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Seo S, Kuwada A, Hashimoto T, Kuhara Y, Amioka A, Murao N, Nakashima A, Sakabe R, Hotei H, Tahara K, Nagata S, Dohi Y. [Hemorrhagic Colon Cancer with Left Atrial Thrombus Formation after Anticoagulant Therapy Discontinuation-A Case Report]. Gan To Kagaku Ryoho 2023; 50:1548-1550. [PMID: 38303337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
The patient was a 72-year-old female. She had been taking rivaroxaban for chronic atrial fibrillation; however, she stopped taking it due to anemia and was hospitalized urgently. A contrast-enhanced computed tomography(CT)scan showed a 30 mm mass in the ascending colon, and a colonoscopy revealed ascending colon cancer(cT3, cN0, cM0, cStage Ⅱa). The tumor was hemorrhagic and was thought to have caused the anemia. On day 6 of hospitalization, another contrast- enhanced CT scan showed a poorly contrast-enhanced area in the left atrium, and transesophageal echocardiography revealed 2 left atrial thrombi(27 mm and 17 mm). Since early induction of anticoagulation therapy was considered, an emergency open right colectomy was performed to remove the cause of the bleeding. Intravenous heparin therapy was started the day after surgery and was switched to oral apixaban therapy on the fourth postoperative day. The postoperative course was good, and she was discharged home on the 17th postoperative day. This patient had conflicting clinical problems simultaneously; however, immediate decision-making and initiation of treatment were effective.
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Kuhara Y, Hotei H, Hashimoto T, Seo S, Amioka A, Murao N, Kuwada A, Nakashima A, Sakabe R, Tahara K. Successful omental flap coverage repair of a rectovaginal fistula after low anterior resection: a case report. Surg Case Rep 2023; 9:61. [PMID: 37071261 PMCID: PMC10113401 DOI: 10.1186/s40792-023-01642-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 04/10/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Rectovaginal fistula (RVF) is a troublesome and refractory complication after low anterior resection (LAR) for rectal cancer. An omental flap repair was performed for the RVF caused due to Crohn's disease and childbirth trauma. However, there are few cases of an omental flap repair for RVF after LAR. Herein, we present a successfully repaired case of RVF by omental flap coverage after LAR for rectal cancer. CASE PRESENTATION A 50-year-old female patient with advanced rectal cancer underwent laparoscopic LAR with double-stapling technique anastomosis and achieved curative resection. She complained of a stool from the vagina and was diagnosed with RVF on the postoperative day (POD) 18. Conservative therapy was ineffective. We performed laparoscopic fistula resection and direct closure of the vagina and rectum, designed the omentum that could reach the pelvis, repaired RVF by omental flap coverage, and performed transverse colostomy on POD 25. She was discharged on initial POD 48. Seven months after the initial operation, colostomy closure was administered. There was no recurrence of RVF found 1 year after the initial operation. CONCLUSIONS The patient achieved an omental flap coverage for RVF. We successfully performed the omental flap coverage repair in patients with RVF after the leakage of LAR. An omental flap may become an alternative treatment for muscle flap or an effective treatment for RVF.
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Affiliation(s)
- Yuta Kuhara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan.
