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Hirano N, Iseki M, Nakagawa K, Mizuma M, Kamei T, Matsumoto R, Miura S, Kume K, Masamune A, Unno M. A case report of perihilar cholangiocarcinoma in a patient with situs inversus totalis. Clin J Gastroenterol 2024; 17:567-574. [PMID: 38607543 DOI: 10.1007/s12328-024-01940-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Accepted: 02/14/2024] [Indexed: 04/13/2024]
Abstract
Situs inversus totalis is a rare congenital malformation in which organs are positioned in a mirror-image relationship to normal conditions. It often presents with vascular and biliary malformations. Only a few reports have pointed out the surgical difficulties in patients with situs inversus totalis, especially in those with perihilar cholangiocarcinoma. This report describes a 66-year-old male patient who underwent left hemihepatectomy (S5, 6, 7, and 8) with combined resection of the caudate lobe (S1), extrahepatic bile duct, and regional lymph nodes for perihilar cholangiocarcinoma with situs inversus totalis. Cholangiocarcinoma was mainly located in the perihilar area and progressed extensively into the bile duct. Surgery was performed after careful evaluation of the unusual anatomy. Although several vascular anomalies required delicate manipulation, the procedures were performed without major intraoperative complications. Postoperatively, bile leakage occurred, but the patient recovered with drainage treatment. The patient was discharged on the 29th postoperative day. Adjuvant chemotherapy with S-1 was administered for approximately 6 months. There was no recurrence 15 months postoperatively. Appropriate imaging studies and an understanding of unusual anatomy make surgery safe and provide suitable treatment for patients with situs inversus totalis.
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Affiliation(s)
- Naohiro Hirano
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
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Kashiwagi R, Ishida M, Onodera K, Aoki S, Iseki M, Miura T, Ohtsuka H, Mizuma M, Nakagawa K, Kamei T, Unno M. Laparoscopic excision of accessory spleen for recurrent autoimmune hemolytic anemia after splenectomy: a case report. Surg Case Rep 2024; 10:110. [PMID: 38700738 PMCID: PMC11068696 DOI: 10.1186/s40792-024-01884-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/01/2024] [Indexed: 05/06/2024] Open
Abstract
BACKGROUND Splenectomy is indicated in cases of autoimmune hemolytic anemia (AIHA), which are refractory to medical management. In post-splenectomy, there exists a theoretical risk of AIHA recurrence, especially if an accessory spleen undergoes compensatory hypertrophy. In this context, we present a unique case of recurrent AIHA managed through laparoscopic excision of the accessory spleen (LEAS). CASE PRESENTATION A 60-year-old male underwent laparoscopic splenectomy (LS) for AIHA refractory to standard medical therapies. Following the surgery, there was a marked improvement in hemolytic anemia symptoms, and oral steroid therapy was terminated 7 months post-LS. Nonetheless, a year after the LS, the patient exhibited a marked decline in hemoglobin levels, dropping to a concerning 5.8 g/dl, necessitating the reintroduction of oral steroids. A subsequent contrast-enhanced computed tomography (CT) scan unveiled an enlarged accessory spleen. The patient then underwent LEAS, during which the accessory spleen, obscured within adipose tissue, proved challenging to visualize laparoscopically. This obstacle was surmounted utilizing intraoperative ultrasonography (US), enabling successful excision of the accessory spleen. The post-surgical period progressed without complications, and the steroid dosage was reduced to one-twelfth of its initial preoperative quantity. CONCLUSIONS Recurrent AIHA can be instigated by post-splenectomy compensatory hypertrophy of the accessory spleen. Ensuring comprehensive splenic tissue excision is crucial in AIHA management to obviate recurrent stemming from hypertrophic remnants. In scenarios of AIHA recurrence tied to an enlarged accessory spleen, LEAS stands as a viable and effective therapeutic modality.
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Affiliation(s)
- Ryosuke Kashiwagi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Koichi Onodera
- Department of Hematology, Tohoku University Hospital, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, Miyagi, 980-8574, Japan.
