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Hijioka S, Yamashige D, Esaki M, Honda G, Higuchi R, Masui T, Shimizu Y, Ohtsuka M, Kumamoto Y, Katanuma A, Gotohda N, Akita H, Unno M, Endo I, Yokoyama Y, Yamada S, Matsumoto I, Ohtsuka T, Hirano S, Yasuda H, Kawai M, Aoki T, Nakamura M, Hashimoto D, Rikiyama T, Horiguchi A, Fujii T, Mizuno S, Hanada K, Tani M, Hatori T, Ito T, Okuno M, Kagawa S, Tajima H, Ishii T, Sugimoto M, Onoe S, Takami H, Takada R, Miura T, Kurita Y, Kamei K, Mataki Y, Okazaki K, Takeyama Y, Yamaue H, Satoi S. Factors affecting nonfunctioning small pancreatic neuroendocrine neoplasms and proposed new treatment strategies. Clin Gastroenterol Hepatol 2024:S1542-3565(24)00351-3. [PMID: 38615727 DOI: 10.1016/j.cgh.2024.03.029] [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: 11/10/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND & AIMS Despite previously reported treatment strategies for nonfunctioning small (≤20 mm) pancreatic neuroendocrine neoplasms (pNENs), uncertainties persist. We aimed to evaluate the surgically resected cases nonfunctioning small pNENs (NF-spNENs) in a large Japanese cohort to elucidate an optimal treatment strategy for NF-spNENs. METHODS In this Japanese multicenter study, data were retrospectively collected from patients who underwent pancreatectomy between January 1996 and December 2019, were pathologically diagnosed with pNEN, and were treated according to the WHO 2019 classification. Overall, 1,490 patients met the eligibility criteria, and 1,014 were included in the analysis cohort. RESULTS In the analysis cohort, 606 patients (59.8%) had NF-spNENs, with 82% classified as grade 1 (NET-G1) and 18% as grade 2 (NET-G2) or higher. The incidence of lymph node metastasis (N1) by grade was significantly higher in NET-G2 (G1: 3.1% vs. G2: 15.0%). Independent factors contributing to N1 were NET-G2 or higher and tumor diameter ≥15 mm. The predictive ability of tumor size for N1 was high. Independent factors contributing to recurrence included multiple lesions, NET-G2 or higher, tumor diameter ≥15 mm, and N1. However, the independent factor contributing to survival was tumor grade (NET-G2 or higher). The appropriate timing for surgical resection of NET-G1 and NET-G2 or higher was when tumors were >20 and >10 mm, respectively. For neoplasms with unknown preoperative grades, tumor size >15 mm was considered appropriate. CONCLUSIONS NF-spNENs are heterogeneous with varying levels of malignancy. Therefore, treatment strategies based on tumor size alone can be unreliable; personalized treatment strategies that consider tumor grading are preferable.
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Affiliation(s)
- Susumu Hijioka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan.
| | - Daiki Yamashige
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Minoru Esaki
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Ryota Higuchi
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Toshihiko Masui
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuhiro Shimizu
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Yusuke Kumamoto
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Akio Katanuma
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Hirofumi Akita
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Itaru Endo
- Department of Gastroenterological Surgery, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Yukihiro Yokoyama
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Suguru Yamada
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Takao Ohtsuka
- Department of Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Satoshi Hirano
- Department of Gastroenterological Surgery II, Faculty of Medicine, Hokkaido University, Sapporo, Japan
| | - Hiroaki Yasuda
- Department of Molecular Gastroenterology and Hepatology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Manabu Kawai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Taku Aoki
- Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University School of Medicine Bantane Hospital, Nagoya, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Shugo Mizuno
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University, Mie, Japan
| | - Keiji Hanada
- Department of Gastroenterology, Onomichi General Hospital, Onomichi, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Otsu, Japan
| | - Takashi Hatori
- Digestive Diseases Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tetsuhide Ito
- Neuroendocrine Tumor Center, Fukuoka Sanno Hospital, International University of Health and Welfare, Fukuoka, Japan
| | - Masataka Okuno
- Department of Gastroenterological Surgery, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Shingo Kagawa
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Hiroshi Tajima
- Department of General-Pediatric-Hepatobiliary Pancreatic Surgery, Kitasato University School of Medicine, Sagamihara, Japan
| | - Tatsuya Ishii
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Hokkaido, Japan
| | - Motokazu Sugimoto
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shunsuke Onoe
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hideki Takami
- Department of Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Ryoji Takada
- Department of Hepatobiliary and Pancreatic Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Takayuki Miura
- Department of Surgery, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Yusuke Kurita
- Department of Gastroenterology and Hepatology, Yokohama City University Graduate School of Medicine, Kanagawa, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Yuko Mataki
- Department of Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, Kagoshima, Japan
| | - Kazuichi Okazaki
- Department of Internal Medicine, Kansai Medical University Kori Hospital, Osaka, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Hirakata, Japan
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Imamura S, Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Yoshida Y, Taketomo Y, Yoshida S, Takeyama Y, Noso S, Maeda N, Ikegami H. High Incidence of Diabetes Mellitus After Distal Pancreatectomy and Its Predictors: A Long-term Follow-up Study. J Clin Endocrinol Metab 2024; 109:619-630. [PMID: 37889837 PMCID: PMC10876401 DOI: 10.1210/clinem/dgad634] [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: 07/28/2023] [Revised: 10/18/2023] [Accepted: 10/25/2023] [Indexed: 10/29/2023]
Abstract
CONTEXT Glucose tolerance worsens after distal pancreatectomy (DP); however, the long-term incidence and factors affecting interindividual variation in this worsening are unclear. OBJECTIVE To investigate the changes in diabetes-related traits before and after DP and to clarify the incidence of diabetes and its predictors. METHODS Among 493 registered patients, 117 underwent DP. Among these, 56 patients without diabetes before surgery were included in the study. Glucose and endocrine function were prospectively assessed using a 75-g oral glucose tolerance test preoperatively, 1 month after DP, and every 6 months thereafter for up to 36 months. Pancreatic volumetry was performed using multidetector row computed tomography before and after surgery. RESULTS Insulin secretion decreased and blood glucose levels worsened after DP. Residual pancreatic volume was significantly associated with the reserve capacity of insulin secretion but not with blood glucose levels or the development of diabetes. Among 56 patients, 33 developed diabetes mellitus. The cumulative incidence of diabetes at 36 months after DP was 74.1%. Multivariate Cox regression analysis showed that impaired glucose tolerance as a preoperative factor as well as a decreased insulinogenic index and impaired glucose tolerance at 1 month postoperatively were identified as risk factors for diabetes following DP. CONCLUSION Impaired glucose tolerance and reduced early-phase insulin response to glucose are involved in the development of new-onset diabetes after DP; the latter is an additional factor in the development of diabetes and becomes apparent when pancreatic beta cell mass is reduced after DP.
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Affiliation(s)
- Shuzo Imamura
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Fumimaru Niwano
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yuta Yoshida
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Sawa Yoshida
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Norikazu Maeda
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
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Ikenaga N, Hashimoto T, Mizusawa J, Kitabayashi R, Sano Y, Fukuda H, Nakata K, Shibuya K, Kitahata Y, Takada M, Kamei K, Kurahara H, Ban D, Kobayashi S, Nagano H, Imamura H, Unno M, Takahashi A, Yagi S, Wada H, Shirakawa H, Yamamoto N, Hirono S, Gotohda N, Hatano E, Nakamura M, Ueno M. A multi-institutional randomized phase III study comparing minimally invasive distal pancreatectomy versus open distal pancreatectomy for pancreatic cancer; Japan Clinical Oncology Group study JCOG2202 (LAPAN study). BMC Cancer 2024; 24:231. [PMID: 38373949 PMCID: PMC10875854 DOI: 10.1186/s12885-024-11957-9] [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] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 02/05/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Minimally invasive distal pancreatectomy (MIDP), including laparoscopic and robotic distal pancreatectomy, has gained widespread acceptance over the last decade owing to its favorable short-term outcomes. However, evidence regarding its oncologic safety is insufficient. In March 2023, a randomized phase III study was launched in Japan to confirm the non-inferiority of overall survival in patients with resectable pancreatic cancer undergoing MIDP compared with that of patients undergoing open distal pancreatectomy (ODP). METHODS This is a multi-institutional, randomized, phase III study. A total of 370 patients will be enrolled from 40 institutions within 4 years. The primary endpoint of this study is overall survival, and the secondary endpoints include relapse-free survival, proportion of patients undergoing radical resection, proportion of patients undergoing complete laparoscopic surgery, incidence of adverse surgical events, and length of postoperative hospital stay. Only a credentialed surgeon is eligible to perform both ODP and MIDP. All ODP and MIDP procedures will undergo centralized review using intraoperative photographs. The non-inferiority of MIDP to ODP in terms of overall survival will be statistically analyzed. Only if non-inferiority is confirmed will the analysis assess the superiority of MIDP over ODP. DISCUSSION If our study demonstrates the non-inferiority of MIDP in terms of overall survival, it would validate its short-term advantages and establish its long-term clinical efficacy. TRIAL REGISTRATION This trial is registered with the Japan Registry of Clinical Trials as jRCT 1,031,220,705 [ https://jrct.niph.go.jp/en-latest-detail/jRCT1031220705 ].
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Affiliation(s)
- Naoki Ikenaga
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan
| | - Tadayoshi Hashimoto
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
- Department of Gastroenterology and Gastrointestinal Oncology, National Cancer Center Hospital East, Kashiwa, Japan
- Translational Research Support Office, National Cancer Center Hospital East, Kashiwa, Japan
| | - Junki Mizusawa
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Ryo Kitabayashi
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Yusuke Sano
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Haruhiko Fukuda
- Japan Clinical Oncology Group Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Kohei Nakata
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Yuji Kitahata
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - Minoru Takada
- Department of Surgery, Teine Keijinkai Hospital, Hokkaido, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Hiroshi Kurahara
- Department of Digestive Surgery, Kagoshima University, Kagoshima, Japan
| | - Daisuke Ban
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Hajime Imamura
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Amane Takahashi
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Shintaro Yagi
- Department of Hepato-Biliary-Pancreatic Surgery and Transplantation, Kanazawa University, Ishikawa, Japan
| | - Hiroshi Wada
- Department of Gastroenterological Surgery, Osaka International Cancer Institute, Osaka, Japan
| | - Hirofumi Shirakawa
- Department of HepatoBiliary-Pancreatic Surgery, Tochigi Cancer Center, Tochigi, Japan
| | - Naoto Yamamoto
- Department of Gastrointestinal Surgery, Kanagawa Cancer Center, Kanagawa, Japan
| | - Seiko Hirono
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Gastroenterological Surgery, Hyogo Medical University, Hyogo, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, 812-8582, Fukuoka, Japan.
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan
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Satoi S, Kimura Y, Shimizu R, Matsumoto M, Kawaguchi K, Yoshida Y, Murase T, Kamei K, Matsumoto I, Nakai T, Takeyama Y. Gastrectomy reduces pancreatic secretory function via pancreatic atrophy. Surg Today 2023; 53:1372-1379. [PMID: 37084095 PMCID: PMC10678800 DOI: 10.1007/s00595-023-02685-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 12/20/2022] [Accepted: 04/02/2023] [Indexed: 04/22/2023]
Abstract
PURPOSE Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. METHODS The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. RESULTS After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). CONCLUSIONS The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.
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Affiliation(s)
- Shumpei Satoi
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Yutaka Kimura
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Rie Shimizu
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masataka Matsumoto
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Kohei Kawaguchi
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yuta Yoshida
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takaaki Murase
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Keiko Kamei
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Ippei Matsumoto
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Faculty of Medicine, Department of Surgery, Kindai University, 377-2, Ohno-Higashi, Osaka-Sayama, Osaka, 589-8511, Japan
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Nakamura I, Hatano E, Baba H, Kamei K, Wada H, Shimizu J, Kanai M, Yoshimura K, Nagano H, Ioka T. Impact of conversion surgery after chemotherapy in patients with initially unresectable and recurrent biliary tract cancer. Ann Gastroenterol Surg 2023; 7:1009-1020. [PMID: 37927929 PMCID: PMC10623972 DOI: 10.1002/ags3.12713] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/19/2023] [Accepted: 06/27/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Gemcitabine, cisplatin, and S-1 chemotherapy was superior to gemcitabine and cisplatin chemotherapy for progression-free survival and overall survival for unresectable and recurrent biliary tract cancer in a randomized phase III trial (KHBO1401). This study aimed to evaluate the outcome of conversion surgery after chemotherapy in biliary tract cancer patients (ancillary study, KHBO1401-3C). Methods A total of 246 patients were enrolled in KHBO1401. We compared progression-free and overall survivals between the conversion surgery and non-conversion surgery groups. Results Eight patients (3.3%) underwent conversion surgery with chemotherapy, seven of whom were diagnosed with unresectable disease and one with recurrence. Six and two patients received gemcitabine, cisplatin, and S-1 chemotherapy as well as gemcitabine and cisplatin chemotherapy, respectively. Three patients in the conversion surgery group who received gemcitabine, cisplatin, and S-1 chemotherapy showed no disease progression and survived without postoperative chemotherapy. Preoperative carbohydrate antigen 19-9 (CA19-9) level was a prognostic factor for conversion surgery. After correcting for immortal time bias, 1-year progression-free survival rates in the conversion surgery and non-conversion surgery groups were 50.0% and 19.0%, respectively (hazard ratio 0.343, 95% confidence interval 0.286-0.843, p = 0.0092). One-year overall survival rates in the conversion surgery and non-conversion surgery groups were 87.5% and 56.0%, respectively (hazard ratio 0.222, 95% confidence interval 0.226-0.877, p = 0.0197). Conclusions Conversion surgery might be an option for the treatment of unresectable and recurrent biliary tract cancer in patients with normal preoperative CA19-9 level.