| | - Hiroshi Hotei
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Tatsunori Hashimoto
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Shingo Seo
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ai Amioka
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Naoki Murao
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Aki Kuwada
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Akira Nakashima
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Ryutaro Sakabe
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
| | - Kou Tahara
- Department of Surgery, Kure Kyosai Hospital, Nishityuo-2-3-28, Kure, Hiroshima, 730-0802, Japan
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Amioka A, Kidate K, Ito R, Murao N, Kuwada A, Nakashima A, Sakabe R, Tahara K, Hotei H. P51-3 Examination of CARG toxicity scores in palbociclib therapy for elderly patients with breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Sakabe R, Sakoda T, Yoshimura K, Murao N, Kuwada A, Tahara K, Hotei H, Maeda Y. [Locally Advanced Rectal Cancer Presenting with Perforation That Was Successfully Resected after Preoperative Chemotherapy with mFOLFOX6 plus Panitumumab]. Gan To Kagaku Ryoho 2019; 46:475-477. [PMID: 30914588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We report a case of locally advanced rectal cancer presenting with perforation that was successfully resected after preoperative chemotherapy. A 66-year-old woman visited our emergency room complaining of lower abdominal pain. Abdominal CT showed a rectal tumor with fluid collection and free air in the pelvis. The patient was diagnosed with panperitonitis secondary to cancerous perforation and underwent sigmoid colostomy. A biopsy specimen of the rectal tumor showed well-differentiated tubular adenocarcinoma and wild-type RAS. After 8 courses of mFOLFOX6 plus panitumumab, the tumor shrank remarkably, and radical surgery(low anterior resection with D3 lymph node dissection)was performed. Microscopic examination of the resected specimen showed that almost half of the tumor cells were replaced by histiocytes and necrotic tissue. Preoperative chemotherapy with panitumumab may be an effective treatment for RAS wild-type locally advanced colon cancer, even if the primary tumor develops perforation.
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Sakabe R, Shirakawa K, Yoshimura K, Otsuka H, Kuwada A, Tahara K, Hotei H, Maeda Y. [Nephrotic Syndrome Induced by Ramucirumab for Metastatic Rectal Cancer]. Gan To Kagaku Ryoho 2018; 45:1205-1207. [PMID: 30158421] [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: 06/08/2023]
Abstract
We report a case of nephrotic syndrome induced by ramucirumab for metastatic rectal cancer. A 48-year old woman who had received FOLFIRI plus ramucirumab for rectal cancer with liver, lung, and bone metastases presented to our hospital with edema and increased body weight. Laboratory studies showed hypoalbuminemia and severe proteinuria, and the patient was diagnosed with nephrotic syndrome. After administration of an angiotensin II receptor blocker and thiazide diuretic, her symptoms disappeared and serum albumin level normalized. To the best of our knowledge, this is the first detailed report of nephrotic syndrome related to ramucirumab. This case serves to emphasize that the possibility of nephrotic syndrome should be considered during anti-vascular endothelial growth factor therapy.
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Sebastião FA, Nomura D, Sakabe R, Pilarski F. Hematology and Productive Performance of Nile Tilapia (Oreochromis niloticus) Naturally Infected With Flavobacterium columnare. Braz J Microbiol 2013; 42:282-9. [PMID: 24031633 PMCID: PMC3768935 DOI: 10.1590/s1517-83822011000100036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Revised: 03/31/2010] [Accepted: 06/21/2010] [Indexed: 11/22/2022] Open
Abstract
Columnaris disease is one of the main causes of mortality in tilapia rearing and is responsible for large economic losses worldwide. Hematology is a tool that makes it possible to study organisms’ physiological responses to pathogens. It may assist in making diagnoses and prognoses on diseases in fish populations. The hematological variables of nile tilapia were studied in specimens with a clinical diagnosis of columnaris disease and in specimens that were disease-free. The total erythrocyte count, hemoglobin rate, hematocrit percentage, mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), mean corpuscular volume (MCV), organic defense blood cell percentages (leukocytes and thrombocytes) and hepatosomatic and splenosomatic index were determined. The results showed that there were changes in the erythrocytic series and in organic defense blood cells, in the fish infected with the bacterium, with reductions in erythrocytic variables and significant increases in the numbers of circulating lymphocytes and neutrophils.