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Omori Y, Aoki S, Ono Y, Kokumai T, Yoshimachi S, Sato H, Kusaka A, Iseki M, Douchi D, Miura T, Maeda S, Ishida M, Mizuma M, Nakagawa K, Mizukami Y, Furukawa T, Unno M. Clonal analysis of metachronous double biliary tract cancers. J Pathol 2024; 263:113-127. [PMID: 38482714 DOI: 10.1002/path.6265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 01/07/2024] [Accepted: 01/22/2024] [Indexed: 04/04/2024]
Abstract
The molecular mechanisms underpinning the development of metachronous tumors in the remnant bile duct following surgical resection of primary biliary tract carcinomas (BTCs) are unknown. This study aimed to elucidate these mechanisms by evaluating the clinicopathologic features of BTCs, the alterations to 31 BTC-related genes on targeted sequencing, and the aberrant expression of p53, p16, SMAD4, ARID1A and β-catenin on immunohistochemistry. Twelve consecutive patients who underwent resection of metachronous BTCs following primary BTC resection with negative bile duct margins were enrolled. Among the 12 metachronous tumors, six exhibited anterograde growth in the lower portion and six exhibited retrograde growth in the upper portion of the biliary tree. Surgical resection of metachronous BTCs resulted in recurrence-free survival in seven, local recurrence in five, and death in two patients. Nine achieved 5-year overall survival after primary surgery. Molecular analyses revealed that recurrently altered genes were: TP53, SMAD4, CDKN2A, ELF3, ARID1A, GNAS, NF1, STK11, RNF43, KMT2D and ERBB3. Each of these was altered in at least three cases. A comparison of the molecular features between 12 paired primary and metachronous BTCs indicated that 10 (83%) metachronous tumors developed in clonal association with corresponding primary tumors either successionally or phylogenically. The remaining two (17%) developed distinctly. The successional tumors consisted of direct or evolved primary tumor clones that spread along the bile duct. The phylogenic tumors consisted of genetically unstable clones and conferred a poor prognosis. Metachronous tumors distinct from their primaries harbored fewer mutations than successional and phylogenic tumors. In conclusion, over 80% of metachronous BTCs that develop following primary BTC resection are probably molecularly associated with their primaries in either a successional or a phylogenetic manner. Comparison between the molecular features of a metachronous tumor and those of a preceding tumor may provide effective therapeutic clues for the treatment of metachronous BTC. © 2024 The Authors. The Journal of Pathology published by John Wiley & Sons Ltd on behalf of The Pathological Society of Great Britain and Ireland.
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Affiliation(s)
- Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Takashi Kokumai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shingo Yoshimachi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Kusaka
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daisuke Douchi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shimpei Maeda
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
- Division of Gastroenterology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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Inoue K, Morikawa T, Ishida M, Miura T, Kashiwagi R, Kokumai T, Aoki S, Iseki M, Nakayama S, Douchi D, Ohtsuka H, Mizuma M, Nakagawa K, Kamei T, Unno M. Chronic Glucocorticoid Use is a Potential Risk Factor for Delayed Pancreatic Fistula after Laparoscopic Distal Pancreatectomy: A Retrospective Analysis. TOHOKU J EXP MED 2023; 261:221-228. [PMID: 37648507 DOI: 10.1620/tjem.2023.j072] [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] [Indexed: 09/01/2023]
Abstract
Pancreatic fistula is a potentially morbid complication after distal pancreatectomy. Chronic glucocorticoid use is one of the risk factors for pancreatic fistula in pancreaticoduodenectomy, though it has not been reported in distal pancreatectomy. We explored whether chronic glucocorticoid use can be a risk factor for pancreatic fistula in distal pancreatectomy. We reviewed 408 consecutive patients who underwent elective distal pancreatectomy from 2011 to 2021. We evaluated two kinds of pancreatic fistula (postoperative pancreatic fistula and delayed pancreatic fistula). We defined delayed pancreatic fistula as a patient who was re-admitted for pancreatic fistula after the first discharge from the hospital. Preoperative characteristics and postoperative outcomes were analyzed. Two hundred sixty-seven patients underwent open distal pancreatectomy, while 141 patients had laparoscopic distal pancreatectomy. A comparison of patient with and without chronic glucocorticoid use showed that only patients with chronic glucocorticoid use developed delayed pancreatic fistula (0% vs. 16.7%; p < 0.001). In addition, delayed pancreatic fistula occurred in only laparoscopic distal pancreatectomy patients with chronic glucocorticoid use (0% vs. 25.0%; p < 0.001). Although sample size is small, it is reasonable to presume that chronic glucocorticoid use is a potential risk factor for delayed pancreatic fistula in laparoscopic distal pancreatectomy.
