S6). One and a half years after the initial surgery, CEA and CA19-9 increased, and contrast-enhanced CT and MRI showed a hypovascular lesion with dilation of the distal pancreatic duct in the pancreatic body. Adenocarcinoma was detected by brushing cytology of the lesion and pancreatic juice cytology by ERCP. From the results of various examinations, the lesion was diagnosed as pancreatic ductal adenocarcinoma. We performed distal pancreatectomy, and initially the histopathological diagnosis was pancreatic body cancer(pT3N1aM0, pStage ⅡB). In a follow-up CT after surgery, a suspected metastatic lymph node was pointed out in the mediastinum, but it was difficult to distinguish between metastasis from colorectal cancer and one from pancreatic cancer. Immunostaining of the tumor tissue and comparative study of the excised specimens of colon and pancreas was performed in order to assume the primary lesion of the lymph node. As a result, both tissues were CK7(-)/CK20(+), and the lesion at first considered to be primary pancreatic cancer was originally the pancreatic metastasis from colon cancer. Bone metastases were also found on FDG-PET/CT around the same time, and then systemic chemotherapy for colorectal cancer was introduced. Four and a half years have passed since the first surgery, and he is still alive and undergoing treatment.
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Affiliation(s)
- Masataka Hirano
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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Aomatsu M, Kagawa Y, Nishizawa Y, Inoue A, Takeuchi T, Tsuji Y, Hirano M, Yokono Y, Komatsu H, Miyazaki Y, Tomokuni A, Fujitani K, Goto M, Iwase K, Motoori M. [Robot Assisted Lower Anterior Resection for Anastomotic Recurrence of Colorectal Cancer-A Case Report]. Gan To Kagaku Ryoho 2021; 48:1798-1800. [PMID: 35046334] [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: 06/14/2023]
Abstract
Patient undergoing R0 resection have the good survival advantage following surgery for recurrent rectal cancer. Robotic surgery for anastomotic local recurrence of rectal cancer has never been reported before. An 80-year-old woman who had undergone high anterior resection for rectal cancer 1 years previously got colonoscopy. It revealed a 10 mm sized, elevated lesion on the anastomotic site, and a biopsy revealed an adenocarcinoma(tub1). Computed tomography and positron emission tomography-computed tomography showed no signs of distant metastasis, and we decided to conduct radical surgery with robot-assisted laparoscope. Robot-assisted laparoscopic lower anterior resection with resection of left hypogastric nerve was carried out. Histological assessment showed that R0 resection was performed. The patient was discharged on postoperative day 8th without postoperative complication. She is alive without recurrence at 1 year after the last operation.
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Kagawa Y, Inoue A, Nishizawa Y, Kawai K, Ohta T, Hata T, Naito A, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Fujitani K, Kato T, Takeda Y, Murata K. [A Long-Survival Case of Lower Rectal Cancer with Unresectable Liver Metastases Treated with FOLFOXIRI plus Bevacizumab(BEV)]. Gan To Kagaku Ryoho 2021; 48:1819-1821. [PMID: 35046341] [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: 06/14/2023]
Abstract
A woman in her 30s visited our hospital complaining primarily of melena. Colonoscopy revealed the presence of a type 1 tumor in 2 cm from anal verge. Contrast-enhanced CT showed an unresectable massive liver metastasis in the left lobe of the liver and another metastasis in the right lobe. The patient received front-line chemotherapy with Leucovorin, fluorouracil, oxaliplatin, and irinotecan(FOLFOXIRI)plus bevacizumab(BEV). A year later, a marked reduction of liver metastases and primary lesions was confirmed by CT scan imaging. A multidisciplinary team recommended resection of the liver metastases followed by laparoscopic intersphincteric resection for primary lesions. However, after 1 year, a recurrence was diagnosed in the liver; hence, FOLFOXIRI plus BEV was reintroduced for volume reduction. The patient underwent a repeat hepatectomy since enough volume reduction was confirmed. One year later, she experienced a re-relapse of the metastasis in the liver. Currently, she is still undergoing chemotherapy following 7 years since the first visit. Long-term survival can be expected following surgical treatment during chemotherapy.