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Affiliation(s)
- Ikuo Nakamura
- Department of Gastroenterological SurgeryHyogo Medical UniversityHyogoJapan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical ScienceKumamoto UniversityKumamotoJapan
| | - Keiko Kamei
- Department of SurgeryKindai University Faculty of MedicineOsakasayamaJapan
| | - Hiroshi Wada
- Department of Gastroenterological SurgeryOsaka International Cancer InstituteOsakaJapan
| | - Junzo Shimizu
- Department of SurgeryToyonaka Municipal HospitalToyonakaJapan
| | - Masashi Kanai
- Department of Clinical Oncology and Pharmacogenomics, Graduate School of MedicineKyoto UniversityKyotoJapan
| | - Kenichi Yoshimura
- Center for Integrated Medical ResearchHiroshima UniversityHiroshimaJapan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Graduate School of MedicineYamaguchi UniversityYamaguchiJapan
| | - Tatsuya Ioka
- Oncology CenterYamaguchi University HospitalUbeJapan
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Todaka A, Sasaki M, Ueno H, Goto T, Murohisa G, Mizuno N, Ozaka M, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Nanami S, Boku N. FOLFIRINOX in Pancreatic Cancer: Risk Factors for Febrile Neutropenia and Severe Neutropenia - Nationwide Study Analysis. Anticancer Res 2023; 43:4115-4123. [PMID: 37648306 DOI: 10.21873/anticanres.16601] [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: 06/07/2023] [Revised: 07/04/2023] [Accepted: 07/05/2023] [Indexed: 09/01/2023]
Abstract
BACKGROUND/AIM FOLFIRINOX (FFX) is a standard treatment for patients with advanced pancreatic cancer. However, it often causes serious hematological adverse events. This study aimed to identify the risk factors for febrile neutropenia (FN) and grade 4 (G4) neutropenia during treatment with FFX in the real world. PATIENTS AND METHODS We analyzed data obtained from a nationwide multicenter observational study (JASPAC 06) that included 399 patients with unresectable or recurrent pancreatic cancer who received FFX at 27 institutions in Japan. RESULTS Nadir neutrophil counts occurred from day 8 to day 22 of cycle 1, and granulocyte colony-stimulating factor was administered to over a quarter of the patients in the first cycle. Of 399 patients, FN and G4 neutropenia occurred in 51 (13%) and 108 (27%) patients, respectively. Most FN (83%) and G4 neutropenia (75%) occurred in the first or second cycles. Multivariate logistic regression analyses showed that total bilirubin (TB) > the upper limit of normal range (ULN) and no dose modification from the original regimen were significantly associated with FN, and that TB > ULN, no dose modification from the original regimen, low platelet count (<15×104/μl), and recurrent disease after pancreatectomy were independent risk factors for G4 neutropenia. CONCLUSION No dose modification from the original regimen and TB > ULN were risk factors for FN and G4 neutropenia.
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Affiliation(s)
- Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan;
| | - Mitsuhito Sasaki
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Chiba, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Takuma Goto
- Division of Metabolism and Biosystemic Science, Gastroenterology, and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Gou Murohisa
- Department of Gastroenterology, Seirei Hamamatsu General Hospital, Shizuoka, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masato Ozaka
- Department of Gastroenterology, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Kazuhiro Uesugi
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | | | - Hideyuki Hayashi
- Department of Gastroenterology and Hepatology, Hokkaido University, Hokkaido, Japan
| | - Kentaro Sudo
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Yosuke Horita
- Department of Chemotherapy and Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Shoko Nanami
- The Mt. Fuji Foundation for Healthcare Innovation and Cluster Development, Shizuoka, Japan
| | - Narikazu Boku
- Department of Oncology and General Medicine, IMSUT Hospital, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan
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7
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Mitsunaga S, Ikeda M, Nomura S, Morizane C, Todaka A, Kamei K, Yanagibashi H, Mizuno N, Gotoh K, Kawamoto Y, Shirakawa H, Okano N, Nomura T, Takahashi A, Makino I, Anbo Y, Ohta K, Katayama H, Konishi M, Ueno M. Effects of gene expression in 5-FU metabolic pathways in a phase III trial evaluating adjuvant S-1 therapy compared to surgery alone following curative resection for biliary tract cancer (JCOG1202A1). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
732 Background: S-1, an oral fluoropyrimidine derivative, is standard adjuvant therapy in Japanese patients with resected biliary tract cancer (BTC), based on the results of JCOG1202, a phase III trial evaluating adjuvant S-1 following curative resection for BTC compared to surgery alone. The efficacy of 5-FU-based therapy is related to the expression of enzymes involved in 5-FU metabolic pathways, such as thymidylate synthase (TS), thymidine phosphorylase (TP), orotate phosphoribosyltransferase (OPRT) and dihydropyrimidine dehydrogenase (DPD). The aim of this study was to evaluate the impact of messenger RNA (mRNA) levels of the four 5-FU metabolic pathway genes on the outcomes of patients enrolled in JCOG1202. Methods: Tumor cell RNA was isolated from formalin-fixed paraffin-embedded primary BTC specimens resected in 264 of 440 randomized patients in JCOG1202. The four 5-FU metabolic pathway genes were measured in 183 patients (surgery alone: n = 94; adjuvant S-1: n = 89) who were randomly divided to training (n = 96) or validation set (n = 87). The endpoints of interest were the predictive values of the four genes for the efficacy of adjuvant S-1 on overall survival and relapse-free survival (RFS), and we here report the results regarding RFS. Cut-off levels for mRNA expression were selected in the training set which minimized the bootstrap p-values (2,000 samples) of an interaction term of treatment (surgery alone or S-1) and mRNA expression in a Cox regression model. Results: There were no obvious differences in each mRNA level and clinical characteristics between surgery alone and adjuvant S-1 groups. RFS tended to be better with adjuvant S-1 (hazard ratio [HR] = 0.790, [95% confidence interval: 0.524-1.192]) compared to surgery alone, which was maintained in the low DPD population (HR = 0.440 [0.216-0.898] in training set and 0.748 [0.334-1.675] in validation set), in the low TP population (HR = 0.709 [0.388-1.296] and 0.602 [0.287-1.262]), and in the high OPRT population (HR = 0.520 [0.152-1.779] and 0.609 [0.161-2.304]). Conclusions: The efficacy of adjuvant S-1 on RFS was representative in BTC patients with intratumoral gene expressions of low DPD, low TP, and high OPRT, which was disappeared in the population with high DPD, high TP, and low OPRT. These biomarkers might be useful to predict therapeutic benefits with S-1 containing chemotherapy for BTC.
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Affiliation(s)
- Shuichi Mitsunaga
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shogo Nomura
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | | | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai Hospital, Osaka, Japan
| | - Hiroo Yanagibashi
- Department of Hepatobiliary-Pancreatic Surgery, Chiba Cancer Center, Chiba, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Kunihito Gotoh
- Department of Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasuyuki Kawamoto
- Division of Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hirofumi Shirakawa
- Department of Hepatobiliary-Pancreatic Surgery, Tochigi Cancer Center, Utsunomiya, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Tatsuya Nomura
- Department of Gastrointestinal Surgery, Niigata Cancer Center Hospital, Niigata, Japan
| | - Amane Takahashi
- Department of Gastroenterological Surgery, Saitama Cancer Center, Saitama, Japan
| | - Isamu Makino
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Kanazawa University Hospital, Kanazawa, Japan
| | - Yoshiyasu Anbo
- Department of Surgery, Teine-keijinkai hospital, Sapporo, Japan
| | - Koji Ohta
- Department of Digestive Surgery, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Hiroshi Katayama
- JCOG Data Center/Operations Office, National Cancer Center Hospital, Tokyo, Japan
| | - Masaru Konishi
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
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8
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Okano N, Sakamaki K, Mie T, Watanabe K, Kobayashi S, Todaka A, Suzuki Y, Kitamura H, Tanaka K, Nakagawa K, Kamei K, Umemoto K, Azemoto N, Kawamoto Y, Yanagimoto H, Tsuji K, Imaoka H, Terashima T, Ueno M, Furuse J. Outcomes of FOLFIRINOX and gemcitabine plus nab-paclitaxel in patients with early recurrent pancreatic cancer after adjuvant S-1: A propensity score–matching analysis. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.4_suppl.707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
707 Background: An oral fluoropyrimidine, S-1, is a standard adjuvant (adj) chemotherapy practice in Japan for patients (pts) with resected pancreatic cancer (PC). Patients experiencing recurrence after adj S-1 administration are treated with FOLFIRINOX (FFX), including intravenous fluoropyrimidine, or gemcitabine plus nab-paclitaxel (GN), which is commonly used as the first-line chemotherapy approach in pts with advanced PC. Some pts have good response to FFX with acceptable toxicity levels even though recurrence within 6 months (mo) after the last S-1 administration is attributed to PC refractory to fluoropyrimidine. To the best of our knowledge, there is no clinical study comparing FFX and GN in this particular population. Methods: This multi-center, retrospective study included pts with PC that had a recurrence-free interval (RFI) < 6 mo from the last adj S-1 administration and were treated with FFX or GN between December 2013 and 2018. The decision to administer FFX or GN was taken by the attending physicians. The primary endpoint was overall survival (OS). Secondary endpoints included progression-free survival (PFS), objective response, and serious adverse events (SAE). The OS and PFS were calculated from the time of initiation of treatment with FFX or GN. To adjust confounding factors in the comparison of FFX with GN, propensity score-matching (PSM) analysis was performed. Potentially confounding factors were identified by univariate analysis for OS, and statistical significance was set at p < 0.1. Results: A total of 284 (FFX; 50, GN; 234) pts were enrolled from 32 institutions in Japan. Potential confounding factors comprised curability, pathological T/N, tumor differentiation status, reasons for the end of S-1 administration, chemotherapy regimen, performance status, serum albumin/C-reactive protein/carbohydrate antigen 19-9 levels, and presence or absence of liver metastasis before initiating the administration of FFX or GN. After PSM, 43 pts each in the FFX and GN groups were compared in pairs. The patient characteristics, excluding age, in the matched pair were well-balanced; the proportion of pts aged < 65 years in the FFX and GN groups was 61% and 30%, respectively. The median OS and PFS were longer in the GN group than in the FFX group; OS was 14.5 vs. 11.1 mo (hazard ratio [HR], 0.61; 95% confidence interval [CI], 0.38-0.97); PFS was 7.1 vs. 5.1 mo (HR, 0.65; 95% CI, 0.41-1.02). The objective response, disease control rates, and observed SAE in the GN and FFX groups were 20/19%, 80/66%, and 14/19% respectively. Seventy-two percent of the pts in the GN group received subsequent therapies of FFX/S-1/FOLFIRI/FOLFOX (28/12/9/5%); while 77% of the FFX group pts received subsequent therapies of GN/GEM (54/7%). Conclusions: Real world data suggests that GN may be recommended in PC pts with RFI < 6 mo from the last administration of adj S-1.