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Affiliation(s)
- Koetsu Inoue
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Ryosuke Kashiwagi
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kokumai
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Shun Nakayama
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Daisuke Douchi
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
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Kashiwagi R, Funayama R, Aoki S, Matsui A, Klein S, Sato Y, Suzuki T, Murakami K, Inoue K, Iseki M, Masuda K, Mizuma M, Naito H, Duda DG, Unno M, Nakayama K. Collagen XVII regulates tumor growth in pancreatic cancer through interaction with the tumor microenvironment. Cancer Sci 2023; 114:4286-4298. [PMID: 37688308 PMCID: PMC10637054 DOI: 10.1111/cas.15952] [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: 04/01/2023] [Revised: 08/15/2023] [Accepted: 08/21/2023] [Indexed: 09/10/2023] Open
Abstract
Expression of the gene for collagen XVII (COL17A1) in tumor tissue is positively or negatively associated with patient survival depending on cancer type. High COL17A1 expression is thus a favorable prognostic marker for breast cancer but unfavorable for pancreatic cancer. This study explored the effects of COL17A1 expression on pancreatic tumor growth and their underlying mechanisms. Analysis of published single-cell RNA-sequencing data for human pancreatic cancer tissue revealed that COL17A1 was expressed predominantly in cancer cells rather than surrounding stromal cells. Forced expression of COL17A1 did not substantially affect the proliferation rate of the mouse pancreatic cancer cell lines KPC and AK4.4 in vitro. However, in mouse homograft tumor models in which KPC or AK4.4 cells were injected into syngeneic C57BL/6 or FVB mice, respectively, COL17A1 expression promoted or suppressed tumor growth, respectively, suggesting that the effect of COL17A1 on tumor growth was influenced by the tumor microenvironment. RNA-sequencing analysis of tumor tissue revealed effects of COL17A1 on gene expression profiles (including the expression of genes related to cell proliferation, the immune response, Wnt signaling, and Hippo signaling) that differed between C57BL/6-KPC and FVB-AK4.4 tumors. Our data thus suggest that COL17A1 promotes or suppresses cancer progression in a manner dependent on the interaction of tumor cells with the tumor microenvironment.
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Affiliation(s)
- Ryosuke Kashiwagi
- Department of Cell ProliferationART, Graduate School of Medicine, Tohoku UniversitySendaiJapan
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Ryo Funayama
- Department of Cell ProliferationART, Graduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Shuichi Aoki
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Aya Matsui
- Department of Vascular Physiology, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
| | - Sebastian Klein
- PathologyUniversity Hospital CologneCologneGermany
- Radiation Oncology/Steele Laboratories for Tumor BiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Yukihiro Sato
- Department of Cell ProliferationART, Graduate School of Medicine, Tohoku UniversitySendaiJapan
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Tsubasa Suzuki
- Department of Cell ProliferationART, Graduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Keigo Murakami
- Department of Investigative Pathology, Graduate School of MedicineTohoku UniversitySendaiJapan
| | - Koetsu Inoue
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Masahiro Iseki
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Kunihiro Masuda
- Department of SurgerySouth Miyagi Medical CenterShibata‐gunJapan
| | - Masamichi Mizuma
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Hisamichi Naito
- Department of Vascular Physiology, Graduate School of Medical ScienceKanazawa UniversityKanazawaJapan
| | - Dan G. Duda
- Radiation Oncology/Steele Laboratories for Tumor BiologyMassachusetts General HospitalBostonMassachusettsUSA
| | - Michiaki Unno
- Department of SurgeryGraduate School of Medicine, Tohoku UniversitySendaiJapan
| | - Keiko Nakayama
- Department of Cell ProliferationART, Graduate School of Medicine, Tohoku UniversitySendaiJapan