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Takeuchi T, Inoue A, Nishizawa Y, Kagawa Y, Aomatsu M, Tsuji Y, Hirano M, Komatsu H, Tomokuni A, Miyazaki Y, Motoori M, Fushimi H, Iwase K, Gotoh M, Fujitani K. [A Case of Squamous Cell Cancer of the Anus Treated with Chemoradiotherapy]. Gan To Kagaku Ryoho 2021; 48:2133-2135. [PMID: 35045516] [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: 06/14/2023]
Abstract
BACKGROUND In Japan, the standard treatment for squamous cell anal cancer(SCAC)has not been established. Herein, we report a case of SCAC that completely responded to chemoradiotherapy(CRT). CASE A woman in her 80s presented with anal pain and bleeding. Computed tomography revealed bilateral inguinal adenopathy and a tumor in the anal canal. Histopathological examination of endoscopic biopsies showed adenocarcinoma. Thus, she was diagnosed with anal canal adenocarcinoma and lymph node metastases:cT3, cN1a(No. 292), cM0, cStage Ⅲc(Japanese Classification of Colorectal, Appendiceal, and Anal Carcinoma, 9th edition). Owing to her advanced age and refusal of a stoma, CRT(S-1, mitomycin C, and radiotherapy)was administered with the expectation that salvage surgery in the form of rectal amputation would eventually be necessary. The tumor noticeably shrank after CRT. The patient is alive to this date,14 months after the final round of CRT.
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Affiliation(s)
- Takuro Takeuchi
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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Nishizawa Y, Kagawa Y, Inoue A, Aomatsu N, Takeuchi T, Tsuji Y, Hirano M, Nakano Y, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Goto M, Iwase K, Fujitani K. [A Case of Laparoscopic High Anterior Resection for Rectal Cancer with Autosomal Dominant Polycystic Kidney Disease]. Gan To Kagaku Ryoho 2021; 48:1807-1809. [PMID: 35046337] [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: 06/14/2023]
Abstract
The case was a 61-year-old woman. She was diagnosed with autosomal dominant polycystic kidney disease(ADPKD)at the age of 38 and started hemodialysis at the age of 42. She was diagnosed with rectal cancer(RS)at the age of 61. Laparoscopic high anterior resection and D3 lymphadenectomy were carried out. Although the intra-abdominal space was limited by the huge renal cysts, laparoscopic surgery can be safely performed by arranging the port closer to the midline, taking the patient's position sufficiently, and using some useful tips. Laparoscopic surgery for the patient with ADPKD was considered a useful approach.
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Affiliation(s)
- Yujiro Nishizawa
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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38
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Komatsu H, Tomokuni A, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Motoori M, Fujitani K, Iwase K. [A Case of Nonalcoholic Fatty Liver Disease after Pancreatoduodenectomy Which Reduced Tolerability of Chemotherapy for Postoperative Recurrence]. Gan To Kagaku Ryoho 2021; 48:1816-1818. [PMID: 35046340] [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: 06/14/2023]
Abstract
A man in his 60s underwent pancreaticoduodenectomy(PD)for ampullary cancer(pT3, N1, M0, pStage ⅡB). One year after the operation, lymph node recurrence was observed, and gemcitabine/cisplatin regimen was introduced. Once the disease was controlled, but the tolerability of chemotherapy deteriorated due to severe anorexia and general fatigue around the 6th course of the regimen, thus we stopped the chemotherapy. The performance status was remarkably dropped and the oral intake was notably decreased, and subsequently he got hospitalized. Blood examination on admission showed signs of liver failure(Alb 1.9 g/dL, T-Bil 2.0 mg/dL, PT 36.2%, NH3 159μg/dL). CT scan revealed marked deterioration of fatty liver and newly recognized retention of ascites. We diagnosed this clinical state as liver dysfunction caused by aggravation of nonalcoholic fatty liver disease(NAFLD)due to pancreatic exocrine insufficiency after PD. Immediately pancreatic enzyme replacement therapy(pancrelipase)was performed, and liver function gradually improved. He was discharged 17 days after admission. One month after discharge, CT scan showed that the fatty liver was markedly improved and the ascites disappeared. Around the same time, the chemotherapy was able to be resumed with the improvement of general condition.