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Affiliation(s)
- Naohiro Okano
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Kentaro Sakamaki
- Center for Data Science, Yokohama City University, Kanagawa, Japan
| | - Takafumi Mie
- Hepato-Biliary-Pancreatic Medicine Department, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Kazuo Watanabe
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | | | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Yuko Suzuki
- Department of Gastroenterology, Saitama Cancer Center, Saitama, Japan
| | - Hidetoshi Kitamura
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Kazunari Tanaka
- Center for Gastroenterology, Teine Keijinkai Hospital, Sapporo, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai Hospital, Osaka, Japan
| | - Kumiko Umemoto
- Department of Clinical Oncology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nobuaki Azemoto
- Center for Liver-Biliary-Pancreatic Diseases, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Yasuyuki Kawamoto
- Division of Cancer Center, Hokkaido University Hospital, Sapporo, Japan
| | - Hiroaki Yanagimoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University, Kobe, Japan
| | - Kunihiro Tsuji
- Department of Gastroenterology, Ishikawa Prefectural Central Hospital, Kanazawa, Japan
| | - Hiroshi Imaoka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa-Shi, Japan
| | | | | | - Junji Furuse
- Department of Gastroenterology, Kanagawa Cancer Center, Yokohama, Japan
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9
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Ioka T, Kanai M, Kobayashi S, Sakai D, Eguchi H, Baba H, Seo S, Taketomi A, Takayama T, Yamaue H, Takahashi M, Sho M, Kamei K, Fujimoto J, Toyoda M, Shimizu J, Goto T, Shindo Y, Yoshimura K, Hatano E, Nagano H. Randomized phase III study of gemcitabine, cisplatin plus S-1 versus gemcitabine, cisplatin for advanced biliary tract cancer (KHBO1401- MITSUBA). J Hepatobiliary Pancreat Sci 2023; 30:102-110. [PMID: 35900311 PMCID: PMC10086809 DOI: 10.1002/jhbp.1219] [Citation(s) in RCA: 48] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Revised: 06/22/2022] [Accepted: 07/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Gemcitabine/cisplatin (GC) combination therapy has been the standard palliative chemotherapy for patients with advanced biliary tract cancer (BTC). No randomized clinical trials have been able to demonstrate the survival benefit over GC during the past decade. In our previous phase II trial, adding S-1 to GC (GCS) showed promising efficacy and we aimed to determine whether GCS could improve overall survival compared with GC for patients with advanced BTC. METHODS We performed a mulitcenter, randomized phase III trial across 39 centers. Enrolled patients were randomly allocated (1:1) to either the GCS or GC arm. The GCS regimen comprised gemcitabine (1000 mg/m2 ) and cisplatin (25 mg/m2 ) infusion on day 1 and 80 mg/m2 of S-1 on days 1-7 every 2 weeks. The primary endpoint was overall survival (OS) and the secondary endpoints were progression-free survival (PFS), response rate (RR), and adverse events (AEs). This study is registered with Clinical trial identification: NCT02182778. RESULTS Between July 2014 and February 2016, 246 patients were enrolled. The median OS and 1-year OS rate were 13.5 months and 59.4% in the GCS arm and 12.6 months and 53.7% in the GC arm, respectively (hazard ratio [HR] 0.79, 90% confidence interval [CI]: 0.628-0.996; P = .046 [stratified log-rank test]). Median PFS was 7.4 months in the GCS arm and 5.5 months in the GC arm (HR 0.75, 95% CI: 0.577-0.970; P = .015). RR was 41.5% in the GCS arm and 15.0% in the GC arm. Grade 3 or worse AEs did not show significant differences between the two arms. CONCLUSIONS GCS is the first regimen which demonstrated survival benefits as well as higher RR over GC in a randomized phase III trial and could be the new first-line standard chemotherapy for advanced BTC. To exploit the advantage of its high RR, GCS is now tested in the neoadjuvant setting in a randomized phase III trial for potentially resectable BTC.
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Affiliation(s)
- Tatsuya Ioka
- Department of Oncology Center, Yamaguchi University Hospital, Yamaguchi, Japan.,Department of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Masashi Kanai
- Department of Medical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Sakai
- Department of Frontier Science for Cancer and Chemotherapy, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, Kumamoto, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Hokkaido, Japan
| | - Tadatoshi Takayama
- Department of Digestive Surgery, Nihon University School of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Takahashi
- Department of Medical Oncology, Tohoku University Hospital, Sendai, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Nara, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Jiro Fujimoto
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Hyogo, Japan
| | - Masanori Toyoda
- Department of Medical Oncology/Hematology, Kobe University Hospital and Graduate School of Medicine, Hyogo, Japan
| | - Junzo Shimizu
- Department of Surgery, Toyonaka Municipal Hospital, Osaka, Japan
| | - Takuma Goto
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Hokkaido, Japan
| | - Yoshitaro Shindo
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Kenichi Yoshimura
- Medical Center for Clinical and Translational Research, Hiroshima University Hospital, Hiroshima, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Nagano
- Department of Gastroenterological, Breast and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
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10
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Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Taketomo Y, Yoshida S, Takeyama Y, Noso S, Ikegami H. Three-Year Observation of Glucose Metabolism After Pancreaticoduodenectomy: A Single-Center Prospective Study in Japan. J Clin Endocrinol Metab 2022; 107:3362-3369. [PMID: 36074913 PMCID: PMC9693916 DOI: 10.1210/clinem/dgac529] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Indexed: 11/19/2022]
Abstract
CONTEXT The glucose tolerance of patients changes considerably from before to after pancreaticoduodenectomy wherein approximately half of the pancreas is resected. OBJECTIVE The aim of this prospective study was to investigate the incidence of and risk factors for diabetes after pancreaticoduodenectomy. METHODS This study is a part of an ongoing prospective study, the Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy (KIP-MEP) study. Of the 457 patients enrolled to date, 96 patients without diabetes who underwent pancreaticoduodenectomy were investigated in this study. Preoperatively, 1 month post-pancreaticoduodenectomy, and every 6 months thereafter, the glucose metabolism and endocrine function were evaluated using the 75 g oral glucose tolerance test. Various other metabolic, endocrine, and exocrine indices were also examined over a period of up to 36 months. RESULTS Of the 96 patients analyzed in this study, 33 were newly diagnosed with diabetes. The cumulative diabetes incidence at 36 months following pancreaticoduodenectomy was 53.8%. The preoperative insulinogenic index and ΔC-peptide in the glucagon stimulation test were significantly lower in the progressors to diabetes than in the nonprogressors. Multivariate Cox regression analysis demonstrated that the insulinogenic index was the only significant risk factor for new-onset diabetes. CONCLUSION The majority of patients developed new-onset diabetes after pancreaticoduodenectomy, and a low value of the insulinogenic index was suggested to be a risk factor for diabetes. Preoperative assessment for the prediction of the onset of diabetes serves as useful information for patients and is important for postoperative glycemic control and diabetes management in patients who require pancreaticoduodenectomy.
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Affiliation(s)
- Fumimaru Niwano
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Sawa Yoshida
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka 589-8511, Japan
| | - Hiroshi Ikegami
- Correspondence: Hiroshi Ikegami, MD, PhD, Department of Endocrinology, Metabolism, and Diabetes, Kindai University Faculty of Medicine 377-2 Ohno-higashi, Osaka-sayama, Osaka 589-8511, Japan.
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11
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Suto H, Kamei K, Kato H, Misawa T, Unno M, Nitta H, Satoi S, Kawabata Y, Ohtsuka M, Rikiyama T, Sudo T, Matsumoto I, Hirao T, Okano K, Suzuki Y, Sata N, Isaji S, Sugiyama M, Takeyama Y. Risk factors associated with hypoglycemic events after total pancreatectomy: A nationwide multicenter prospective study in Japan. Surgery 2022; 172:962-967. [PMID: 35820975 DOI: 10.1016/j.surg.2022.04.031] [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: 12/29/2021] [Revised: 03/27/2022] [Accepted: 04/25/2022] [Indexed: 02/07/2023]
Abstract
BACKGROUND The number of total pancreatectomy cases have increased worldwide, expanding the need for new insulin products and high-titer pancrelipases. However, the current data that is focused on hypoglycemic events after a total pancreatectomy from large nationwide series are still lacking. This study is aimed to assess the risk factors associated with hypoglycemic events after a total pancreatectomy. METHODS Data were prospectively collected from 216 consecutive patients who underwent total pancreatectomies between August 2015 and December 2017 from 68 Japanese centers. Of the 216 patients, 166 with a follow-up period of 1 year were analyzed. The risk factors for hypoglycemic events at 6 and 12 months (postoperative months 6 and 12) were investigated based on the results of a nationwide multicenter prospective study. RESULTS Of the 166 patients, 57 (34%) and 70 (42%) experienced moderate or severe hypoglycemic events or hypoglycemia unawareness on a monthly basis at postoperative months 6 and 12, respectively. Multivariate analysis revealed that body weight loss after surgery ≥0.3 kg and total cholesterol level ≤136 mg/dL at postoperative month 6, and glycated hemoglobin level ≤8.9% and rapid-acting insulin use at postoperative month 12 were independent risk factors for hypoglycemic events after a total pancreatectomy. There were different independent risk factors depending on the postoperative period. CONCLUSION Patients with body weight loss after surgery, low total cholesterol level, strict glycemic control, and using rapid-acting insulin should be aware of the occurrence of hypoglycemic events after their total pancreatectomy. In order to prevent hypoglycemic events after a total pancreatectomy, we need to consider optimal nutritional and glycemic control according to the postoperative period.
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Affiliation(s)
- Hironobu Suto
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan.
| | - Keiko Kamei
- Department of Surgery, Kindai University, Osaka, Japan
| | - Hiroyuki Kato
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - Masayuki Ohtsuka
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takeshi Sudo
- Department of Surgery, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | | | - Tomohiro Hirao
- Department of Public Health, Kagawa University, Kagawa, Japan
| | - Keiichi Okano
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - Shuji Isaji
- Director of Mie University Hospital, Mie, Japan
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12
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Tamagawa H, Sugimoto N, Watanabe T, Satake H, Kataoka K, Kamei K, Kobayashi M, Munakata K, Fukunaga M, Kotaka M, Satoh T, Kanazawa A, Kurata T, Tomita N. P-78 A phase II study of resection followed by capecitabine plus oxaliplatin for liver metastasis of colorectal cancer (REX study): Final analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.04.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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13
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Matsumoto I, Kamei K, Kawaguchi K, Yoshida Y, Matsumoto M, Lee D, Murase T, Satoi S, Takebe A, Takeyama Y. Longitudinal Pancreaticojejunostomy for Pancreaticodigestive Tract Anastomotic Stricture After Pancreaticoduodenectomy. Ann Gastroenterol Surg 2022; 6:412-419. [PMID: 35634185 PMCID: PMC9130871 DOI: 10.1002/ags3.12528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/19/2021] [Accepted: 11/08/2021] [Indexed: 11/23/2022] Open
Abstract
Aim Pancreaticodigestive tract anastomotic stricture is a long-term complication of pancreticoduodenectomy (PD). However, optimal treatment has not yet been defined. We conducted longitudinal pancreaticojejunostomy (LPJ) in symptomatic patients with anastomotic stricture after PD. This study aimed to evaluate the efficacy of this procedure. Methods Pancreticoduodenectomy was performed in 605 patients at our institution between January 2005 and April 2020. Of these, 15 patients (2.5%) developed symptomatic pancreaticodigestive tract anastomotic stricture after PD. Three patients were referred to our institution owing to recurrent pancreatitis with anastomotic stricture after PD. LPJ was indicated for these 18 patients, and they were enrolled in this study. Results The median time from the initial operation to LPJ was 2.0 y. Preoperative clinical presentations included obstructive pancreatitis in 10 patients, a rapid deterioration of glucose tolerance in nine, and severe steatorrhea in two. Surgical morbidity ≥grade III defined by the Clavien-Dindo classification was not observed. After LPJ, preoperative symptoms improved in 16 patients (89%) during a median follow-up of 39 mo. Nine of the 10 patients with obstructive pancreatitis achieved complete pain relief. All nine patients with a rapid deterioration of glucose tolerance showed improved endocrine function. Daily insulin requirement was significantly decreased after LPJ (11.6 ± 3.3 vs 3.4 ± 4.3 units, P = .0239). Four of the seven patients who required insulin injections were free of insulin after LPJ. Conclusion LPJ is a safe and effective surgical procedure for symptomatic patients with stricture of the pancreaticodigestive tract anastomosis after PD.
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Affiliation(s)
- Ippei Matsumoto
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Keiko Kamei
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Kohei Kawaguchi
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Yuta Yoshida
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | | | - Dongha Lee
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Takaaki Murase
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Shumpei Satoi
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
| | - Atsushi Takebe
- Department of SurgeryKindai University Faculty of MedicineOsakaJapan
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Hashimoto D, Satoi S, Ishikawa H, Kodera Y, Kamei K, Hirano S, Fujii T, Uemura K, Tsuchida A, Yamada S, Yamamoto T, Hirota K, Sekimoto M. Efficacy of active hexose correlated compound on survival of patients with resectable/borderline resectable pancreatic cancer: a study protocol for a double-blind randomized phase II study. Trials 2022; 23:135. [PMID: 35151367 PMCID: PMC8841079 DOI: 10.1186/s13063-021-05934-x] [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: 02/17/2021] [Accepted: 12/10/2021] [Indexed: 11/12/2022] Open
Abstract
Background The prognosis of pancreatic ductal adenocarcinoma remains very poor. One possible reason for the short survival of patients with this disease is malnutrition, which can be present at the initial diagnosis, and continue after pancreatectomy. Then, it is important to improve nutritional status and to decrease adverse events during neoadjuvant and adjuvant chemotherapy. Active hexose correlated compound (AHCC) is a standardized extract of cultured Lentinula edodes mycelia, and is considered a potent biological response modifier in the treatment of cancer. To evaluate the survival impact of AHCC on the patients with pancreatic ductal adenocarcinoma, we plan to perform this trial. Methods This is a prospective multicenter phase II trial in patients with resectable/borderline resectable pancreatic ductal adenocarcinoma to investigate the efficacy of AHCC regarding survival. Patients will begin taking AHCC or placebo on the first day of neoadjuvant therapy. AHCC or placebo will be continued until 2 years after surgery. The primary endpoint will be 2-year disease-free survival. The secondary endpoints are the completion rate, dose intensity, and adverse event profile of preoperative chemotherapy; response rate to preoperative chemotherapy; rate of decrease in tumor marker (carbohydrate antigen 19-9, carcinoembryonic antigen) concentrations during preoperative chemotherapy; entry rate, completion rate, dose intensity, and adverse event profile of adjuvant chemotherapy; safety of the protocol therapy (adverse effect of AHCC); 2-year overall survival rate; and nutrition score before and after preoperative chemotherapy, and before and after adjuvant chemotherapy. We will enroll 230 patients, and the study involves eight leading Japanese institutions that are all high-volume centers in pancreatic surgery. Discussion AHCC is expected to function as a supportive food in patients with pancreatic ductal adenocarcinoma, to reduce the proportion of severe adverse events related to neoadjuvant chemotherapy, and to increase the completion proportion of multimodal treatments, resulting in improved survival. Trial registration The trial protocol has been registered in the protocol registration system at the Japan Registry of Clinical Trials (Trial ID: jRCTs051200029). At the time of the submission of this paper (October 2020), the protocol version is 2.0. The completion date is estimated to be November 2024.