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Iseki M, Mizuma M, Unno M, Maruyama H, Akagi S, Shimoda M, Uemura K, Inoue T, Shiomi H, Watanabe M, Kobayashi M, Matsuda A, Mizuuchi Y, Aoki T, Shinkawa H, Takahata R, Makino K, Arai H, Yokoyama Y, Takeda S, Yaguchi Y, Kitagawa Y. Prognostic impact of postoperative infection after resection of biliary malignancy: A multicenter retrospective cohort study. Surgery 2023; 174:1145-1152. [PMID: 37599194 DOI: 10.1016/j.surg.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 05/05/2023] [Accepted: 05/24/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND The aim of this study was to investigate the prognostic impact of postoperative infections in patients who underwent resection for biliary malignancy, including intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, gallbladder carcinoma, and carcinoma of the ampulla of Vater. METHODS This study was conducted in an 11-center retrospective cohort study. Patients with biliary tract cancer who underwent curative resection between April 2013 and March 2015 at 11 institutions in Japan were enrolled. We analyzed the prevalence of postoperative infection, infection-related factors, and prognostic factors. RESULTS Of the total 290 cases, 33 were intrahepatic cholangiocarcinoma, 60 were perihilar cholangiocarcinoma, 120 were distal cholangiocarcinoma, 55 were gallbladder carcinoma, and 22 were carcinoma of the ampulla of Vater. Postoperative infectious complications, including remote infection, were observed in 146 patients (50.3%), and Clavien-Dindo ≥III in 115 patients (39.7%). Postoperative infections occurred more commonly in the patients who received pancreaticoduodenectomy and bile duct resection. Patients with infectious complications had a significantly poorer prognosis than those without (median overall survival 38 months vs 62 months, P = .046). In a diagnosis-specific analysis, although there was no correlation between infectious complications and overall survival in intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, distal cholangiocarcinoma, and carcinoma of the ampulla of Vater, infectious complications were a significantly poor prognostic factor in gallbladder carcinoma (P = .031). CONCLUSION Postoperative infection after surgery for biliary tract cancer commonly occurred, especially in patients who underwent pancreaticoduodenectomy and bile duct resection. Postoperative infection is relatively associated with the prognosis of patients with biliary malignancy, especially gallbladder carcinoma.
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Affiliation(s)
- Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Maruyama
- Department of Surgery, Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Shinji Akagi
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Mazda Hospital, Hiroshima, Japan
| | - Mitsugi Shimoda
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastroenterological Surgery, Ibaraki Medical Center, Tokyo Medical University, Ibaraki, Japan
| | - Kenichiro Uemura
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Japan
| | - Toru Inoue
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastrointestinal Surgery, Osaka City General Hospital, Japan
| | - Hisanori Shiomi
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Nagahama Red Cross Hospital, Shiga, Japan
| | - Manabu Watanabe
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Minako Kobayashi
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Infection Control and Prevention, Nippon Medical School, Musashikosugi Hospital, Kanagawa, Japan
| | - Akihisa Matsuda
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Yusuke Mizuuchi
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Taku Aoki
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Hepato-Biliary-Pancreatic Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Hiroji Shinkawa
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Hepatobiliary-Pancreatic Surgery, Osaka Metropolitan University Graduate School of Medicine, Japan
| | - Risa Takahata
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Medical Risk Management and Infection Control, National Defense Medical Collage, Saitama, Japan
| | - Kenta Makino
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Graduate School of Medicine, Kyoto University, Japan
| | - Hiroki Arai
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Nippon Medical School Chiba Hokusoh Hospital, Japan
| | - Yasuyuki Yokoyama
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | - Shigeru Takeda
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Japan
| | - Yoshihisa Yaguchi
- Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan; Department of Surgery, Sassa General Hospital, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan; The Japan Society of Surgical Infection, Tokyo, Japan
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7