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Affiliation(s)
- Hisateru Komatsu
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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39
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Inoue A, Kagawa Y, Nishizawa Y, Hirano M, Song X, Nakai K, Sumimoto S, Yokono Y, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Iwase K, Goto M, Fujitani K. [Risk Factors for Recurrence in Patients with Pathological Stage Ⅱ Colorectal Cancer]. Gan To Kagaku Ryoho 2021; 48:1938-1940. [PMID: 35045453] [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: 06/14/2023]
Abstract
BACKGROUND The risk factors for recurrence in patients with pStage Ⅱ colorectal cancer still remains controversial. The aim of this study was to investigate the risk factors for recurrence after surgery in patients with pStage Ⅱ colorectal cancer. METHOD We retrospectively reviewed 311 patients with primary pStage Ⅱ colorectal cancer who underwent radical resection without neoadjuvant therapy at our institute between January 2014 and December 2019. RESULTS Of 311 patients, 32 patients(10.3%)developed recurrences after surgery at a median follow-up of 32.9(0.23-74.2)months. The 3-year and 5-year recurrence-free survival(RFS)rate was 88.4% and 87.6%, respectively. A multivariate analysis for RFS showed that only pT4 (HR: 4.06, 95%CI: 1.60-10.29, p=0.003) was an independent risk factor. CONCLUSION This study revealed that pT4 was an independent risk factor for recurrence after surgery in patients with pStage Ⅱ colorectal cancer.
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Affiliation(s)
- Akira Inoue
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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40
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Tsuji Y, Inoue A, Nishizawa Y, Kagawa Y, Aomatsu M, Takeuchi T, Hirano M, Komatsu H, Miyazaki Y, Tomokuni A, Matsuoka K, Fushimi H, Motoori M, Iwase K, Fujitani K. [A Case of Unresectable Liver Metastasis from Rectal Cancer Treated with Conversion Therapy]. Gan To Kagaku Ryoho 2021; 48:1804-1806. [PMID: 35046336] [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: 06/14/2023]
Abstract
We reported a case of rectal cancer with unresectable liver metastases treated with resection of the primary lesion followed by systemic chemotherapy with curative resection. A woman in her 40s was diagnosed with rectal RS carcinoma and unresectable liver metastasis, mFOLFOX6 plus panitumumab therapy was initiated after laparoscopic high anterior resection of the rectal lesion. After 5 courses of chemotherapy, significant shrinkage of the liver metastatic lesion and increase of the remnant liver volume were observed. Percutaneous transhepatic portal vein embolization( PTPE) was performed with the aim of further preserving remnant liver volume. Since the hepatic reserve was sufficient, the treatment strategy was to perform radical hepatectomy. Extended right hepatic lobectomy, S4 partial resection, and cholecystectomy were performed. The patient didn't relapse at 11 months after hepatectomy.
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Affiliation(s)
- Yoshito Tsuji
- Dept. of Gastrointestinal Surgery, Osaka General Medical Center
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Itami T, Komatsu H, Nishizawa Y, Inoue A, Kagawa Y, Miyazaki Y, Tomokuni A, Fushimi H, Motoori M, Fujitani K, Iwase K. [A Case of Undifferentiated Carcinoma of Gallbladder with Five Year Recurrence-Free Survival after Radical Resection]. Gan To Kagaku Ryoho 2021; 48:2017-2019. [PMID: 35045479] [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: 06/14/2023]
Abstract
A woman in her 60s realized heart palpitations and was pointed out anemia. CT revealed a tumor measuring 7 cm, with internal necrosis, originating from the gallbladder and invading the liver, and diagnosed as gallbladder cancer. There existed no distant metastasis and we performed cholecystectomy with partial resection of segment 4a+5 of the liver and lymph node resection. Histopathological examination revealed highly atypical cells with large nuclei and polynuclear cells and poor cell junctions in the specimen, and the tumor was histologically diagnosed as an undifferentiated carcinoma. Metastases were not detected in dissected lymph nodes, and this case was diagnosed as undifferentiated carcinoma of gallbladder, T3a, N0, M0, Stage ⅢA(JSHBPS 6th). She was discharged at 13 days after the operation with no apparent postoperative complications. Postoperative adjuvant chemotherapy with administration of TS-1 was conducted for half a year. Now over 5 years have passed since the operation, and she is alive without recurrence.
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Affiliation(s)
- Takefumi Itami
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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42
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Aoyama S, Nishizawa Y, Kagawa Y, Inoue A, Kawamura N, Takao T, Hirano M, Nakano Y, Komatsu H, Miyazaki Y, Tomokuni A, Motoori M, Gotoh M, Iwase K, Fujitani K. [Robotic Surgery Can Complete Radical Surgery and Urinary Tract Reconstruction for Locally Advanced Rectal Cancer with Ureteral Invasion-A Case Report]. Gan To Kagaku Ryoho 2021; 48:1535-1537. [PMID: 35046247] [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: 06/14/2023]
Abstract
A 82-year-old man presented with diarrhea and fatigue. He had no past medical or surgical history except chronic renal failure. Locally advanced rectal cancer with invasion to left ureter was detected in computed tomography. Colonoscopy revealed a circular lesion 12 cm from the anal verge. Biopsy showed moderately differentiated adenocarcinoma. There was no sign of distal metastasis and we decided to conduct radical surgery. Robot-assisted laparoscopic lower anterior resection with partial resection of left ureter, and diverting ileostomy were carried out. Besides, urinary tract reconstruction of ureterocystoneostomy using Lich-Gregoir technique was conducted by urologists also with robot assistance. The pathological stage of the disease was pT4b(left ureter)N1bM0, pStage Ⅲc. The resection margin was secured and radical surgery was achieved. The patient was discharged on postoperative day 22nd without postoperative complication. He is alive without recurrence at 6 months after the operation.