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CHAN E, Basu B, Ghiggeri G, Gillion-Boyer O, Hogan J, Ishikura K, Kamei K, Hamada R, Parekh R, Sinha R, Vivarelli M, Xu H, Yap H, Gipson- M. Kemper & other collaborators D, Tullus K. POS-467 Long-term efficacy and safety of repeated rituximab therapy in children with frequently-relapsing, steroid-dependent nephrotic syndrome: an international multicentre study. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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16
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Ngu NT, Phuong LNN, Anh LH, Loc HT, Tam NT, Huan PKN, Diep TH, Kamei K. The Efficiency of Bacteriophages Against Salmonella Typhimurium Infection in Native Noi Broilers. Braz J Poult Sci 2022. [DOI: 10.1590/1806-9061-2021-1561] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- NT Ngu
- Can Tho University, Vietnam
| | - LNN Phuong
- Can Tho University, Vietnam; Department of Agriculture and Rural Development, Vietnam
| | - LH Anh
- Can Tho University, Vietnam
| | - HT Loc
- Can Tho University, Vietnam
| | - NT Tam
- Can Tho University, Vietnam
| | | | - TH Diep
- Tien Giang University, Vietnam
| | - K Kamei
- Kyoto Institute of Technology, Japan
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17
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Kato H, Kamei K, Suto H, Misawa T, Unno M, Nitta H, Satoi S, Kawabata Y, Ohtsuka M, Rikiyama T, Sudo T, Matsumoto I, Okano K, Suzuki Y, Sata N, Isaji S, Sugiyama M, Takeyama Y. Incidence and risk factors of nonalcoholic fatty liver disease after total pancreatectomy: A first multicenter prospective study in Japan. J Hepatobiliary Pancreat Sci 2021; 29:428-438. [PMID: 34863034 DOI: 10.1002/jhbp.1093] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 11/06/2021] [Accepted: 11/19/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND/PURPOSE In the present study we aimed to prospectively assess the current prevalence and risk factors of nonalcoholic fatty liver disease (NAFLD) after total pancreatectomy (TP). METHODS Between August 2015 and December 2017, we prospectively collected data from 68 Japanese centers on 148 consecutive patients who underwent TP whose computed tomography (CT) attenuation values were evaluated for 12 months. We defined post-TP NAFLD as a liver parenchyma CT value of less than 40 Hounsfield units (HU). Data on perioperative variables were retrieved from all patients and evaluated using univariate and multivariate analyses to identify the perioperative risk factors of NAFLD. RESULTS In this prospective cohort study, supplementation of pancreatic exocrine enzymes was provided to all 148 patients, and 97% of them were treated with high-titer pancrelipase (median dosage: 1800 mg) postoperatively. Indeed, 29 patients (19.6%) developed NAFLD within a year after TP. Multivariate analysis revealed that female sex (P = .002), higher body mass index (BMI) (P = .001), and postoperative diarrhea (P = .038) were independent risk factors for post-TP NAFLD. However, post-TP NAFLD ameliorated in 11 patients (37.9%) at 12 months after surgery. CONCLUSIONS Among patients with risk factors such as female sex, higher BMI, and postoperative diarrhea, attention should be paid to the occurrence of NAFLD after TP.
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Affiliation(s)
- Hiroyuki Kato
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University, Osaka, Japan
| | - Hironobu Suto
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Takeyuki Misawa
- Department of Surgery, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | | | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takeshi Sudo
- Department of Surgery, Kure Medical Center and Chugoku Cancer Center, Hiroshima, Japan
| | | | - Keiichi Okano
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Yasuyuki Suzuki
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Naohiro Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
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Okada KI, Kawai M, Hirono S, Sho M, Tani M, Matsumoto I, Yamada S, Amano R, Toyama H, Yamashita YI, Gocho T, Shibuya K, Nagai M, Maehira H, Kamei K, Ohira G, Shirai Y, Takami H, Kimura N, Fukumoto T, Baba H, Kodera Y, Nakao A, Shimokawa T, Katsuda M, Yamaue H. ISOlation Procedure vs. conventional procedure during Distal Pancreatectomy (ISOP-DP trial): study protocol for a randomized controlled trial. Trials 2021; 22:633. [PMID: 34530885 PMCID: PMC8447574 DOI: 10.1186/s13063-021-05523-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 08/06/2021] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Radical antegrade modular pancreatosplenectomy (RAMPS) is an isolation procedure in pancreatosplenectomy for pancreatic body/tail cancer. Connective tissues around the bifurcation of the celiac axis are dissected, followed by median-to-left retroperitoneal dissection. This procedure has the potential to isolate blood and lymphatic flow to the area of the pancreatic body/tail and the spleen to be excised. This is achieved by division of the inflow artery, transection of the pancreas, and then division of the outflow vein in the early phases of surgery. In cases of pancreatic ductal adenocarcinoma (PDAC), the procedure has been shown to decrease intraoperative blood loss and increase R0 resection rate by complete clearance of the lymph nodes. This trial investigates whether the isolation procedure can prolong the survival of patients with pancreatic ductal adenocarcinoma who undergo distal pancreatosplenectomy (DPS) compared with those that undergo the conventional approach. METHODS/DESIGN Patients with PDAC scheduled to undergo DPS are randomized before surgery to undergo either a conventional procedure (arm A) or to undergo the isolation procedure (arm B). In arm A, the pancreatic body, tail, and spleen are mobilized, followed by removal of the regional lymph nodes. The splenic vein is transected at the end of the procedure. The timing of division of the splenic artery (SA) is not restricted. In arm B, regional lymph nodes are dissected, then we transect the root of the SA, the pancreas, then the splenic vein. At the end of the procedure, the pancreatic body/tail and spleen are mobilized and removed. In total, 100 patients from multiple Japanese high-volume centers will be randomized. The primary endpoint is 2-year recurrence-free survival by intention-to-treat analysis. Secondary endpoints include intraoperative blood loss, R0 resection rate, and overall survival. DISCUSSION If this trial shows that the isolation procedures can improve survival with a similar R0 rate and with a similar number of lymph node dissections to the conventional procedure, the isolation procedure is expected to become a standard procedure during DPS for PDAC. Conversely, if there were no significant differences in endpoints between the groups, it would demonstrate justification of either procedure from surgical and oncological points of view. TRIAL REGISTRATION UMIN Clinical Trials Registry UMIN000041381 . Registered on 10 August 2020. ClinicalTrials.gov NCT04600063 . Registered on 22 October 2020.
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Affiliation(s)
- Ken-Ichi Okada
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Manabu Kawai
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Seiko Hirono
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Masaji Tani
- Department of Surgery, Shiga University of Medical Science, Ōtsu, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Hospital, Osaka, Japan
| | - Suguru Yamada
- Department of Surgery, Nagoya Central Hospital, Nagoya, Japan
| | - Ryosuke Amano
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Hirochika Toyama
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Takeshi Gocho
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Minako Nagai
- Department of Surgery, Nara Medical University, Kashihara, Japan
| | - Hiromitsu Maehira
- Department of Surgery, Shiga University of Medical Science, Ōtsu, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Hospital, Osaka, Japan
| | - Go Ohira
- Department of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Osaka City University, Osaka, Japan
| | - Yoshihiro Shirai
- Department of Surgery, Jikei University School of Medicine, Tokyo, Japan
| | - Hideki Takami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Nana Kimura
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan
| | - Takumi Fukumoto
- Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Akimasa Nakao
- Department of Surgery, Nagoya Central Hospital, Nagoya, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Masahiro Katsuda
- Clinical Study Support Center, Wakayama Medical University, Wakayama, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan.
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Matsumoto I, Kamei K, Satoi S, Murase T, Matsumoto M, Kawaguchi K, Yoshida Y, Dongha L, Takebe A, Nakai T, Takeyama Y. Efficacy of the slow firing method using a reinforced triple-row stapler for preventing postoperative pancreatic fistula during laparoscopic distal pancreatectomy. Surg Today 2021; 52:260-267. [PMID: 34322726 DOI: 10.1007/s00595-021-02344-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 03/09/2021] [Accepted: 05/07/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the "slow firing method" using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP. METHODS This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas. RESULTS Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10 days. Preoperative diabetes (13.6 vs. 0.2%, P = 0.044) and thickness of the pancreas ≥ 15 mm (13.8% vs. 0%, P = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8-29) min. CONCLUSION The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.
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Affiliation(s)
- Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shumpei Satoi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takaaki Murase
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masataka Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kohei Kawaguchi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuta Yoshida
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Lee Dongha
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Atsushi Takebe
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
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Niwano F, Babaya N, Hiromine Y, Matsumoto I, Kamei K, Noso S, Taketomo Y, Takeyama Y, Kawabata Y, Ikegami H. Glucose Metabolism After Pancreatectomy: Opposite Extremes Between Pancreaticoduodenectomy and Distal Pancreatectomy. J Clin Endocrinol Metab 2021; 106:e2203-e2214. [PMID: 33484558 PMCID: PMC8063252 DOI: 10.1210/clinem/dgab036] [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] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Indexed: 12/15/2022]
Abstract
CONTEXT The rate of glucose metabolism changes drastically after partial pancreatectomy. OBJECTIVE This work aims to analyze changes in patients' glucose metabolism and endocrine and exocrine function before and after partial pancreatectomy relative to different resection types (Kindai Prospective Study on Metabolism and Endocrinology after Pancreatectomy: KIP-MEP study). METHODS A series of 278 consecutive patients with scheduled pancreatectomy were enrolled into our prospective study. Of them, 109 individuals without diabetes, who underwent partial pancreatectomy, were investigated. Data were compared between patients with pancreaticoduodenectomy (PD, n = 73) and those with distal pancreatectomy (DP, n = 36). RESULTS Blood glucose levels during the 75-g oral glucose tolerance test (75gOGTT) significantly decreased after pancreatectomy in the PD group (area under the curve [AUC] -9.3%, P < .01), and significantly increased in the DP population (AUC + 16.8%, P < .01). Insulin secretion rate during the 75gOGTT and glucagon stimulation test significantly decreased after pancreatectomy both in the PD and DP groups (P < .001). Both groups showed similar homeostasis model assessment of insulin resistance (HOMA-IR) values after pancreatectomy. Decrease in exocrine function quality after pancreatectomy was more marked in association with PD than DP (P < .01). Multiple regression analysis indicated that resection type and preoperative HOMA-IR independently influenced glucose tolerance-related postoperative outcomes. CONCLUSIONS Blood glucose levels after the OGTT differed markedly between PD and DP populations. The observed differences between PD and DP suggest the importance of individualization in the management of metabolism and nutrition after partial pancreatectomy.