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Inoue K, Mizuma M, Motoi F, Kokumai T, Sato H, Kusaka A, Aoki S, Iseki M, Douchi D, Miura T, Maeda S, Ishida M, Ohtsuka H, Nakagawa K, Kamei T, Unno M. CA19-9 With Two-stage Resection Is Useful for Conversion Surgery in PDAC With Synchronous Oligometastases. Anticancer Res 2023; 43:5223-5234. [PMID: 37909951 DOI: 10.21873/anticanres.16724] [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: 09/10/2023] [Revised: 10/02/2023] [Accepted: 10/03/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND/AIM Pancreatic adenocarcinoma (PDAC) with synchronous oligometastases may indicate a surgical benefit after chemotherapy. We investigated whether primary and metastatic resection of PDAC with oligometastases can improve the survival and then explored prognostic factors to identify indications for conversion surgery. PATIENTS AND METHODS We reviewed 425 patients with PDAC who underwent pancreatic resection from 2005 to 2019. Clinical characteristics and outcomes were analyzed. Two-stage resection was defined as preceding metastasectomy and subsequent primary resection after chemotherapy. RESULTS Fifteen patients (3.5%) had synchronous oligometastases. We evaluated the overall survival of the patients with oligometastases and those without metastases. The survival curves almost completely overlapped (median survival time: 35.9 vs. 32.1 months). The univariate Cox regression analysis revealed a normal level of preoperative CA19-9 (p=0.075), two-stage resection (p=0.072), and R0 resection (p=0.064) were likely promising prognostic factors. The combination of a normal level of preoperative CA19-9 with two-stage resection was a significant prognostic factor (p=0.038). In addition, patients with a normal preoperative CA19-9 level and two-stage resection had better survival (46.1 vs. 28.1 months, p=0.026). CONCLUSION The combination of normal preoperative CA19-9 with two-stage resection can be a useful way to identify patients with PDAC and oligometastases for surgical indication.
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Affiliation(s)
- Koetsu Inoue
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan;
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Yamagata University, Yamagata, Japan
| | - Takashi Kokumai
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideaki Sato
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Akiko Kusaka
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Daisuke Douchi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shimpei Maeda
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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8
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Maemoto R, Noda H, Ichida K, Miyakura Y, Kakizawa N, Machida E, Aizawa H, Kato T, Iseki M, Fukui T, Muto Y, Fukai S, Tsujinaka S, Hatsuzawa Y, Watanabe F, Nagamori M, Takahashi J, Kimura Y, Maeda S, Takayama N, Sakio R, Takahashi R, Takenami T, Matsuzawa N, Mieno M, Rikiyama T. Aqueous Povidone-Iodine Versus Normal Saline For Intraoperative Wound Irrigation on The Incidence of Surgical Site Infection in Clean-Contaminated Wounds After Gastroenterological Surgery: A Single-Institute, Prospective, Blinded-Endpoint, Randomized Controlled Trial. Ann Surg 2023; 277:727-733. [PMID: 36538622 DOI: 10.1097/sla.0000000000005786] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE This trial evaluated the superiority of intraoperative wound irrigation (IOWI) with aqueous povidone-iodine (PVP-I) compared with that with saline for reducing the incidence of surgical site infection (SSI). BACKGROUND IOWI with aqueous PVP-I is recommended for the prevention of SSI by the World Health Organization and the Centers for Disease Control and Prevention, although the evidence level is low. METHODS This single institute in Japan, prospective, randomized, blinded-endpoint trial was conducted to assess the superiority of IOWI with aqueous PVP-I in comparison with IOWI with saline for reducing the incidence of SSI in clean-contaminated wounds after gastroenterological surgery. Patients 20 years or older were assessed for eligibility, and the eligible participants were randomized at a 1:1 ratio using a computer-generated block randomization. In the study group, IOWI was performed for 1 minute with 40 mL of aqueous 10% PVP-I before skin closure. In the control group, the procedure was performed with 100 mL of saline. Participants, assessors, and analysts were masked to the treatment allocation. The primary outcome was the incidence of incisional SSI in the intention-to-treat set. RESULTS Between June 2019 and March 2022, 941 patients were randomized to the study group (473 patients) or the control group (468 patients). The incidence of incisional SSI was 7.6% in the study group and 5.1% in the control group (risk difference 0.025, 95% CI -0.006 to 0.056; risk ratio 1.484, 95% CI 0.9 to 2.448; P =0.154). CONCLUSION The current recommendation of IOWI with aqueous PVP-I should be reconsidered.