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Affiliation(s)
- Shu Aoyama
- Dept. of Gastroenterological Surgery, Osaka General Medical Center
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Fujitani K, Kurokawa Y, Takeno A, Kawabata R, Omori T, Imamura H, Hirao M, Endo S, Kawada J, Moon JH, Kobayashi N, Takahashi T, Yamasaki M, Takiguchi S, Mori M, Eguchi H, Doki Y. ASO Visual Abstract: A Prospective Multicenter Interventional Study of Surgical Resection for Liver Metastasis from Gastric Cancer: R0 Resection Rate and Operative Morbidity and Mortality. Ann Surg Oncol 2021. [PMID: 34725763 DOI: 10.1245/s10434-021-10787-4] [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: 11/18/2022]
Affiliation(s)
- Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | | | - Takeshi Omori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Motohiro Hirao
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Shunji Endo
- Department of Surgery, Higashi-Osaka Medical Center, Higashi-Osaka, Japan
| | - Junji Kawada
- Department of Surgery, Kaizuka Municipal Hospital, Kaizuka, Japan
| | - Jeong Ho Moon
- Department of Surgery, Osaka 2nd Police Hospital, Osaka, Japan
| | - Noboru Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Mori
- Department of Surgery and Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Imamura H, Matsuyama J, Nishikawa K, Endo S, Kawase T, Kimura Y, Fukui J, Kawada J, Kurokawa Y, Fujitani K, Sakai D, Kawakami H, Tsujinaka T, Shimokawa T, Matsubara Y, Satoh T, Furukawa H. Effects of an oral elemental nutritional supplement in gastric cancer patients with adjuvant S-1 chemotherapy after gastrectomy: A multicenter, open-label, single-arm, prospective phase II study (OGSG1108). Ann Gastroenterol Surg 2021; 5:776-784. [PMID: 34755009 PMCID: PMC8560593 DOI: 10.1002/ags3.12487] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 12/23/2022] Open
Abstract
AIM Post-surgical weight loss influences chemotherapy compliance and may be a risk factor for survival. Intake of an oral elemental nutritional supplement (OENS) can reduce weight loss after gastric cancer (GC) surgery. We assessed whether therapy completion levels would increase in patients receiving postoperative adjuvant chemotherapy in combination with an OENS. METHODS This was a multicenter, open-label, single-arm, phase II study in GC patients who underwent curative total or distal gastrectomy (TG/DG) and received adjuvant S-1 chemotherapy. The primary endpoint was the S-1 completion rate for 1 year with a relative performance (RP) value of ≥70%; secondary endpoints included factors affecting the completion rate of S-1, RP value after eight S-1 courses, S-1 and OENS persistence rates, nutritional index, OENS compliance, and safety. RESULTS In 71 efficacy-evaluable patients, the S-1 completion rate was 69.0% (TG, 68.0%; DG, 69.6%) and the RP value was 87.5 (TG, 89.1; DG, 87.5). Over eight treatment courses, median persistence rates were 89.0% for S-1 and 93.8% for the OENS. The mean OENS compliance was 81.8% at the fourth S-1 course and 52.9% at the eighth course. The incidence of Grade 3 or 4 adverse events was 27.2%, most commonly neutropenia (12.3%). CONCLUSIONS The completion rate of S-1 for 1 year in patients who could take the OENS exceeded the pre-defined threshold level. Randomized controlled trials are warranted to confirm the role of OENS in adjuvant chemotherapy.