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Affiliation(s)
- Fumimaru Niwano
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Naru Babaya
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Yoshihisa Hiromine
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Shinsuke Noso
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Yasunori Taketomo
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Yumiko Kawabata
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
| | - Hiroshi Ikegami
- Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, Osaka-sayama, Osaka, Japan
- Correspondence: Hiroshi Ikegami, MD, PhD, Department of Endocrinology, Metabolism and Diabetes, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
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21
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Suto H, Kamei K, Kato H, Misawa T, Unno M, Nitta H, Satoi S, Kawabata Y, Ohtsuka M, Rikiyama T, Sudo T, Matsumoto I, Hirao T, Okano K, Suzuki Y, Sata N, Isaji S, Sugiyama M, Takeyama Y. Diabetic control and nutritional status up to 1 year after total pancreatectomy: a nationwide multicentre prospective study. Br J Surg 2021; 108:e237-e238. [PMID: 33821972 DOI: 10.1093/bjs/znab097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 01/20/2021] [Accepted: 02/18/2021] [Indexed: 01/09/2023]
Affiliation(s)
- H Suto
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - K Kamei
- Department of Surgery, Kindai University, Osaka, Japan
| | - H Kato
- Department of Hepatobiliary Pancreatic and Transplant Surgery, Mie University Graduate School of Medicine, Mie, Japan
| | - T Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Chiba, Japan
| | - M Unno
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - H Nitta
- Department of Surgery, Iwate Medical University, Iwate, Japan
| | - S Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - Y Kawabata
- Department of Digestive and General Surgery, Faculty of Medicine, Shimane University, Shimane, Japan
| | - M Ohtsuka
- Department of General Surgery, Chiba University, Chiba, Japan
| | - T Rikiyama
- Department of Surgery, Saitama Medical Centre, Jichi Medical University, Saitama, Japan
| | - T Sudo
- Department of Surgery, Kure Medical Centre and Chugoku Cancer Centre, Hiroshima, Japan
| | - I Matsumoto
- Department of Surgery, Kindai University, Osaka, Japan
| | - T Hirao
- Department of Public Health, Kagawa University, Kagawa, Japan
| | - K Okano
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - Y Suzuki
- Department of Gastroenterological Surgery, Kagawa University, Kagawa, Japan
| | - N Sata
- Department of Surgery, Jichi Medical University, Tochigi, Japan
| | - S Isaji
- Director of Mie University Hospital, Mie, Japan
| | - M Sugiyama
- Director of Tokyo Rosai Hospital, Tokyo, Japan
| | - Y Takeyama
- Department of Surgery, Kindai University, Osaka, Japan
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Yoshida Y, Matsumoto I, Tanaka T, Yamao K, Hayashi A, Kamei K, Satoi S, Takebe A, Nakai T, Takenaka M, Takeyama Y. Pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct leading to pancreatic pleural effusion: a case report. Surg Case Rep 2020; 6:222. [PMID: 32975612 PMCID: PMC7519021 DOI: 10.1186/s40792-020-00987-7] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 09/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background Pancreatic pleural effusion and ascites are defined as fluid accumulation in the thoracic and abdominal cavity, respectively, due to direct leakage of the pancreatic juice. They usually occur in patients with acute or chronic pancreatitis but are rarely associated with pancreatic neoplasm. We present here an extremely rare case of pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct, leading to pancreatic pleural effusion. Case presentation A 51-year-old man complained of dyspnea. Left-sided pleural effusion was detected on the chest X-ray. Pleural puncture was performed, and the pleural fluid indicated a high amylase content (36,854 IU/L). Hence, the patient was diagnosed with pancreatic pleural effusion. Although no tumor was detected, the computed tomography (CT) scan showed a pseudocyst and dilation of the main pancreatic duct in the pancreatic tail. Magnetic resonance cholangiopancreatography showed a fistula from the pseudocyst into the left thoracic cavity. Endoscopic retrograde pancreatic drainage was attempted; however, it failed due to stenosis in the main pancreatic duct in the pancreatic body. Endoscopic ultrasound revealed a hypoechoic mass measuring 15 × 15 mm in the pancreatic body that was not enhanced in the late phase of contrast perfusion and was thus suspected to be an invasive ductal carcinoma. The patient underwent distal pancreatectomy with splenectomy and the postoperative course was uneventful. Histopathological examination confirmed a neuroendocrine tumor of the pancreas (NET G2). The main pancreatic duct was compressed by the tumor. Increased pressure on the distal pancreatic duct by the tumor might have caused formation of the pseudocyst and pleural effusion. To the best of our knowledge, this is the first case report of pancreatic pleural effusion associated with a neuroendocrine tumor. Conclusions Differential diagnosis of a pancreatic neoplasm should be considered, especially when a patient without a history of pancreatitis presents with pleural effusion.
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Affiliation(s)
- Yuta Yoshida
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan.
| | - Tomonori Tanaka
- Department of Pathology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Kentaro Yamao
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Akihiro Hayashi
- Gastroenterology, Tottori Prefectural Central Hospital, 730, Ezu, Tottori, Tottori, 680-0000, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Shumpei Satoi
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Atsushi Takebe
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Mamoru Takenaka
- Department of Gastroenterology and Hepatology, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, 377-2 Ohno-higashi, Osaka-sayama, Osaka, 589-8511, Japan
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Kamei K, Ohnishi T, Nakata K, Danno K, Ohkawa A, Miyake Y, Okazaki S, Fukunaga M, Toyokawa A, Hamada T, Shindoh J, Kanazawa A. A new monitoring tool CLIP test for progression of oxaliplatin-induced peripheral neuropathy: A multicenter prospective study. Asia Pac J Clin Oncol 2020; 16:e257-e262. [PMID: 32893979 DOI: 10.1111/ajco.13404] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 05/26/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Oxaliplatin-induced peripheral neuropathy (OIPN) is a common adverse events that can limit a patient's quality of life during/after chemotherapy. However, no appropriate methods have been established yet for monitoring the risk of progression of OIPN. METHODS A simple assessment tool using gem clips, the CLIP test, was established and its performance in predicting the risk of progression to ≥grade 2 peripheral sensory neuropathy (CTCAE ver. 4.0) was investigated in patients receiving chemotherapy with oxaliplatin. RESULTS Among 101 patients included in this study, 71 patients developed CTCAE ≥grade 1 peripheral neuropathy (grade 1, n = 67; grade 2, n = 4) at a median of 63 (range, 14-259) days after the start of treatment. Of the 67 patients with grade 1 peripheral neuropathy, 17 showed progression to ≥grade 2 neuropathy after a median interval of 84 (range, 21-246) days. Of these patients, 27 showed a positive result of the CLIP test at a median of 91 (range, 14-224) days, excluding one patient who already showed a positive result of the test at the baseline. Therefore, the risk ratio for the development of CTCAE ≥grade 2 peripheral neuropathy was 8.3 in the patients who showed a positive result on the CLIP test. Multivariate analysis confirmed that a positive results on the CLIP test was significantly correlated with the risk of future development of CTCAE ≥grade 2 peripheral neuropathy (odds ratio, 9.37; P = 0.002). CONCLUSION A positive result on the CLIP test predict is predictive of the risk of progression of OIPN during chemotherapy with oxaliplatin.
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Affiliation(s)
- Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Tadashi Ohnishi
- Department of Surgery, Nishinomiya Municipal Central Hospital, Nishinomiya, Japan
| | - Ken Nakata
- Department of Coloproctological Surgery, Sakai City Medical Center, Sakai, Japan
| | - Katsuki Danno
- Department of Surgery, Minoh City Hospital, Minoh, Japan
| | - Atsushi Ohkawa
- Department of Surgery, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan
| | - Yasuhiro Miyake
- Department of Surgery, Osaka Minato Central Hospital, Osaka, Japan
| | - Satoshi Okazaki
- Department of Surgery, Kansai Medical University Kori Hospital, Neyagawa, Japan
| | - Mutsumi Fukunaga
- Department of Surgery, Hyogo Prefectural Nishinomiya Hospital, Nishinomiya, Japan
| | | | - Tetsuhiro Hamada
- Department of Surgery, Takarazuka City Hospital, Takarazuka, Japan
| | - Junichi Shindoh
- Department of Gastroenterological Surgery, Toranomon Hospital, Tokyo, Japan
| | - Akiyoshi Kanazawa
- Department of Surgery, Shimane Prefectural Central Hospital, Izumo, Japan
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Ohki Y, Okamoto Y, Iinuma T, Yamamoto H, Toyotome T, Yahiro M, Yonekura S, Sakurai D, Kamei K. Local fungus-specific Immunoglobulin E production in chronic rhinosinusitis with nasal polyps. Rhinology 2020; 58:136-144. [PMID: 31904030 DOI: 10.4193/rhin18.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Chronic rhinosinusitis with nasal polyps (CRSwNP) is a heterogeneous disease, and its pathogenesis remains controversial. This study aimed to examine the involvement of fungi in CRSwNP pathogenesis. METHODS We enrolled 29 controls and 111 CRSwNP patients. We analyzed fungi in the nasal secretions, serum fungus-specific immunoglobulin E (IgE) levels, and nasal polyp (NP) IgE levels. Moreover, we evaluated the correlation between patients' IgE levels and computed tomography (CT) scores. RESULTS There was no difference in fungal detection rate between CRSwNP patients with and without asthma. Specific IgEs against various antigens were highly detectable in NPs of CRSwNP patients. In CRSwNP patients, fungus-specific IgE levels in NPs were correlated with CT scores. Serum fungus-specific IgEs became undetectable after operation in more than half of the CRSwNP patients without asthma but not in those with asthma. Other serum airborne antigen-specific IgEs did not become undetectable after operation. CONCLUSIONS Fungus-specific IgEs were highly detectable in NPs of CRSwNP patients, and NPs comprised a major region of specific IgE production. Fungi may therefore play an important role in CRSwNP pathogenesis by inducing Th2 immune responses, including IgE synthesis.
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Affiliation(s)
- Y Ohki
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Y Okamoto
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - T Iinuma
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - H Yamamoto
- Division of Otolaryngology, Kimitsu Central Hospital, Kimitsu, Japan
| | - T Toyotome
- Diagnostic Center for Animal Health and Food Safety, Obihiro University of Agriculture and Veterinary Medicine, Obihiro, Japan
| | - M Yahiro
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - S Yonekura
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - D Sakurai
- Department of Otolaryngology, Head and Neck Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
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Matsumoto I, Kamei K, Murase T, Yoshida Y, Kawaguchi K, Matsumoto M, Satoi S, Takebe A, Nakai T, Takeyama Y. Surgical treatment for chronic pancreatitis: A single-center retrospective study in Japan. J Hepatobiliary Pancreat Sci 2020; 27:632-639. [PMID: 32603018 DOI: 10.1002/jhbp.795] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/13/2020] [Accepted: 06/23/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND/PURPOSE To determine the short- and long-term results of surgical treatments for chronic pancreatitis (CP) at a high-volume center in Japan. METHODS The records of 151 consecutive patients undergoing surgery for CP were retrospectively reviewed. Selection of surgical procedures used had been according to the Japanese Clinical Practice Guidelines for CP 2015. Long-term (≥1 year) follow-up was performed in 100 patients (median of 37 months). RESULTS Surgical drainage procedures were performed in 107 patients (Frey operation in 81, longitudinal pancreaticojejunostomy in 26), pancreatic resection in 37 (subtotal stomach-preserving pancreaticoduodenectomy in 11, distal pancreatectomy in 26), and other procedures in six. The rates of postoperative mortality and morbidity were 1% and 26%, respectively. The rates of complete and partial pain relief were 62% and 37%. The frequency of occurrence of severe morbidity was significantly higher after pancreatic resection than in patients receiving drainage procedures (13% vs 2%, P = .019). The rate of new-onset diabetes was also significantly higher after resection than drainage (60% vs 25%, P = .017). CONCLUSIONS Surgical treatment for painful chronic pancreatitis can be safe and effective. An optimal procedure should guarantee pain relief and preserve a maximum of pancreatic function.
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Affiliation(s)
- Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takaaki Murase
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yuta Yoshida
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Kohei Kawaguchi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Masataka Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Shumpei Satoi
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Atsushi Takebe
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Takuya Nakai
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Kindai University Faculty of Medicine, Osaka-sayama, Japan
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Matsumoto I, Kamei K, Satoi S, Murase T, Matsumoto M, Kawaguchi K, Yoshida Y, Lee D, Takebe A, Nakai T, Takeyama Y. Conversion to open laparotomy during laparoscopic distal pancreatectomy: lessons from a single-center experience in 70 consecutive patients. Surg Today 2020; 51:70-78. [PMID: 32577881 DOI: 10.1007/s00595-020-02056-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/08/2020] [Accepted: 06/10/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE The purpose of this study was to determine the factors influencing conversion from laparoscopic distal pancreatectomy (LDP) to open surgery, and the effect of such conversion on the outcome. METHODS This retrospective single-center study included 70 consecutive patients undergoing LDP. The primary endpoint was the rate of conversion to open surgery during LDP. The secondary endpoints were determining the reasons for conversion to open surgery, with detailed analyses of these cases and a comparison of the surgical outcome with and without conversion. RESULTS Seven patients (10%) required conversion to open surgery during LDP. Pancreatic ductal adenocarcinoma (PDAC) was identified as a risk factor for conversion (p = 0.010). The reasons for conversion included technical difficulty (two bleeding, one severe adhesion) and pancreatic stump-related issues (two margin-positive, two stapling failures). Although the overall morbidity rate (29 vs. 11%, p = 0.48) and the rate of clinically relevant postoperative pancreatic fistula (14 vs. 5%, p = 0.82) were no different for the patients with or without open conversion, the postoperative hospital stay was significantly longer in the former (median 15 vs. 10 days, p = 0.03). CONCLUSIONS Careful preoperative assessment is required when planning LDP for PDAC. Although conversion to open surgery does not result in failure of LDP, efforts to reduce the duration of postoperative hospital stay and the occurrence of complications are desirable to improve the outcome of LDP.
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Affiliation(s)
- Ippei Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan.
| | - Keiko Kamei
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Shumpei Satoi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takaaki Murase
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Masataka Matsumoto
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Kohei Kawaguchi
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yuta Yoshida
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Dongha Lee
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Atsushi Takebe
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Takuya Nakai
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
| | - Yoshifumi Takeyama
- Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osakasayama, Osaka, 589-8511, Japan
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27
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Hino Y, Muraosa Y, Oguchi M, Yahiro M, Yarita K, Watanabe A, Sakaida E, Yokote K, Kamei K. Drain outlets in patient rooms as sources for invasive fusariosis: an analysis of patients with haematological disorders. J Hosp Infect 2020; 105:S0195-6701(20)30204-8. [PMID: 32360338 DOI: 10.1016/j.jhin.2020.04.029] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 04/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND Invasive fusariosis (IF) is a frequently fatal disease as there are few antifungals to treat it, making the prevention of IF crucial. However, fusarium infections have not been as thoroughly studied as other common pathogenic fungi such as Aspergillus or Candida. AIM To investigate the epidemiology of IF in patients with haematological diseases in Japan and to elucidate the infectious route of fusarium infection. METHODS We retrospectively analysed 29 IF cases in patients with haematological diseases from 2009 to 2019 in Japan. To discover the infectious source of IF, we performed an indoor environment survey targeted at indoor air and drain outlets in medical institutions and residences using culture-based and metagenomic methods. Finally, we performed aerosol- and droplet-mediated dispersion studies. FINDINGS The epidemiological study showed that the primary pathogen of IF was Fusarium solani species complex (FSSC), and the most common species was Fusarium petroliphilum. Most patients were likely to develop IF during hospitalization. A fusarium culture was positive in 26 of 72 drain samples. Few fusarium were detected from air samples; by contrast, 29 of 108 isolates from the drain outlets were identified as fusarium. Furthermore, similar results were obtained in the metagenomic analysis. Interestingly, species belonging to FSSC were isolated from indoor drain outlets, which was similar to those of the IF patients. In the droplet-mediated dispersion study, eight to 17 colonies of fusarium were isolated. CONCLUSION Our study indicates that causative Fusarium spp. could inhabit drain outlets in hospitals or residences, and droplet-mediated fusarium dispersion is a potential cause of IF.