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Affiliation(s)
- Ryo Maemoto
- Department of Surgery, Saitama Medical Center
| | | | | | | | | | | | | | | | | | - Taro Fukui
- Department of Surgery, Saitama Medical Center
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center
| | - Shota Fukai
- Department of Surgery, Saitama Medical Center
| | | | | | | | | | | | | | | | | | | | | | | | | | - Makiko Mieno
- Department of Medical Statistics, Center for Information, Jichi Medical University, Saitama, Japan
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9
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Hirano N, Aoki S, Mizuma M, Nakagawa K, Inoue K, Iseki M, Nakayama S, Douchi D, Miura T, Ishida M, Ohtsuka H, Morikawa T, Ohnuma S, Kamei T, Unno M. [A Case of an Elderly Patient Who Underwent Conversion Resection for Pancreatic Cancer with Positive Peritoneal Cytology]. Gan To Kagaku Ryoho 2023; 50:224-226. [PMID: 36807179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
We report a case of an elderly patient, 82 years-old, with initially-unresectable pancreatic head cancer, who successfully underwent complete resection of the primary lesion after systemic chemotherapy for 6 months. The patient had a history of pancreatic body-tail resection for intraductal papillary mucinous carcinoma in 2005. In 2020, a routine examination revealed an increased CA19-9 value of 1,958 U/mL and showed a pancreatic head tumor of 35 mm on CT images. Finally, the tumor was pathologically diagnosed as pancreatic cancer by a biopsied sample. Although CT images showed no distant metastasis, peritoneal lavage cytology was indicated as positivity(H0P0CY1)in the staging laparoscopy. We implanted a peritoneal port and introduced systemic chemotherapy of gemcitabine and nab-paclitaxel combination therapy. This treatment for 6 months induced tumor shrinkage to 30 mm on the CT image, normalized CA19-9 value to 22.6 U/mL, and negative cytology in the collected lavage fluid from the peritoneal port. The patient's general condition was maintained even after the chemotherapy and the lavage cytology was pathologically diagnosed as negative(H0P0CY0)in the repeated staging laparoscopy, therefore we decided to perform pancreaticoduodenectomy as a conversion surgery. The patient was discharged on the 21st postoperative day with an uneventful course and underwent adjuvant chemotherapy of S-1 for 6 months. No recurrence was found in 8 months after the surgery. In such a case of the selected elderly patient with a maintained general condition, it is feasible to undergo multimodal treatments including conversion surgery for an initially-unresectable pancreatic cancer with positive peritoneal cytology.
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Affiliation(s)
- Naohiro Hirano
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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10
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Shimura M, Mizuma M, Motoi F, Kusaka A, Aoki S, Iseki M, Inoue K, Douchi D, Nakayama S, Miura T, Ishida M, Ohtsuka H, Nakagawa K, Morikawa T, Kamei T, Unno M. Negative prognostic impact of sarcopenia before and after neoadjuvant chemotherapy for pancreatic cancer. Pancreatology 2023; 23:65-72. [PMID: 36473785 DOI: 10.1016/j.pan.2022.11.010] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 11/12/2022] [Accepted: 11/24/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To elucidate the prognostic impact of sarcopenia before and after neoadjuvant chemotherapy (NAC) for pancreatic cancer (PC). METHODS We retrospectively studied 75 consecutive PC patients who underwent neoadjuvant gemcitabine plus S-1 combination therapy followed by pancreatectomy between 2008 and 2016. According to the skeletal muscle volume index (SMI), the patients were divided into the muscle attenuation group (MAG) and normal group (NG) before or after NAC. Prognostic factors for overall survival (OS) were analyzed by Cox proportional hazards models. RESULTS The MAG showed significantly poorer OS than the NG before and after NAC. Pre-NAC, median OS was 20.0 months in the MAG versus 49.0 months in the NG (p = 0.006). Post-NAC, median OS was 21.3 months in the MAG versus 48.8 months in the NG (p = 0.014). Multivariate analysis, excluding muscle attenuation after NAC because of confounding factors and lower hazard ratio (2.08, 95% confidence interval: 1.14-3.78, p = 0.016) than that before NAC (2.14, 1.23-3.70, p = 0.007) by univariate analysis, revealed the following independent prognostic factors: muscle attenuation pre-NAC (2.25, 1.26-4.05, p = 0.007); borderline resectability (1.96, 1.04-3.69, p = 0.038); operative blood loss (2.60, 1.38-4.88, p = 0.003); and distant metastasis (3.31, 1.40-7.82, p = 0.006). CONCLUSIONS Sarcopenia before and after NAC for PC is suggested to be a poor prognostic factor, with a stronger impact before than after NAC.