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Affiliation(s)
- Hiroshi Imamura
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Jin Matsuyama
- Department of Gastroenterological SurgeryHigashiosaka City Medical CenterHigashiosakaJapan
| | - Kazuhiro Nishikawa
- Department of SurgeryNational Hospital Organization Osaka National HospitalOsakaJapan
| | - Shunji Endo
- Department of Digestive SurgeryKawasaki Medical SchoolOkayamaJapan
| | - Tomono Kawase
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Yutaka Kimura
- Department of SurgeryKindai University Faculty of MedicineOsaka‐SayamaJapan
| | | | - Junji Kawada
- Department of SurgeryOsaka general medical centerOsakaJapan
| | - Yukinori Kurokawa
- Department of Gastroenterological SurgeryOsaka University Graduate School of MedicineSuitaJapan
| | | | - Daisuke Sakai
- Department of Frontier Science for Cancer and ChemotherapyOsaka University Graduate School of MedicineSuitaJapan
| | - Hisato Kawakami
- Department of Medical OncologyKindai University Faculty of MedicineOsaka‐SayamaJapan
| | | | - Toshio Shimokawa
- Clinical Study Support CenterWakayama Medical University HospitalWakayamaJapan
| | | | - Taroh Satoh
- Department of Frontier Science for Cancer and ChemotherapyOsaka University Graduate School of MedicineSuitaJapan
| | - Hiroshi Furukawa
- Department of SurgeryKindai University Faculty of MedicineOsaka‐SayamaJapan
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Shiraishi O, Makino T, Yamasaki M, Tanaka K, Yamashita K, Ishida T, Sugimura K, Miyata H, Motoori M, Fujitani K, Takeno A, Hirao M, Kimura Y, Satoh T, Yano M, Doki Y, Yasuda T. Two versus three courses of preoperative cisplatin and fluorouracil plus docetaxel for treating locally advanced esophageal cancer: short-term outcomes of a multicenter randomized phase II trial. Esophagus 2021; 18:825-834. [PMID: 33738656 DOI: 10.1007/s10388-021-00831-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 12/14/2020] [Accepted: 03/12/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To compare short-term outcomes between two- vs. three courses of neoadjuvant chemotherapy (NAC) to clarify the optimal treatment for esophageal squamous cell cancer (ESCC) in a multicenter, randomized, phase II trial. BACKGROUND An optimal number of NAC cycles remains to be established for locally advanced ESCC. METHODS Patients with locally advanced ESCC were randomly assigned to either two (N = 91) or three (N = 89) courses of DCF (70 mg/m2 intravenous docetaxel and 70 mg/m2 intravenous cisplatin on day 1, and a continuous 700 mg/m2 fluorouracil infusion for 5 days) every 3 weeks followed by surgery. We compared the two groups for perioperative parameters, adverse events, and the response to NAC. RESULTS The two- and three-course groups showed similar completion rates and overall NAC dose reductions. Although the two-course group showed significantly lower overall grades 3-4 leukopenia and anemia compared to the three-course group, the two groups had similar overall toxicity rates. Postoperative complications were not significantly different between the two groups, except arrhythmia (13 vs. 0%, P = 0.0007). Only two postoperative in-hospital deaths occurred in the three-course group, due to sepsis following severe pneumonia. Compared to the two-course group, the three-course group was associated with a significantly better clinical response (42.9 vs. 65.2%, P = 0.0027) and a relatively higher rate of pathological complete response (9.1 vs. 15.3%, P = 0.212). CONCLUSION Both two- and three-course DCF regimens in the NAC setting seemed to be equally feasible in locally advanced ESCC patients. Additional DCF courses led to a better NAC response without increasing the incidence of adverse events or postoperative morbidity. CLINICAL TRIAL REGISTRATION University Hospital Medical Information Network Clinical Trials Registry of Japan (Identification Number UMIN 000015788).