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Affiliation(s)
- Y Hino
- Medical Mycology Research Center, Chiba University, Chiba, Japan; Department of Haematology, Chiba University Hospital, Chiba, Japan; Department of Endocrinology, Haematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Y Muraosa
- Medical Mycology Research Center, Chiba University, Chiba, Japan.
| | - M Oguchi
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - M Yahiro
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - K Yarita
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - A Watanabe
- Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - E Sakaida
- Department of Haematology, Chiba University Hospital, Chiba, Japan; Department of Endocrinology, Haematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Yokote
- Department of Endocrinology, Haematology and Gerontology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - K Kamei
- Medical Mycology Research Center, Chiba University, Chiba, Japan
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Matsumoto M, Matsumoto I, Kamei K, Yoshida Y, Kawaguchi K, Murase T, Satoi S, Takebe A, Nakai T, Takeyama Y. [A Case of Emergency Pancreaticoduodenectomy for Tumor Bleeding in Duodenal Cancer with Multiple Liver Metastases]. Gan To Kagaku Ryoho 2020; 47:108-110. [PMID: 32381874] [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: 06/11/2023]
Abstract
A 62 year-old female presenting with shortness of breath and severe anemia(Hb level 4.4 g/dL)was diagnosed with tumor bleeding and duodenal cancer by gastrointestinal endoscopy.Computed tomography scan revealed multiple liver metastases.After admission, the Hb level dropped from 9.1 g/dL to 5.1 g/dL in one night, and emergency pancreaticoduodenectomy( PD)was performed to control the bleeding.The postoperative course was uneventful, and the patient was discharged on postoperative day(POD)16.Systemic chemotherapy was initiated 1 month after surgery, but the patient died from the disease 13 months after surgery.Emergency PD could be a treatment option in patients with uncontrolled tumor bleeding and fatal conditions.
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Fujimoto M, Inaba Y, Takahashi T, Nakanishi G, Muraosa Y, Yahiro M, Kamei K, Murata SI. Image Gallery: Granulomatous dermatitis due to infection with the chlorophyllic green alga Desmodesmus. Br J Dermatol 2019; 179:e167. [PMID: 30318802 DOI: 10.1111/bjd.17007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- M Fujimoto
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
| | - Y Inaba
- Department of Dermatology, Wakayama Medical University, Wakayama, Japan
| | - T Takahashi
- Department of Dermatology, Shiga University of Medical Science, Shiga, Japan
| | - G Nakanishi
- Department of Dermatology, Shiga University of Medical Science, Shiga, Japan
| | - Y Muraosa
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - M Yahiro
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - K Kamei
- Division of Clinical Research, Medical Mycology Research Center, Chiba University, Chiba, Japan
| | - S-I Murata
- Department of Diagnostic Pathology, Wakayama Medical University, Wakayama, Japan
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30
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Kamei K, Shindoh J, Kiya Y, Matsumoto I, Hashimoto M, Takeyama Y. Conversion surgery after extensive chemotherapy for stage IV mixed adenoneuroendocrine carcinoma (MANEC) of the gallbladder: clinical implications from the patterns of response and recurrence. Clin J Gastroenterol 2019; 13:240-246. [PMID: 31617127 DOI: 10.1007/s12328-019-01053-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Accepted: 09/28/2019] [Indexed: 02/07/2023]
Abstract
A 53-year-old woman who was diagnosed as having advanced gallbladder cancer (T3N1M1, Stage IVB) showed a dramatic response to chemotherapy using gemcitabine + cisplatin and surgery with curative intent was attempted. Histopathological examination revealed residual tumor limited to the perimuscular connective tissue of the gallbladder (T2bN0M0, Stage IIB) and a mixture of poorly differentiated adenocarcinoma and neuroendocrine carcinoma (NEC) components was confirmed. At 6 months after the surgery, a small peritoneal nodule was detected and chemotherapy was resumed with gemcitabine, cisplatin, and S-1. However, the recurrent lesion showed no response at all and gradually formed a mass with the liver and kidney. Considering the difficulty of intensive chemotherapy and the relatively indolent progression of the disease at 15 months after the recurrence was first detected, repeat resection was performed. Histopathology of the resected lesions revealed only a NEC components. Although surgical intervention may be effective in selected cases, given that the NEC component is often associated with progression and recurrence of the disease, the chemotherapy regimen would need to include drugs for the NEC component in cases where the histopathological diagnosis of MANEC has been established.
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Affiliation(s)
- Keiko Kamei
- Department of Surgery, Kindai University, Osaka, Japan
| | - Junichi Shindoh
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan. .,Okinaka Memorial Institute for Medical Disease, Tokyo, Japan.
| | - Yoshitaka Kiya
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
| | | | - Masaji Hashimoto
- Department of Gastroenterological Surgery, Toranomon Hospital, 2-2-2 Toranomon, Minato-ku, Tokyo, Japan
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Yoshida Y, Matsumoto I, Matsumoto M, Kawaguchi K, Murase T, Kamei K, Satoi S, Takebe A, Nakai T, Takeyama Y. Transpancreatic mattress suture with Vicryl mesh around the stump decreases postoperative pancreatic fistula after distal pancreatectomy. J Hepatobiliary Pancreat Sci 2019; 26:510-516. [DOI: 10.1002/jhbp.664] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Yuta Yoshida
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Ippei Matsumoto
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Masataka Matsumoto
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Kohei Kawaguchi
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Takaaki Murase
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Keiko Kamei
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Shumpei Satoi
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Atsushi Takebe
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Takuya Nakai
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
| | - Yoshifumi Takeyama
- Department of Surgery Faculty of Medicine Kindai University 377‐2 Ohno‐higashi Osakasayama Osaka 589‐8511 Japan
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Iwasaki T, Takeyama Y, Yoshida Y, Kawaguchi K, Matsumoto M, Murase T, Kamei K, Takebe A, Matsumoto I, Nakai T. Identification of aberrant subvesical bile duct by using intraoperative fluorescent cholangiography: A case report. Int J Surg Case Rep 2019; 61:115-118. [PMID: 31357101 PMCID: PMC6664166 DOI: 10.1016/j.ijscr.2019.07.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/30/2019] [Accepted: 07/09/2019] [Indexed: 02/07/2023] Open
Abstract
Aberrant subvesical bile duct poses risk of bile duct injury during cholecystectomy. Intraoperative fluorescent cholangiography (IFC) could allow us to identify a fine minute bile duct. IFC is one of a promising technique to improve the safety of cholecystectomy further.
Introduction Aberrant subvesical bile ducts are rare structural anomaly located in the peri-hepatic gallbladder fossa. This duct poses the risk for intraoperative bile duct injury resulting in clinically relevant bile leakage. Presentation of case Aberrant subvesical bile duct was detected by preoperative magnetic resonance cholangiopancreatography in a 52-year old woman with gallbladder polypoid tumor harboring the risk to be gallbladder cancer. During open cholecystectomy with full thickness dissection, the aberrant duct was identified by intraoperative fluorescent cholangiography (IFC), and dissected safely. Discussion Aberrant subvesical bile ducts are mostly found unexpectedly as intra and/or postoperative bile leakage, and remain an important cause of bile duct injuries after laparoscopic cholecystectomy. IFC, which offers real-time imaging of biliary anatomy, has a potential to overcome these problems. Conclusion We performed cholecystectomy by using IFC to identify the aberrant subvesical bile duct. To the best of our knowledge, this is the first report showing the fluorescence image of an aberrant subvesical bile duct in a state of nature.
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Affiliation(s)
| | | | - Yuta Yoshida
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | - Kohei Kawaguchi
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | | | - Takaaki Murase
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | - Keiko Kamei
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | - Atsushi Takebe
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
| | - Takuya Nakai
- Department of Surgery, Kindai University, Faculty of Medicine, Japan
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Matsumoto I, Kamei K, Omae K, Suzuki S, Matsuoka H, Mizuno N, Ozaka M, Ueno H, Kobayashi S, Uesugi K, Kobayashi M, Todaka A, Fukutomi A. FOLFIRINOX for locally advanced pancreatic cancer: Results and prognostic factors of subset analysis from a nation-wide multicenter observational study in Japan. Pancreatology 2019; 19:296-301. [PMID: 30638853 DOI: 10.1016/j.pan.2019.01.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 10/24/2018] [Revised: 12/19/2018] [Accepted: 01/03/2019] [Indexed: 12/11/2022]
Abstract
BACKGROUND FOLFIRINOX (oxaliplatin, irinotecan, 5-fluorouracil, leucovorin) treatment significantly improved overall survival in the recent phase III study and became a standard therapy for metastatic pancreatic cancer. However, treatment for locally advanced pancreatic cancer is still controversial. We conducted subset analyses from a nation-wide multicenter observational study in Japan to evaluate the tolerability and efficacy of FOLFIRINOX in patients with locally advanced pancreatic cancer and to investigate independent prognostic factors with pre-treatment variables. METHODS The study included 66 patients with unresectable locally advanced pancreatic cancer from 27 institutions in Japan who received FOLFIRINOX as first-line treatment between December 20, 2013 and December 19, 2014 and surveyed until December 2015. RESULTS The median age was 63 with the Eastern Cooperative Oncology Group performance status of 0 or 1. Major Grade 3 or 4 adverse events included neutropenia (64%), leukopenia (33%), febrile neutropenia (15%), and diarrhea (15%). Severe adverse event occurred in 14 patients (11%) without fatal event. The median overall survival and progression-free survival times were 18.5 and 7.6 months, respectively. The objective response rate 15.2% and the disease control rate was 81.9%. A high modified Glasgow prognostic score (mGPS, ≥1) (95%CI 1.96-12.5) and female (95%CI 0.20-0.97) were identified as independent poor prognostic factors. CONCLUSIONS First-line FOLFIRINOX treatment for locally advanced pancreatic cancer seems to be effective with acceptable toxicities. A high mGPS may be associated with poor survival in patients with locally advanced pancreatic cancer who receive FOLFIRINOX. This study was registered at the UMIN Clinical Trials Registry (UMIN000014658).
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Affiliation(s)
- Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Keiko Kamei
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Katsuhiro Omae
- Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Shuhei Suzuki
- Department of Clinical Oncology, Yamagata University Hospital, Yamagata, Japan
| | | | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Aichi, Japan
| | - Masato Ozaka
- Department of Gastroenterology, The Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Kobayashi
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Kazuhiro Uesugi
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Ehime, Japan
| | - Marina Kobayashi
- Clinical Trial Promotion Section, Shizuoka Industrial Foundation Pharma Valley Center, Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akira Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
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Yamashita T, Hattori M, Nakada T, Hayashi T, Kamei K, Tatsuya T, Nagao Y, Mase T, Wada M, Mizuno T, Shimozuma K, Iwata H, Yamaguchi T. Abstract P4-11-02: Subjective and objective assessment of efficacy of frozen gloves and socks to prevent nab-paclitaxel-induced peripheral neuropathy in patients with breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-11-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent side-effect of taxanes which play a central role in the treatment of breast cancer. CIPN can negatively influence long-term quality of life, warranting the development of effective prevention strategies. This study investigates the efficacy of frozen gloves and socks (FGS) in reducing the incidence and severity of nab-paclitaxel-induced peripheral neuropathy. Endpoints were evaluated using both clinician and patient reports.
Methods: This is a multicenter phase II single arm trial study of the effects of FGS for advanced or metastatic breast cancer patients receiving nab-paclitaxel (260 mg/m2) every 3 weeks. Patients wore FGS on their diseased side hand and foot for 60 min during infusion. The other side acted as the untreated control. CIPN was assessed using Patient Neurotoxicity Questionnaire (PNQ), PRO-CTCAE and CTCAE at baseline and every cycle of nab-paclitaxel. The primary endpoint was the incidence of CIPN assessed by PNQ (grade C or higher) after receipt of up to 4 cycles of nab-paclitaxel.
Results: Between September 2012 and January 2015, 50 patients from 16 sites were enrolled in this study. Of 50 patients, 27 (54%) received at least 4 cycles of nab-paclitaxel. There was a trend for the incidence of CIPN assessed by PNQ and PRO-CTCAE to be lower in the intervention side than in the control side, although this difference was not statistically significant. The incidence of CIPN assessed by CTCAE was significantly lower in the treated hand (Table).