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Affiliation(s)
- Mitsuhiro Shimura
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
| | - Fuyuhiko Motoi
- Department of Gastroenterological, General, Breast and Thyroid Surgery, Yamagata University Graduate School of Medical Science, 2-2-2 Iidanishi, Yamagata, 990-9585, Japan
| | - Akiko Kusaka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Koetsu Inoue
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Daisuke Douchi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Shun Nakayama
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
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11
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Hirano N, Iseki M, Morikawa T, Umino Y, Aoki S, Inoue K, Nakayama S, Miura T, Masuda K, Ishida M, Ohtsuka H, Mizuma M, Nakagawa K, Kume K, Masamune A, Kamei T, Unno M. Pancreaticoduodenectomy for pancreatic head cancer with cavernous transformation of the portal vein: a case report. Surg Case Rep 2022; 8:127. [PMID: 35771287 PMCID: PMC9247133 DOI: 10.1186/s40792-022-01463-0] [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: 04/18/2022] [Accepted: 05/27/2022] [Indexed: 12/01/2022] Open
Abstract
Background Cavernous transformation of the portal vein (CTPV) due to extrahepatic portal vein obstruction is a rare vascular anomaly. Since its symptoms usually appear in childhood, most of the adult cases are detected unexpectedly with other diseases. Only a few reports have described surgical difficulties in patients with CTPV. We report a case of pancreatic head cancer with CTPV in a patient who underwent pancreaticoduodenectomy. Case presentation A 77-year-old man with epigastric and back pain was referred to our hospital. Computed tomography revealed a tumor in the pancreatic head and a CTPV near the hepatic hilum. CTPV consisted of two main collateral vessels connected by multiple surrounding small vessels. Also, portal vein obstruction was observed near the hepatic hilum, which was far from the pancreatic head tumor. After confirming that there was no distant metastasis by a thorough whole-body search, we performed a pancreaticoduodenectomy following neoadjuvant chemotherapy. During the operation, we carefully manipulated the area of the CTPV and omitted lymph node dissection in the hepatoduodenal ligament to prevent massive venous bleeding and intestinal congestion. Pancreaticoduodenectomy was performed without any intraoperative complications and the postoperative course was uneventful. Complete tumor resection was histologically confirmed. Conclusion Although pancreaticoduodenectomy for patients with CTPV involves many surgical difficulties, we successfully performed it by determining specific treatment strategies tailored to the patient and following careful and delicate surgical procedures.
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12
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Okada K, Uemura K, Ohge H, Iseki M, Mizuma M, Shinkawa H, Takahata R, Aoki T, Makino K, Arai H, Miyake T, Takeda S, Yokoyama Y, Yaguchi Y, Kobayashi M, Matsuda A, Shiomi H, Watanabe M, Akagi S, Inoue T, Tanemoto K, Maruyama H. Prognostic impact of postoperative infection in patients with pancreatic cancer: A multicenter cohort study. Surgery 2022; 172:1768-1775. [PMID: 36307331 DOI: 10.1016/j.surg.2022.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 07/24/2022] [Accepted: 09/01/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Postoperative infection after pancreatectomy in patients with pancreatic cancer often leads to poor prognosis. The aim of this study was to determine the prognostic effect of postoperative infection in patients with pancreatic cancer. METHODS A multicenter cohort study was performed using a common database of patients with pancreatic cancer who underwent curative pancreatic resections between April 2013 and March 2015 at 15 high-volume centers in Japan. The rate of postoperative infection was determined, and patient demographic characteristics, clinicopathologic factors, and prognostic factors for overall survival were analyzed. RESULTS Of the 462 eligible patients who underwent curative pancreatectomy, postoperative infection occurred in 141 patients (31%), including 114 surgical site infections (25%), 50 remote infections (11%), and 23 combined infections (5%). Risk factors for postoperative infection included high body mass index, nondiabetes, and longer operation time. In the survival analysis, patients with postoperative infection had significantly worse overall survival than patients without postoperative infection. The median survival times were 21.9 and 33.0 months (P = .023), respectively, for patients with and without postoperative infection. According to the multivariate analysis for overall survival, lack of adjuvant therapy (P = .002), but not postoperative infection (P = .829), predicted poor prognosis. The multivariate analysis revealed that postoperative infection (P < .001) was an independent risk factor for lack of adjuvant therapy. CONCLUSION Postoperative infection in patients with pancreatic cancer may indirectly worsen the prognosis by preventing timely adjuvant therapy.