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Affiliation(s)
- Osamu Shiraishi
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Tomoki Makino
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Koji Tanaka
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Kotaro Yamashita
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tomo Ishida
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Keijiro Sugimura
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Hiroshi Miyata
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Masaaki Motoori
- Department of Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Chuo Ward, Osaka, Japan
| | - Yutaka Kimura
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka-Sayama, Osaka, Japan
| | - Taroh Satoh
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masahiko Yano
- Department of Digestive Surgery, Osaka International Cancer Institute, Osaka, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka University, 2-2-E2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Takushi Yasuda
- Faculty of Medicine, Department of Surgery, Kindai University, Osaka-Sayama, Osaka, Japan
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Aoyama S, Motoori M, Miyazaki Y, Sugimoto T, Nishizawa Y, Komatsu H, Inoue A, Kagawa Y, Tomokuni A, Iwase K, Fujitani K. Successful treatment of remnant gastric cancer with afferent loop syndrome managed by percutaneous transhepatic cholangial drainage followed by elective gastrectomy: a case report. Surg Case Rep 2021; 7:219. [PMID: 34585307 PMCID: PMC8478987 DOI: 10.1186/s40792-021-01304-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 09/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background There are only few reported cases of remnant gastric cancer with concomitant afferent loop syndrome. Emergency surgery is the standard treatment strategy for this disease. However, some afferent loop syndrome cases, especially those with complete obstruction, can lead to a septic state, which makes performing emergency surgery risky. We describe a case of remnant gastric cancer with complete afferent loop obstruction, which was successfully managed by radical surgery following percutaneous transhepatic cholangial drainage of the afferent loop. Case presentation A 71-year-old man presented with nausea and abdominal discomfort. When he was 27 years old, he had undergone distal gastrectomy for a benign gastric ulcer, with gastrojejunostomy (Billroth II reconstruction). Abdominal computed tomography revealed thickening of the anastomosis site and significant dilation of the afferent loop. Gastrointestinal fiberscopy revealed advanced remnant gastric cancer at the anastomosis site, and the stoma of the afferent loop was completely obstructed. We diagnosed the patient with remnant gastric cancer with afferent loop syndrome. Percutaneous transhepatic cholangial drainage was performed twice before surgery to decompress the afferent loop. This provided more time for the patient to recover. Radical surgery of total remnant gastrectomy and Roux-en-Y reconstruction were performed electively. There were no severe postoperative complications. The patient died 8 months following the operation owing to peritoneal dissemination recurrence. Conclusion We encountered a case of remnant gastric cancer with afferent loop obstruction, which was successfully managed by radical surgery following decompression of the afferent loop by percutaneous transhepatic cholangial drainage. Percutaneous transhepatic cholangial drainage effectively managed the afferent loop syndrome, resulting in the safe performance of elective surgery.
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Affiliation(s)
- Shu Aoyama
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, Japan
| | - Masaaki Motoori
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan.
| | - Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Tomoki Sugimoto
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan.,Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita-shi, Osaka, Japan
| | - Yujiro Nishizawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Hisateru Komatsu
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Akira Inoue
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Yoshinori Kagawa
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Akira Tomokuni
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Kazuhiro Iwase
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
| | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56 Bandaihigashi Sumiyoshi-Ku, Osaka, Japan
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Fujitani K, Kurokawa Y, Takeno A, Kawabata R, Omori T, Imamura H, Hirao M, Endo S, Kawada J, Moon JH, Kobayashi N, Takahashi T, Yamasaki M, Takiguchi S, Mori M, Eguchi H, Doki Y. Prospective Multicenter Interventional Study of Surgical Resection for Liver Metastasis from Gastric Cancer: R0 Resection Rate, and Operative Morbidity and Mortality. Ann Surg Oncol 2021; 29:924-932. [PMID: 34480277 DOI: 10.1245/s10434-021-10750-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 08/11/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND The optimal treatment for liver metastasis from gastric cancer (LMGC) remains uncertain. The relevance of surgical resection is controversial. We conducted a prospective multicenter interventional study of surgical resection for LMGC. PATIENTS AND METHODS Patients with synchronous or metachronous LMGC who were surgically fit were registered. The primary endpoint was 3-year overall survival (OS) of patients who underwent R0 resection. Secondary endpoints were R0 resection rate, operative morbidity and mortality, 3-year recurrence-free survival (RFS) of R0 patients, and OS in all registered patients. RESULTS Seventy patients were registered from 24 institutions between December 2011 and November 2019 and received preoperative chemotherapy. Three patients were ineligible, and 19 patients discontinued treatment, with disease progression in 12, adverse events in 4, and consent withdrawal in 3 before surgery. Of the 48 patients eventually undergoing surgery, R0 resection of the primary and/or metastatic GC was accomplished in 43 patients, while 1 patient discontinued treatment for positive peritoneal lavage cytology and 4 patients were considered ineligible based on postoperative pathological findings other than GC. The R0 resection rate of all eligible patients was 68.3% [95% confidence interval (CI) 55.3-79.4%, 43/63 patients], while that of all resected patients was 89.6% (95% CI 77.3-96.5%, 43/48 patients). Postoperative complications were identified in 12 out of 43 patients (27.9%), and Clavien-Dindo grade III or higher complications occurred in seven patients (16.3%). No hospital mortality was observed. CONCLUSIONS R0 resection for LMGC could be performed in approximately two-thirds of all eligible patients, with acceptable surgical morbidity and mortality.