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Affiliation(s)
- F A Sebastião
- Programa de Pós-Graduação em Microbiologia Aplicada à Agropecuária, Universidade Estadual Paulista , Jaboticabal, SP , Brasil
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Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Sakabe R, Kobayashi H, Kondo N, Nakagawa N, Sueda T. Adjuvant chemotherapy with gemcitabine and S-1 after surgical resection for advanced biliary carcinoma: outcomes and prognostic factors. J Hepatobiliary Pancreat Sci 2013; 19:306-13. [PMID: 22270151 DOI: 10.1007/s00534-011-0498-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND/PURPOSE The aims of this study were to evaluate long-term outcomes and to determine prognostic factors for survival in patients with resected biliary carcinoma who received adjuvant gemcitabine plus S-1 chemotherapy. METHODS Seventy patients with International Union Against Cancer (UICC) stage II, III, or IV biliary carcinoma received postoperative adjuvant chemotherapy consisting of intravenous gemcitabine 700 mg/m(2) on day 1 and oral S-1 60-100 mg/body for seven consecutive days, followed by a 1-week pause of chemotherapy. Patients received up to ten 2-week cycles. Long-term outcomes and predictors of survival with this adjuvant chemotherapy regimen were analyzed. RESULTS The median duration of follow-up was 47 months. Fifty-six percent of patients had node-positive disease, and 80% of patients underwent R0 resection. Overall and disease-free survival rates were 91 and 81% at 1 year, 56 and 55% at 3 years, and 40 and 46% at 5 years, respectively. Lymph node status (p = 0.025) and surgical margin status (p = 0.033) were independently associated with long-term survival by multivariate analysis. CONCLUSIONS Adjuvant gemcitabine plus S-1 chemotherapy may be a promising strategy for patients with resected biliary carcinoma, and nodal status and surgical margin status may be predictors of survival with this treatment strategy.
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Affiliation(s)
- Yoshiaki Murakami
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima 734-8551, Japan.
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Sakabe R, Murakami Y, Uemura K, Sudo T, Hashimoto Y, Kondo N, Nakashima A, Ohge H, Sueda T, Hiyama E. Prognostic Significance of Telomerase Activity and Human Telomerase Reverse Transcriptase Expression in Ampullary Carcinoma. Ann Surg Oncol 2012; 19:3072-80. [DOI: 10.1245/s10434-012-2245-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Indexed: 12/19/2022]
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Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, Sakabe R, Kobayashi H, Sueda T. Prognostic factors of patients with advanced gallbladder carcinoma following aggressive surgical resection. J Gastrointest Surg 2011; 15:1007-16. [PMID: 21547707 DOI: 10.1007/s11605-011-1479-9] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2011] [Accepted: 02/27/2011] [Indexed: 01/31/2023]
Abstract
BACKGROUND The prognosis for patients with advanced gallbladder carcinoma is dismal despite aggressive surgical resection. The aim of this study is to determine useful prognostic factors for patients with gallbladder carcinoma following aggressive surgical resection. METHODS Medical records of 62 patients with gallbladder carcinoma who underwent surgical resection were retrospectively reviewed. Univariate and multivariate models were used to analyze the effect of clinicopathological factors on long-term survival. RESULTS According to the UICC staging system, ten (16%), 11 (18%), eight (13%), 16 (25%), nine (15%), and eight patients (13%) were diagnosed with stages I, II, IIIA, IIIB, IVA, and IVB disease, respectively. Partial hepatectomy and pancreatoduodenectomy were performed for 43 (69%) and 11 (18%) patients, respectively. Overall survival rates of all 62 and 41 patients with UICC stages III and IV disease were 71% and 56% at 1 year, 48% and 23% at 3 years, and 48% and 23% at 5 years, respectively (median survival time, 15.8 and 12.7 months, respectively). Multivariate analysis revealed that independent prognostic factors included tumor differentiation (p = 0.006), hepatic invasion (p = 0.002), lymph node metastasis (p = 0.009), and surgical margin status (p = 0.002) for all patients, and adjuvant chemotherapy (p = 0.005), tumor differentiation (p = 0.008), hepatic invasion (p = 0.001), and surgical margin status (p = 0.022) for patients with UICC stages III and IV disease. CONCLUSIONS R0 resection and adjuvant chemotherapy are significant prognostic factors in advanced gallbladder carcinoma and should be performed to improve survival.