Conclusions: Among breast cancer patients who received nab-paclitaxel, FGS produced favorable effects as detected by reduced clinician-reported CTCAE grades for CIPN, although the study did not detect differences in self-reported symptoms of CIPN using PRO-CTCAE or PNQ. Clinical trial information: UMIN000007907.
Difference according to the evaluation method of CIPN Hands (%) Feet (%) InterventionControlp*InterventionControlp*Patient-Reporting CIPNPNQ (grade C or higher)12190.3416160.63Patient-Reporting CIPNPRO-CTCAE Severity ≥ Moderate13180.0815160.56 Interference ≥ Somewhat7100.328100.32Clinician-Grading CIPNCTCAE (≥ Grade II)15190.0314131.0
*McNemar's test
Citation Format: Yamashita T, Hattori M, Nakada T, Hayashi T, Kamei K, Tatsuya T, Nagao Y, Mase T, Wada M, Mizuno T, Shimozuma K, Iwata H, Yamaguchi T. Subjective and objective assessment of efficacy of frozen gloves and socks to prevent nab-paclitaxel-induced peripheral neuropathy in patients with breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-11-02.
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Affiliation(s)
- T Yamashita
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Hattori
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Nakada
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Hayashi
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Kamei
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Tatsuya
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Y Nagao
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Mase
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - M Wada
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Mizuno
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - K Shimozuma
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - H Iwata
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - T Yamaguchi
- Kanagawa Cancer Center, Yokohama, Kanagawa, Japan; Aichi Cnacer Center, Nagoya, Aichi, Japan; Gifu Municipal Hospital, Gifu, Japan; Nagoya Medical Center, Nagoya, Aichi, Japan; Ogaki Municipal Hospital, Ogaki, Gifu, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan; Gifu Prefectural General Medical Center, Gifu, Japan; Ogaki Tokushukai Hospital, Ogaki, Gifu, Japan; Nishio City Hospital, Nishio, Aichi, Japan; Mie University Hospital, Tsu, Mie, Japan; Ritsumeikan University, Kusatsu, Shiga, Japan; Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
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Shirasu H, Todaka A, Omae K, Fujii H, Mizuno N, Ozaka M, Ueno H, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Yukisawa S, Kobayashi M, Fukutomi A. Impact of UGT1A1 genetic polymorphism on toxicity in unresectable pancreatic cancer patients undergoing FOLFIRINOX. Cancer Sci 2018; 110:707-716. [PMID: 30447099 PMCID: PMC6361560 DOI: 10.1111/cas.13883] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [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: 08/15/2018] [Revised: 11/13/2018] [Accepted: 11/14/2018] [Indexed: 12/18/2022] Open
Abstract
Studies have indicated an association between UDP‐glucuronosyltransferase‐1A1 (UGT1A1) genetic polymorphisms and irinotecan‐induced toxicity. We undertook this study to investigate the association between UGT1A1 genetic polymorphisms and toxicity in patients treated with the FOLFIRINOX (comprising oxaliplatin, irinotecan, fluorouracil, and leucovorin) chemotherapy regimen in the JASPAC 06 study. Patients screened for UGT1A1*6 and UGT1A1*28, and treated with either the original FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 180 mg/m2, leucovorin 200 mg/m2, bolus 5‐fluorouracil [5‐FU] 400 mg/m2, and continuous 5‐FU 2400 mg/m2) or a modified FOLFIRINOX (oxaliplatin 85 mg/m2, irinotecan 150 mg/m2, leucovorin 200 mg/m2, and continuous 5‐FU 2400 mg/m2) as first‐line chemotherapy were included. Of 199 patients eligible for this analysis, 79 patients were treated with the original FOLFIRINOX regimen and 120 patients were treated with the modified FOLFIRINOX regimen. In the original FOLFIRINOX group, 54 were UGT1A1 WT, and 25 were UGT1A1 heterozygous type (−/*6, 12 patients; −/*28, 13 patients). In the modified FOLFIRINOX group, 64 were UGT1A1 WT and 56 were UGT1A1 heterozygous type (−/*6, 33 patients; −/*28, 23 patients). In the original FOLFIRINOX group, the incidence of diarrhea was significantly higher among patients with UGT1A1 heterozygous type than among those with UGT1A1 WT and the incidence of leukopenia and diarrhea was significantly higher among patients with UGT1A1 −/*6 than among those with UGT1A1 −/*28. Patients with UGT1A1 heterozygous type, especially those with UGT1A1 −/*6, tended to show a higher incidence rate of severe adverse events, but this was not statistically significant. However, for patients who received the modified FOLFIRINOX, there was no difference in the frequency of adverse events due to UGT1A1 status. In conclusion, patients with heterozygous UGT1A1 polymorphisms treated with the original FOLFIRINOX regimen experienced severe toxicity more frequently than patients with WT UGT1A1.
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Affiliation(s)
- Hiromichi Shirasu
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Akiko Todaka
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiro Omae
- Clinical Research Promotion Unit, Clinical Research Center, Shizuoka Cancer Center, Shizuoka, Japan
| | - Hirofumi Fujii
- Department of Clinical Oncology, Jichi Medical University Hospital, Tochigi, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Masato Ozaka
- Department of Gastroenterology, The Cancer Institute Hospital of the Japanese Foundation For Cancer Research, Tokyo, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Kobayashi
- Department of Gastroenterology, Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Kanagawa, Japan
| | - Kazuhiro Uesugi
- Departments of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | | | - Hideyuki Hayashi
- Department of Gastroenterology and Hepatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Kentaro Sudo
- Division of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Faculty of Medicine, Kyorin University, Tokyo, Japan
| | - Yosuke Horita
- Department of Chemotherapy and Internal Medicine, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Keiko Kamei
- Departments of Surgery, Faculty of Medicine, Kindai University, Osaka, Japan
| | - Seigo Yukisawa
- Departments of Medical Oncology, Tochigi Cancer Center, Tochigi, Japan
| | - Marina Kobayashi
- Clinical Trial Promotion Section, Shizuoka Industrial Foundation Pharma Valley Center, Shizuoka, Japan
| | - Akira Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka, Japan
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Kiuchi Z, Ogura M, Sato M, Kamei K, Ishikura K, Abe J, Ito S. No preventive or therapeutic efficacy of infliximab against macrophage activation syndrome due to systemic juvenile idiopathic arthritis. Scand J Rheumatol 2018; 48:246-248. [PMID: 30406708 DOI: 10.1080/03009742.2018.1493745] [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: 10/27/2022]
Affiliation(s)
- Z Kiuchi
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan.,b Department of Paediatrics , Kyorin University School of Medicine , Tokyo , Japan
| | - M Ogura
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan
| | - M Sato
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan
| | - K Kamei
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan
| | - K Ishikura
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan
| | - J Abe
- c Department of Allergy and Immunology , National Center for Child Health and Development , Tokyo , Japan
| | - S Ito
- a Department of Nephrology and Rheumatology , National Center for Child Health and Development , Tokyo , Japan.,d Department of Paediatrics, Graduate School of Medicine , Yokohama City University , Kanagawa , Japan
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Morinaga S, Takita M, Yoshizawa A, Kamei K, Nakamori S, Ishihara S, Kuramochi H, Yokoyama Y, Uchiyama T, Murohisa G, Kobayashi M, Todaka A, Fukutomi A. FOLFIRINOX for recurrent pancreatic cancer after resection: Nationwide multicenter observational study by Japan adjuvant study group of pancreatic cancer (JASPAC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Terajima H, Kobayashi S, Nagano H, Tomokuni A, Gotoh K, Sakai D, Hatano E, Seo S, Uchida Y, Ajiki T, Satake H, Kamei K, Tohyama T, Hirose T, Ikai I, Morita S, Ioka T. A randomized phase II trial of adjuvant chemotherapy with gemcitabine versus S-1 after major hepatectomy for biliary tract cancer: Kansai Hepato-Biliary Oncology Group (KHBO1208). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy282.145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Saida K, Kamei K, Ogura M, Matsumura S, Kano Y, Sato M, Andoh A, Ishikura K. Azathioprine-induced Agranulocytosis and Severe Alopecia After Kidney Transplantation Associated With a NUDT15 Polymorphism: A Case Report. Transplant Proc 2018; 50:3925-3927. [PMID: 30577288 DOI: 10.1016/j.transproceed.2018.04.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 04/12/2018] [Indexed: 01/17/2023]
Abstract
BACKGROUND Azathioprine (AZA) is the drug recommended for the continuation of immunosuppressive treatment after renal transplant in women during pregnancy. CASE REPORT A 37-year-old Japanese female developed agranulocytosis and severe alopecia after initiation of AZA (50 mg), used as an alternative to mycophenolate mofetil (MMF, 1000 mg) therapy in anticipation of a planned pregnancy. Within 4 days of the initiation of AZA therapy, the patient developed a high fever, leucopenia, and cranial alopecia. Genetic testing revealed a homozygous polymorphism of NUDT15 (rs116855232, NM_018283.3:c.415C>T: p.Arg139Cys), which has previously been identified as a risk factor for AZA-related complications in patients with inflammatory bowel disease. CONCLUSION Genetic screening for NUDT15 could contribute to the prevention of serious adverse reactions to AZA and provide the opportunity for personalized medicine. Identification of a safe alternative to MMF during pregnancy after a renal transplant is a problem to be resolved in the future.
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Affiliation(s)
- K Saida
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - K Kamei
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - M Ogura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - S Matsumura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - Y Kano
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - M Sato
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan
| | - A Andoh
- Department of Medicine, Shiga University of Medical Science, Shiga, Japan
| | - K Ishikura
- Division of Nephrology and Rheumatology, National Center for Child Health and Development, Tokyo, Japan.
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Ueno M, Yamanaka T, Ogura T, Yamaguchi A, Mizuno N, Ozaka M, Ueno H, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Hosokawa T, Henmi T, Kobayashi M, Todaka A, Fukutomi A. The influence of biliary drainage in patients with advanced pancreatic cancer receiving FOLFIRINOX. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.4_suppl.378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
378 Background: FOLFIRINOX (FFX) is a standard of care for patients (pts) with advanced pancreatic cancer (APC). In the original FFX report by Conroy (NEJM, 2011), pts with a biliary drainage were limited and the occurrence of cholangitis was not reported. In practice, however, we experience that a certain fraction of APC pts needs a biliary drainage and some of them have an elevated risk of cholangitis or febrile neutropenia (FN) during the course of FFX. We evaluated the influence of biliary drainage on the efficacy and safety of FFX. Methods: We used individual data from nationwide survey of FFX (JASPAC06). The JASPAC06 was a prospective registry of pts with FFX treated in clinical practice and enrolled 399 pts between December 2013 and November 2014 from 27 centers in Japan. We evaluated the associations of OS and PFS, as well as the frequencies of cholangitis and FN, with the use of biliary drainage. We excluded resected cases because an operative method with choledochojejunostomy was unknown. Results: Of 399 pts in the JASPAC06, 319 were eligible for this analysis and 80 resected cases were excluded. The use of biliary drainage was seen in 28% of pts (mainly bile duct stent inserted); primary dose reduction (modified FFX), 67%; previously untreated tumor, 77%; distant metastases, 76%; pancreas head, 47%. The main results are shown in the table. In summary, cholangitis was more frequent in pts with biliary drainage. Grade 3 or higher FN as well as CRP elevation was observed more frequently in pts with biliary drainage. There was no difference in PFS (median PFS, 7.3 vs. 6.5 mo; logrank, p=0.24) and OS (median OS, 12.3 vs. 12.2 mo; p=0.86) between the two groups. Conclusions: Our observation that the frequency of FN and CRP elevation was significantly higher in pts with biliary drainage indicates a higher risk of infection during the FFX treatment by using biliary drainage.[Table: see text]
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Affiliation(s)
- Makoto Ueno
- Department of Gastroenterology Hepatobiliary and Pancreatic Medical Oncology Division, Yokohama, Japan
| | | | - Takashi Ogura
- St. Marianna University School of Medicine, Kawasaki, Japan
| | | | | | - Masato Ozaka
- Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Kazuhiro Uesugi
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | | | | | | | | | | | | | | | | | - Marina Kobayashi
- Pharma Valley Center, Clinical Trial Promotion Section, Nagaizumi-Cho, Sun-Gun, Japan
| | - Akiko Todaka
- Shizuoka General Hospital Cancer Center, Shizuoka, Japan
| | - Akira Fukutomi
- Shizuoka General Hospital Cancer Center, Shizuoka, Japan
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Fujii M, Tsunoda N, Hattori M, Murata T, Akahane K, Kamei K, Goto Y, Amemiya T, Nishimae K, Kubota T, Ito Y, Kurumiya Y, Yoshihara M, Nakanishi K, Kikumori T, Ando M, Nagino M. The efficacy of eribulin mesylate with trastuzumab for locally advanced or metastatic HER2-positive breast cancer treated with prior pertuzumab and/or T-DM1: Results from a phase II, single arm, multicenter study (N-SOG 10 study). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx654.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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42
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Kamei K, Matsumoto I, Makutani Y, Kawaguchi K, Matsumoto M, Murase T, Satoi S, Nakai T, Kamata K, Imai H, Chikugo T, Takeyama Y. [A Case of Conversion Surgery for a Patient with Initially Unresectable Pancreatic Cancer with a Pathological Complete Response to S-1 Chemotherapy]. Gan To Kagaku Ryoho 2017; 44:1191-1193. [PMID: 29394577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We present a case ofa 67-year-old woman with Stage IV pancreatic head cancer with invasion to the superior mesenteric vein and artery, and distant lymph node metastases. The patient received S-1 mono-chemotherapy. After 2 courses of chemotherapy, the tumor marker was decreased to the normal levels, and the tumor size was dramatically reduced with undetectable lymph node metastases on CT. As the disease status was maintained following chemotherapy, the patient underwent subtotal stomach preserving pancreaticoduodenectomy, 8 months after initiation of the chemotherapy. Histopathologically, no cancer cells were found in the main tumor and dissected lymph nodes. Final diagnosis was made with pathological complete response. The patient was alive without recurrence for 10 months after surgery.