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Affiliation(s)
- Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, Osaka, Japan.
| | - Yukinori Kurokawa
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Japan
| | | | - Takeshi Omori
- Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Hiroshi Imamura
- Department of Surgery, Toyonaka Municipal Hospital, Toyonaka, Japan
| | - Motohiro Hirao
- Department of Surgery, Osaka National Hospital, Osaka, Japan
| | - Shunji Endo
- Department of Surgery, Higashi-Osaka Medical Center, Higashi-Osaka, Japan
| | - Junji Kawada
- Department of Surgery, Kaizuka Municipal Hospital, Kaizuka, Japan
| | - Jeong Ho Moon
- Department of Surgery, Osaka 2nd Police Hospital, Osaka, Japan
| | - Noboru Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Makoto Yamasaki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Shuji Takiguchi
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Masaki Mori
- Department of Surgery and Science, Kyushu University Graduate School of Medicine, Fukuoka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
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Miyazaki Y, Omori T, Fujitani K, Fujita J, Kawabata R, Imamura H, Okada K, Moon JH, Hirao M, Matsuyama J, Saito T, Takahashi T, Kurokawa Y, Yamasaki M, Takiguchi S, Mori M, Doki Y. Oral nutritional supplements versus a regular diet alone for body weight loss after gastrectomy: a phase 3, multicenter, open-label randomized controlled trial. Gastric Cancer 2021; 24:1150-1159. [PMID: 33835329 DOI: 10.1007/s10120-021-01188-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [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: 12/17/2020] [Accepted: 03/29/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Body weight loss (BWL) after gastrectomy is associated with not only a deteriorated quality of life but also a poor prognosis. Oral nutritional supplements (ONS) may be used to minimize BWL, which is observed in the first 3 months after gastrectomy and becomes stable thereafter, although the results of several randomized trials remain controversial. METHODS We performed a multicenter, open-label randomized controlled trial including 1003 gastric cancer patients undergoing curative gastrectomy. Patients were assigned to the ONS group or the control group. In the former, 400 ml (400 kcal) per day for 12 weeks as enteral nutrition was planned, and the actual intake amount was recorded daily by patients themselves. The primary endpoint was BWL 1 year after gastrectomy. RESULTS BWL data were available in 880 patients (ONS 437, control 443). BWL at 3 months was significantly lower in the ONS group than in the control group (7.1 ± 5.6% and 8.5 ± 5.8%, p = 0.0011). However, the difference gradually declined after 6 months and was not significant 1 year after surgery (9.3 ± 8.2% and 9.8 ± 8.7%, p = 0.37). In the ONS group, 50.4% of patients took more than 200 ml/day of ONS (average 301 ml) and showed significantly less BWL (8.2 ± 7.2%) at 1 year than the control (p = 0.0204). CONCLUSION The administration of ONS for 12 weeks after gastrectomy did not improve BWL at 1 year. However, the improvement in BWL remained until 1 year after surgery in patients who took more than 200 kcal/day of ONS.
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Affiliation(s)
- Yasuhiro Miyazaki
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56, Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | | | - Kazumasa Fujitani
- Department of Gastroenterological Surgery, Osaka General Medical Center, 3-1-56, Bandaihigashi Sumiyoshi-ku, Osaka, 558-8558, Japan
| | | | | | | | - Kazuyuki Okada
- Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | | | - Motohiro Hirao
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Takuro Saito
- Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | | | - Shuji Takiguchi
- Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Masaki Mori
- Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichiro Doki
- Osaka University Graduate School of Medicine, Osaka, Japan
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Ito Y, Fujitani K, Sakamaki K, Ando M, Kawabata R, Tanizawa Y, Yoshikawa T, Yamada T, Hirao M, Yamada M, Hihara J, Fukushima R, Choda Y, Kodera Y, Teshima S, Shinohara H, Kondo M. QOL assessment after palliative surgery for malignant bowel obstruction caused by peritoneal dissemination of gastric cancer: a prospective multicenter observational study. Gastric Cancer 2021; 24:1131-1139. [PMID: 33791885 DOI: 10.1007/s10120-021-01179-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 11/03/2020] [Accepted: 03/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patients with peritoneal dissemination of gastric cancer have poor oral intake caused by malignant bowel obstruction (MBO). Palliative surgery has often been undertaken to improve quality of life (QOL), but few prospective studies on palliative surgery in this patient population have been published. PATIENTS AND METHODS We prospectively investigated the significance of palliative surgery using patient-reported QOL measures. Patients underwent palliative surgery by small intestine/colon resection or small intestine/colon bypass or ileostomy/colostomy for MBO. The primary endpoint was change in QOL assessed at baseline, 14 days, 1 month, and 3 months following palliative surgery using the Euro QoL Five Dimensions (EQ-5D™) questionnaire and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire gastric cancer module (QLQ-STO22). Secondary endpoints were postoperative improvement in oral intake and surgical complications. RESULTS Between April 2013 and March 2018, 63 patients were enrolled from 14 institutions. The mean EQ-5D™ utility index baseline score of 0.6 remained consistent. Gastric-specific symptoms mostly showed statistically significant improvement from baseline. Forty-two patients (67%) were able to eat solid food 2 weeks after palliative surgery and 36 patients (57%) tolerated it for 3 months. The rate of overall morbidity of ≥ grade III according to the Clavien-Dindo classification was 16% (10 patients) and the 30-day postoperative mortality rate was 3.2% (2 patients). CONCLUSIONS In patients with MBO caused by peritoneal dissemination of gastric cancer, palliative surgery did not improve QOL while improving solid food intake, with an acceptable postoperative morbidity and mortality rate.