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Affiliation(s)
- Yoshiaki Murakami
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
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Sakabe R, Lyle JM, Crawford CM. The influence of freshwater inflows on spawning success and early growth of an estuarine resident fish species, Acanthopagrus butcheri. J Fish Biol 2011; 78:1529-1544. [PMID: 21539557 DOI: 10.1111/j.1095-8649.2011.02959.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The influence of freshwater inflows and salinity on spawning success of black bream Acanthopagrus butcheri (Sparidae) was investigated over 2 years in a small estuary on the east coast of Tasmania, Australia. The individual spawning seasons experienced quite different freshwater inflows; 2004-2005 was characterized by low flows throughout the season whereas during 2005-2006 there were three relatively large discharge events in the first part of the season. Macroscopic gonad staging of adults was used to define the spawning season and daily increment analysis of otoliths from recently settled recruits was used to backcalculate spawning dates. Gonad staging indicated that adults were in spawning condition over a 3 to 4 month period during spring and summer. The timing and duration of successful spawning, however, differed markedly between years and was linked to the timing of freshwater inflows and salinity conditions, with successful spawning occurring during periods of low freshwater discharge and when salinities in the upper estuary were above c. 15. Growth rates of the recently settled recruits did not differ between years, nor did the timing of spawning within the season influence growth rates. While the latter finding was unexpected, especially given within season temperature variability, these results imply that by the onset of winter earlier spawned fish would be larger than later spawned individuals, potentially conferring advantages for survival and competition for food. Climate change predictions for eastern Tasmania indicate a decrease in river flows in spring and an increase during summer, potentially increasing environmental variability between and within years, with implications for spawning success and subsequent recruitment.
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Affiliation(s)
- R Sakabe
- Marine Research Laboratories, Tasmanian Aquaculture and Fisheries Institute, University of Tasmania, Private Bag 49, Hobart, Tasmania 7001, Australia.
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Murakami Y, Uemura K, Sudo T, Hashimoto Y, Nakashima A, Kondo N, Sakabe R, Ohge H, Sueda T. Prognostic factors after surgical resection for intrahepatic, hilar, and distal cholangiocarcinoma. Ann Surg Oncol 2010; 18:651-8. [PMID: 20945107 DOI: 10.1245/s10434-010-1325-4] [Citation(s) in RCA: 168] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND The prognosis of patients with cholangiocarcinoma is unsatisfactory. Therefore, evaluation of prognostic factors and establishment of new therapeutic strategies are needed to improve their long-term survival. The aim of this study was to identify useful prognostic factors for patients with intrahepatic, hilar, and distal cholangiocarcinoma. MATERIALS AND METHODS Records of 127 patients with cholangiocarcinoma (21 with intrahepatic cholangiocarcinoma, 50 with hilar cholangiocarcinoma, and 56 with distal cholangiocarcinoma) who underwent surgical resection were reviewed retrospectively. Relationships between survival and clinicopathological factors including patient demographics and tumor characteristics were evaluated using univariate and multivariate analysis. RESULTS For all 127 patients, overall 1-, 3-, 5-year survival rates were 80, 51, and 40%, respectively. Univariate analysis revealed that adjuvant chemotherapy (P = .049), tumor differentiation (P = .014), lymph node metastasis (P < .001), surgical margin status (P < .001), UICC pT factor (P < .001), and UICC stage (P < .001) were associated significantly with survival. UICC pT factor (P = .007), adjuvant chemotherapy (P = .009), surgical margin status (P = .012), and lymph node metastasis (P = .014) remained independently associated with long-term survival by multivariate analysis. The 5-year survival rates of patients with or without positive surgical margins were 13 and 49%, respectively. The 5-year survival rates of patients treated with or without adjuvant chemotherapy were 47 and 36%, respectively. CONCLUSIONS R0 resection and adjuvant chemotherapy may be mandatory to achieve long-term survival for patients with cholangiocarcinoma.