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Affiliation(s)
- Keiko Kamei
- Dept. of Surgery, Kindai University Faculty of Medicine
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43
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Sasaki M, Ueno H, Omae K, Goto T, Murohisa G, Mizuno N, Ozaka M, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Hosokawa T, Henmi T, Kobayashi M, Todaka A, Fukutomi A. Risk factors for febrile neutropenia (FN) in unresectable/recurrent pancreatic cancer(PC) patients(pts) receiving FOLFIRINOX (FFX) from JASPAC06 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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44
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Shirasu H, Omae K, Fujii H, Mizuno N, Ozaka M, Ueno H, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Seigo Y, Takafumi H, Henmi T, Kobayashi M, Todaka A, Fukutomi A. The impact of UGT1A1 genetic polymorphism on safety in unresectable pancreatic cancer patients receiving FOLFIRINOX therapy: A subset analysis of JASPAC 06 study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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45
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Hattori M, Shimizu A, Oikawa D, Kamei K, Kaira K, Ishida-Yamamoto A, Nakano H, Sawamura D, Tokunaga F, Ishikawa O. Endoplasmic reticulum stress in the pathogenesis of pretibial dystrophic epidermolysis bullosa. Br J Dermatol 2017; 177:e92-e93. [DOI: 10.1111/bjd.15342] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- M. Hattori
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - A. Shimizu
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - D. Oikawa
- Laboratory of Molecular Cell Biology; Institute for Molecular and Cellular Regulation; Gunma University; Maebashi Gunma Japan
- Department of Pathobiochemistry; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - K. Kamei
- Laboratory of Molecular Cell Biology; Institute for Molecular and Cellular Regulation; Gunma University; Maebashi Gunma Japan
| | - K. Kaira
- Department of Oncology Clinical Development; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
| | - A. Ishida-Yamamoto
- Department of Dermatology; Asahikawa Medical University; Asahikawa Hokkaido Japan
| | - H. Nakano
- Department of Dermatology; Hirosaki University Graduate School of Medicine; Hirosaki Aomori Japan
| | - D. Sawamura
- Department of Dermatology; Hirosaki University Graduate School of Medicine; Hirosaki Aomori Japan
| | - F. Tokunaga
- Laboratory of Molecular Cell Biology; Institute for Molecular and Cellular Regulation; Gunma University; Maebashi Gunma Japan
- Department of Pathobiochemistry; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - O. Ishikawa
- Department of Dermatology; Gunma University Graduate School of Medicine; Maebashi Gunma Japan
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46
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Mizuno N, Todaka A, Mori K, Boku N, Ozaka M, Ueno H, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Yukisawa S, Nakamori S, Yachi Y, Henmi T, Kobayashi M, Fukutomi A. Observational study of FOLFIRINOX (FFX) for unresectable/recurrent pancreatic cancer (PC) in Japanese patients (pts)(JASPAC 06): final results. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw371.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Nanno S, Nakane T, Okamura H, Nishimoto M, Koh H, Nakamae H, Ohsawa M, Yarita K, Kamei K, Hino M. DisseminatedHormographiella aspergillatainfection with involvement of the lung, brain, and small intestine following allogeneic hematopoietic stem cell transplantation: case report and literature review. Transpl Infect Dis 2016; 18:611-6. [DOI: 10.1111/tid.12561] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 04/02/2016] [Indexed: 11/30/2022]
Affiliation(s)
- S. Nanno
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - T. Nakane
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - H. Okamura
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - M. Nishimoto
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - H. Koh
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - H. Nakamae
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - M. Ohsawa
- Diagnostic Pathology; Graduate School of Medicine; Osaka City University; Osaka Japan
| | - K. Yarita
- Medical Mycology Research Center; Chiba University; Chiba Japan
| | - K. Kamei
- Medical Mycology Research Center; Chiba University; Chiba Japan
| | - M. Hino
- Hematology; Graduate School of Medicine; Osaka City University; Osaka Japan
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48
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Kohno K, Terao T, Hatano K, Kodama K, Makino M, Mizokami Y, Kamei K, Sakai A, Shirahama M, Hirakawa H, Kashino G, Matsumoto S, Mori H, Ohashi K, Yano T. Postcomparison of [(18) F]-fluorodeoxyglucose uptake in the brain after short-term bright light exposure and no intervention. Acta Psychiatr Scand 2016; 134:65-72. [PMID: 27028708 DOI: 10.1111/acps.12569] [Citation(s) in RCA: 8] [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] [Accepted: 02/22/2016] [Indexed: 12/01/2022]
Abstract
OBJECTIVE Bright light therapy is widely used as the treatment of choice for seasonal affective disorder. Nonetheless, our understanding of the mechanisms of bright light is limited and it is important to investigate the mechanisms. The purpose of this study is to examine the hypothesis that bright light exposure may increase [(18) F]-fluorodeoxyglucose (FDG) uptake in olfactory bulb and/or hippocampus which may be associated neurogenesis in the human brain. METHOD A randomized controlled trial comparing 5-day bright light exposure + environmental light (bright light exposure group) with environmental light alone (no intervention group) was performed for 55 participants in a university hospital. The uptake of [(18) F]FDG in olfactory bulb and hippocampus using FDG positron emission tomography was compared between two groups. RESULTS There was a significant increase of uptake in both right and left olfactory bulb for bright light exposure group vs. no intervention group. After adjustment of log-transformed illuminance, there remained a significant increase of uptake in the right olfactory bulb. CONCLUSION The present findings suggest a possibility that 5-day bright light exposure may increase [(18) F]FDG in the right olfactory bulb of the human brain, suggesting a possibility of neurogenesis. Further studies are warranted to directly confirm this possibility.
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Affiliation(s)
- K Kohno
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - T Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Hatano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Kodama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - M Makino
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - Y Mizokami
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Kamei
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - A Sakai
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - M Shirahama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - H Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - G Kashino
- Advanced Molecular Imaging Center, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - S Matsumoto
- Department of Radiology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - H Mori
- Department of Radiology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - K Ohashi
- Department of Clinical Pharmacology, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
| | - T Yano
- Advanced Molecular Imaging Center, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan.,Engineering Department, Industrial Equipment Division, Sumitomo Heavy Industries Ltd, Shinagawa, Tokyo, Japan.,Department of Nuclear Medicine, Oita University Faculty of Medicine, Yufu City, Oita Prefecture, Japan
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49
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Kamei K, Terao T, Katayama Y, Hatano K, Kodama K, Shirahama M, Sakai A, Hirakawa H, Mizokami Y, Shiotsuki I, Ishii N, Inoue Y. A Predictive Model of Plasma Lamotrigine Levels. Pharmacopsychiatry 2016; 49:182-185. [PMID: 27111132 DOI: 10.1055/s-0042-105570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Introduction: Lamotrigine is one of several mood stabilizers and its effects for the treatment and prevention of depressive episodes, particularly in bipolar disorder, are generally accepted. Although the findings about a therapeutic window of lamotrigine are yet to be determined, it seems important to obtain information on individual pharmacokinetic peculiarities. This study was conducted to formulate the predictive model of plasma lamotrigine levels. Methods: Using the data of 47 patients whose lamotrigine levels, liver function, and renal function were measured, predictive models of lamotrigine levels were formulated by stepwise multiple regression analyses. The predictive power of the models was compared using another dataset of 25 patients. Results: Two models were created using stepwise multiple regression. The first model was: plasma lamotrigine level (μg/mL)=2.308+0.019×lamotrigine dose (mg/day). The second model was: plasma lamotrigine level (μg/mL)=0.08+0.024×lamotrigine dose (mg/day)+4.088×valproate combination (no=0, yes=1). The predictive power of the second model was better than that of the first model. Discussion: The present study proposes a prompt and relatively accurate equation to predict lamotrigine levels.
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Affiliation(s)
- K Kamei
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - T Terao
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - Y Katayama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - K Hatano
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - K Kodama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - M Shirahama
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - A Sakai
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - H Hirakawa
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - Y Mizokami
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - I Shiotsuki
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - N Ishii
- Department of Neuropsychiatry, Oita University Faculty of Medicine, Yufu, Japan
| | - Y Inoue
- General Research Clinical Center, Oita University Hospital, Japan
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50
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Ozaka M, Todaka A, Mori K, Boku N, Mizuno N, Ueno H, Kobayashi S, Uesugi K, Kobayashi N, Hayashi H, Sudo K, Okano N, Horita Y, Kamei K, Yukisawa S, Nakamori S, Yachi Y, Henmi T, Kobayashi M, Fukutomi A. JASPAC 06: Observational study of FOLFIRINOX therapy for unresectable and recurrent pancreatic cancer—Preliminary report on serious adverse events. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.4_suppl.407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
407 Background: In Japan, indication of FOLFIRINOX for unresectable and recurrent pancreatic cancer was approved in 2013. Because clinical data of FOLFIRINOX in Japanese patients based on only one exploratory trial is limited, this observational study was conducted to survey practical use of FOLFIRINOX and to evaluate incidences of adverse events in Japanese patients. Methods: The subjects were patients with unresectable or recurrent pancreatic cancer who received FOLFIRINOX therapy during one year from Dec. 20, 2013 (approval date of this study). All the subjects were registered and their clinical data were sent to the data center. In this preliminary report, we analyzed patients’ characteristics related to serious adverse event (SAE). This study was approved by the IRB in each institution. Results: Four hundred patients (pts) were registered from 27 institutions in Japan. Median age was 63 years (range 27-80). Sixty-four percent (n = 254) had no prior treatment and 254 pts (60%) had distant metastatic lesions. The UGT1A1 genotype was wild-type in 56.8% of the subjects, heterozygous (*1/*6, *1/*28) in 39.3%, and homozygous (*6/*6, *6/*28, *28/*28) in 3.9%. One hundred forty-one SAEs in 115 pts (28.8%) were reported until Aug. 10, 2015. Most common SAEs were febrile neutropenia (n = 26), neutrophil count decreased (n = 26), anorexia (n = 21) and biliary tract infection (n = 18). Of these 141 events, five events were results in death. The proportion of patients who met the inclusion criteria (as follows: ECOG PS of 0 or 1; age 20-75 years; adequate hematological, liver and renal functions) used in the phase II trial of FOLFIRINOX for Japanese patients was significantly lower in the subjects with SAEs than those without SAE (60.5% vs. 72.4%, p = 0.023). Four of the 5 pts who resulted in death did not fulfill the inclusion criteria; C-reactive protein in 4, platelet count in 1 and hemoglobin in 1. Conclusions: This is a first report to evaluate the safety profile of FOLFIRINOX in Japanese pancreatic cancer patients. These data highlight the importance of patient selection for FOLFIRINOX. The final safety and efficacy results of this study will be reported at the coming meeting. Clinical trial information: UMIN000014658.
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Affiliation(s)
- Masato Ozaka
- Department of Gastroenterology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan
| | | | - Keita Mori
- Clinical Research Center, Shizuoka Cancer Center Hospital, Shizuoka, Japan
| | - Narikazu Boku
- Gastrointestinal Medical Oncology Division, National Cancer Center Hospital, Tokyo, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Hideki Ueno
- Division of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Satoshi Kobayashi
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Kazuhiro Uesugi
- National Hospital Organization Shikoku Cancer Center, Matsuyama, Japan
| | - Noritoshi Kobayashi
- Department of Oncology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hideyuki Hayashi
- Department of Gastroenterology and Hepatology, Hokkaido University, Hokkaido, Japan
| | - Kentaro Sudo
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Naohiro Okano
- Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan
| | | | - Keiko Kamei
- Department of Surgery, Faculty of Medicine, Kinki University, Osakasayama, Japan
| | | | - Shoji Nakamori
- Department of Hepatobiliary and Pancreatic Surgery, Osaka National Hospital, Osaka-Shi, Japan
| | - Yutaka Yachi
- Safety and Risk Management Department, Daiichi Sankyo Company, Ltd., Tokyo, Japan
| | - Toshiyuki Henmi
- Post-Marketing Surveillance Pharmacovigilance Department, Yakult Honsha Company, LTD, Tokyo, Japan
| | - Marina Kobayashi
- Pharma Valley Center, Clinical Trial Promotion Section, Nagaizumi-Cho, Sun-Gun, Japan
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