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Affiliation(s)
- Yuichi Ito
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, 1-1, Kanokoden, Chikusa-ku, Nagoya, Aichi, 464-8681, Japan.
| | - Kazumasa Fujitani
- Department of Surgery, Osaka Prefectural General Medical Center, Osaka, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Yokohama, Japan
| | - Masahiko Ando
- Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Nagoya, Japan
| | | | - Yutaka Tanizawa
- Division of Gastric Surgery, Shizuoka Cancer Center, Shizuoka, Japan
| | - Takaki Yoshikawa
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Takanobu Yamada
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Motohiro Hirao
- Department of Surgery, National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Makoto Yamada
- Department of Surgery, Gifu Municipal Hospital, Gifu, Japan
| | - Jun Hihara
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Ryoji Fukushima
- Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
| | - Yasuhiro Choda
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shin Teshima
- Department of Surgery, National Hospital Organization Sendai Medical Center, Sendai, Japan
| | - Hisashi Shinohara
- Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Masato Kondo
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
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Shitara K, Baba E, Fujitani K, Oki E, Fujii S, Yamaguchi K. Discovery and development of trastuzumab deruxtecan and safety management for patients with HER2-positive gastric cancer. Gastric Cancer 2021; 24:780-789. [PMID: 33997928 PMCID: PMC8205906 DOI: 10.1007/s10120-021-01196-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 04/29/2021] [Indexed: 02/07/2023]
Abstract
Approximately 12-15% of gastric cancers (GCs) are human epidermal growth factor receptor-2 (HER2)-positive (HER2 immunohistochemistry 3 + or 2 + /in situ hybridization + [ERBB2/CEP17 ≥ 2.0]). While the anti-HER2 monoclonal antibody trastuzumab, in combination with chemotherapy, is the standard treatment for HER2-positive GC, other HER2-targeted therapies have not demonstrated survival benefits in patients with GC, despite showing efficacy in patients with HER2-positive breast cancer. This indicates that there are unique challenges to the use of currently available HER2-targeted therapies for the treatment of HER2-positive GC. Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate consisting of an anti-HER2 human monoclonal IgG1 antibody with the same amino acid sequence as trastuzumab, an enzymatically cleavable peptide-based linker, and DXd, a novel topoisomerase I inhibitor, as its released payload. T-DXd has a high drug-antibody ratio (approximately 8) and a demonstrated bystander antitumor effect. It has demonstrated significant efficacy when compared with standard therapies and is approved as third- or later-line treatment for HER2-positive GC in Japan and second- or later-line treatment in the US. T-DXd treatment is associated with gastrointestinal and hematological adverse events, and a risk of interstitial lung disease (ILD), with the ILD risk being higher in Japan than in countries other than Japan. However, most adverse events, including ILD, can be managed with proactive monitoring and T-DXd dose modification, and initiation of adequate treatment. In this review, we summarize the discovery and development of T-DXd and provide guidance for T-DXd safety management, including ILD monitoring, for patients with HER2-positive GC.
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Affiliation(s)
- Kohei Shitara
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba, 277-8577, Japan.
| | - Eishi Baba
- Department of Oncology and Social Medicine, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Kazumasa Fujitani
- Department of Surgery, Osaka Prefectural General Medical Centre, 3-1-56 Bandaihigashi, Sumiyoshi-ku, Osaka, 558-8558, Japan
| | - Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Fujii
- Department of Molecular Pathology, Yokohama City University Graduate School of Medicine, 3-9 Fukuura, Kanazawa-ku, Yokohama, 236-0004, Japan
| | - Kensei Yamaguchi
- Department of Gastroenterological Chemotherapy, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, Japan
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