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Affiliation(s)
- Yoshiaki Murakami
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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Sakabe R, Lyle JM. The influence of tidal cycles and freshwater inflow on the distribution and movement of an estuarine resident fish Acanthopagrus butcheri. J Fish Biol 2010; 77:643-660. [PMID: 20701645 DOI: 10.1111/j.1095-8649.2010.02703.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Movement patterns and habitat utilization by black bream Acanthopagrus butcheri (Sparidae), an estuarine resident species, were investigated using acoustic telemetry in a small estuary on the east coast of Tasmania, Australia. Thirty-four adult A. butcheri were tracked for periods of up to 187 days between August 2005 and January 2006. Although able to tolerate a wide range of salinities, the fish spent most of the time within the upper and middle regions of the estuary, where brackish conditions dominated. The species exhibited extensive movements linked to tidal cycles, with small-scale upstream movements during incoming tides and downstream movements during out going tides. The extent of these movements was positively correlated with the tidal height difference between consecutive tidal peaks and troughs. Freshwater inflows and resultant changes in salinity also significantly influenced distribution and movement patterns. Fish moved downstream during the periods of heavy inflows, returning upstream as salinities increased to c. >10. During the peak of spawning period (November to December) fish moved into the upper region of the estuary, where they aggregated to spawn. Periodic increases in freshwater discharge, however, resulted in fish leaving the spawning grounds and moving downstream. Towards the end of the spawning season (January), the fish became more dispersed throughout the entire estuarine system.
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Affiliation(s)
- R Sakabe
- Marine Research Laboratories, Tasmanian Aquaculture and Fisheries Institute, University of Tasmania, Private Bag 49, Hobart, Tasmania 7001, Australia.
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Kondo N, Murakami Y, Uemura K, Hayashidani Y, Sudo T, Hashimoto Y, Nakashima A, Sakabe R, Shigemoto N, Kato Y, Ohge H, Sueda T. Prognostic impact of perioperative serum CA 19-9 levels in patients with resectable pancreatic cancer. Ann Surg Oncol 2010; 17:2321-9. [PMID: 20336387 DOI: 10.1245/s10434-010-1033-0] [Citation(s) in RCA: 125] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Indexed: 12/19/2022]
Abstract
BACKGROUND Pancreatic cancer is one of the most deadly cancers, and serum carbohydrate antigen 19-9 (CA19-9) level has been reported to be a useful prognostic marker in pancreatic cancer. The purpose of this study was to determine which prognostic factor (preoperative or postoperative serum CA19-9 level) is more useful. METHODS Pre- and postoperative serum CA19-9 levels were measured in 109 patients who underwent surgical resection for pancreatic cancer between 1998 and 2009, and their relationships to clinicopathological factors and overall survival were analyzed with univariate and multivariate methods. RESULTS In univariate analysis, tumor location (P = 0.019), postoperative adjuvant chemotherapy (P < 0.001), residual tumor factor status (P < 0.001), UICC pT stage (P = 0.004), lymph node metastasis (P = 0.015), and UICC final stage (P = 0.015) were significantly associated with overall survival. Differences in overall survival were significant between groups divided on the basis of four postoperative CA19-9 cutoff values (37, 100, 200, and 500 U/ml) but not significant between groups divided on the basis of the same four preoperative CA19-9 cutoff values. Pre- to postoperative increase in CA19-9 level also was significantly associated with poor prognosis. In multivariate analysis, postoperative adjuvant chemotherapy (hazard ratio, 1.59; P = 0.004) and postoperative CA19-9 cutoff value of 37 U/ml (HR, 1.64; P = 0.004) remained independent predictors of prognosis. CONCLUSIONS Postoperative CA19-9 level is a better prognostic factor than preoperative CA19-9 level, and curative surgery for resectable pancreatic cancer should be tried regardless of the preoperative CA19-9 level.
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Affiliation(s)
- Naru Kondo
- Department of Surgery, Division of Clinical Medical Science, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan.
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Hisamatsu K, Takiyama W, Sakabe R, Satou Y, Saeki S, Mukaida H, Yamashita Y, Hirabayashi N, Kaneko M, Ono T. Factors influencing 3D-MRI diagnosis in preoperative breast cancer patients. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.620] [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
620 Background: We presented 3D-MRI will be the useful breast imaging tool in diagnosing intraductal spread and tumor size in breast cancer patients. (ASCO 2008).To do breast conserving surgery, careful management was needed in cases with widely ductal spreading and multifocal lesion. This study was to evaluate factors influencing false negative diagnosis and multifocal types of 3D-MRI, retrospectively. Methods: From July 2000, pre-operative 3D-MRI was underwent 488 cases and images were obtained 479 cases (98%). These patients could be divided into three groups according to 3D-MRI images: pattern 1) localized type (273 cases), 2) widely enhanced type (106 cases) and 3) multi-focal type (100 cases). From April 2005, resected specimen was serially step cut and total specimens were microscopically evaluated. Tumor size in 3D-MRI was 1cm over smaller than resected specimens were defined false negative cases. Investigated factors influencing 3D-MRI were age, patterns of 3D-MRI images, presence of pre-operative chemotherapy, histological type, histological grade, microscopical invasive tumor size (mm) and presence of ductal spreading. Results: The rate of histological confirmed intraductal spread were seen in 58% (158/273cases), 89% (94/106 cases) of patients with 3D-MRI pattern 1) and 2), respectively. Tumor size was correlated between MRI and specimens, significantly (n = 162, r = 06706, p < 0.001). Factors influencing false negative diagnosis of 3D-MRI were presence of pre-operative chemotherapy (p < 0.05), presence of ductal spreading (p < 0.001) and patterns of 3D-MRI images (p < 0.05). In the cases with multi-focal 3D- images, there were only 11(11/41, 26%) cases with true multifocal lesions by total specimens examination. Selection for breast conserving surgery and margin width were based by 3D-MRI images. The proportion of breast-conserved surgery were obtained 90% (437/488 cases) and local failure seen only 6 cases (local failure rate 1.4%) in 3D-MRI guided surgery. (median follow up 52 months). Conclusions: These results suggest that MRI will be the useful breast imaging tool, but caution will be needed in cases with pre-operative systemic therapy, cases expected intraductal spread by imaging tools and cases with multi-focal 3D- images. No significant financial relationships to disclose.
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Affiliation(s)
| | - W. Takiyama
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | - R. Sakabe
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Y. Satou
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | - S. Saeki
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | - H. Mukaida
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | | | | | - M. Kaneko
- Hiroshima City Asa Hospital, Hiroshima, Japan
| | - T. Ono
- Hiroshima City Asa Hospital, Hiroshima, Japan
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Hisamatsu K, Takiyama W, Hirabayashi N, Kaneko M, Ono T, Sakabe R, Stou Y, Saeki S, Mukaida H, Yamashita Y. Factors influencing false negative diagnosis of 3D-MRI in pre-operative breast cancer patients. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4005] [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: 11/16/2022]
Abstract
Abstract
Abstract #4005
Introduction: We presented 3D-MRI will be the useful breast imaging tool in diagnosing intraductal spread and tumor size in breast cancer patients (ASCO 2008). But, false negative cases were very important in breast conserving surgery and careful management was needed in 3D-MRI guided surgery. This study was to review imaging diagnosis using 3D-MRI and to evaluate factors influencing false negative diagnosis of 3D-MRI, retrospectively. Material and methods: From July 2000, pre-operative 3D-MRI was underwent 433 cases of breast cancer patients. Images were obtained 426 cases (98%). Tumor size between 3D-MRI and resected specimens were evaluated retrospectively. Cases with tumor size difference between 3D-MRI and resected specimens less than 1cm were defined related cases and cases with tumor size in 3D-MRI was 1cm more smaller than resected specimens were defined false negative cases. Investigated factors influencing false negative diagnosis of 3D-MRI were age, patterns of 3D-MRI images, presence of pre-operative chemotherapy, histological type, histological grade, microscopical invasive tumor size (mm) and presence of ductal spreading. From April 2005, the entire specimen was serially step cut and evaluated. Results: Tumor diameter from nipple side to lateral margin were measured by MRI and specimens, tumor size was correlated between MRI and specimens, significantly (n=118, r=07186, P < 0.001). On Multivariate analysis revealed that factors influencing 3D-MRI diagnosis were presence of ductal spreading (p=0.0002), patterns of 3D-MRI images (p=0.06) and presence of pre-operative chemotherapy (P=0.04). Factors influencing false negative diagnosis of 3D-MRI were presence of pre-operative chemotherapy (P<0.05), presence of ductal spreading (P<0.01) and infiltration of lymphocyte in the edge of ductal spreading (P<0.05). Selection for breast conserving surgery and margin width were based by 3D-MRI images. The proportion of breast-conserved surgery were obtained 89% (380/426 cases) and local failure seen only 6 cases (local failure rate 1.4%) in 3D-MRI guided surgery. (6-94 months, median follow up 51 months).
 Conclusion: These results suggest that MRI will be the useful breast imaging tool in diagnosing intraductal spread and tumor size in breast cancer patients. But, caution will be needed in cases with pre-operative systemic therapy and cases expected ductal spreading by other imaging tools.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4005.
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Affiliation(s)
- K Hisamatsu
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - W Takiyama
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - N Hirabayashi
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - M Kaneko
- 2 Dept. of Pathology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - T Ono
- 3 Dept. of PRadiology, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - R Sakabe
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Y Stou
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - S Saeki
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - H Mukaida
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
| | - Y Yamashita
- 1 Dept. of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan
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16
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Yamashita Y, Mukaida H, Takiyama W, Hirabayashi N, Hisamatsu K, Saeki S, Sato Y, Sakabe R, Tokunaga M, Yoshiyama T, Kobayashi Y, Shimizu S, Hino Y. Minimally invasive video-assisted thoracoscopic lobectomy for better clinical outcomes in peripheral T1NO lung cancer. Int Surg 2008; 93:226-232. [PMID: 19731858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
It is an unresolved issue whether various thoracotomies affect clinical outcomes. In addition, a wide variety of technical approaches of video-assisted thoracic surgery depend on the facility. We reviewed 152 consecutive patients with clinical T1N0M0 lung cancer that underwent three types of lobectomy with systematic mediastinal lymphadenectomy in a single institute: 46 conventional thoracotomies (OPEN), 50 anterolateral small thoracotomies mainly using the thoracoscope as a light guide (ASSIST), and 56 minimum thoracotomies in which only a thoracoscope view was used (PURE). Total discharge from the chest drainage tube, length of hospital stay, and post-thoracotomy pain were significantly less in PURE than in OPEN and ASSIST. The results of mediastinal lymphadenectomy were equivalent. The 3-year survival rates were also similar among the three groups. We conclude that good clinical outcomes, especially reduced post-thoracotomy pain, seemed to correlate with the lesser degree of destruction of the chest wall with the identical quality as an acceptable cancer operation in PURE.
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Affiliation(s)
- Y Yamashita
- Department of Surgery, Hiroshima City Asa Hospital, Hiroshima, Japan.
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17
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Hisamatsu K, Takiyama W, Sakabe R, Satou Y, Saiki S, Mukaida H, Yamashita Y, Hirabayashi N, Kaneko M, Ono T. Factors influencing 3D-MRI diagnosis in preoperative breast cancer patients. J Clin Oncol 2008. [DOI: 10.1200/jco.2008.26.15_suppl.607] [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: 11/20/2022] Open
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