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Affiliation(s)
- Kenjiro Okada
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Kenichiro Uemura
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan.
| | - Hiroki Ohge
- Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroji Shinkawa
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Risa Takahata
- Department of Medical Risk Management and Infection Control, National Defense Medical College, Tokorozawa, Japan
| | - Taku Aoki
- Second Department of Surgery, Dokkyo Medical University, Tochigi, Japan
| | - Kenta Makino
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Arai
- Department of Surgery, Nippon Medical School Chiba-Hokusoh Hospital, Chiba, Japan
| | - Toru Miyake
- Department of Surgery, Shiga University of Medical Science, Shiga, Japan
| | - Shigeru Takeda
- Department of Gastroenterological, Breast, and Endocrine Surgery, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Yasuyuki Yokoyama
- Department of Digestive Surgery, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan
| | | | - Minako Kobayashi
- Department of Infection Control and Prevention, Nippon Medical School Musashikosugi Hospital, Kanagawa, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Akihisa Matsuda
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Hisanori Shiomi
- Department of Surgery, Nagahama Red Cross Hospital, Shiga, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Manabu Watanabe
- Department of Surgery, Toho University Ohashi Medical Center, Tokyo, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Shinji Akagi
- Department of Surgery, Mazda Hospital, Hiroshima, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Toru Inoue
- Department of Surgery, Osaka City General Hospital, Osaka, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Kazuo Tanemoto
- Department of Cardiovascular Surgery, Kawasaki Medical School, Kurashiki, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
| | - Hiroshi Maruyama
- Department of Surgery, Nippon Medical School Tama-Nagayama Hospital, Tokyo, Japan; Clinical Research Support Committee, Japan Society for Surgical Infection, Tokyo, Japan
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13
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Noda H, Maemoto R, Ichida K, Aizawa H, Endo Y, Iseki M, Maeda S, Kato T, Watanabe F, Rikiyama T. Implementation of intraoperative wound irrigation with aqueous 10% povidone–iodine and triclosan‐coated sutures is not effective for reducing the incidence of incisional surgical site infection after major hepato‐biliary‐pancreatic surgery in patients with preoperative biliary drainage. J Hepato Biliary Pancreat 2022. [DOI: 10.1002/jhbp.1271] [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] [Received: 07/03/2022] [Revised: 09/24/2022] [Accepted: 10/05/2022] [Indexed: 11/17/2022]
Affiliation(s)
- Hiroshi Noda
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Ryo Maemoto
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Hidetoshi Aizawa
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Masahiro Iseki
- Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan
| | - Shimpei Maeda
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Takarharu Kato
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center Jichi Medical University Saitama Japan
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14
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Umino Y, Mizuma M, Akamatsu D, Aoki S, Iseki M, Kawaguchi K, Masuda K, Ishida M, Ohtsuka H, Nakagawa K, Morikawa T, Kamei T, Kume K, Masamune A, Unno M. [Reconstruction of Portal Vein and Superior Mesenteric Vein Using Superficial Femoral Vein Graft in Surgical Resection of Pancreatic Head Cancer-A Case Report]. Gan To Kagaku Ryoho 2021; 48:1783-1785. [PMID: 35046329] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We report a case of reconstruction of the portal vein(PV)and superior mesenteric vein(SMV)using a superficial femoral vein graft in total pancreatectomy for pancreatic cancer. A 62-year-old man visited a previous hospital due to epigastric pain and bilirubinuria and was diagnosed with pancreatic cancer. The patient was referred to our hospital for further examination and treatment. Abdominal CT scan revealed a 30 mm pancreatic head tumor with an abutment of almost 360 degrees around the superior mesenteric artery(SMA)and extensive involvement from the PV to branches of the SMV, radiologically classified as locally advanced unresectable pancreatic cancer. Although gemcitabine plus nab-paclitaxel combination therapy(GnP)was performed, the patient developed drug-induced lung injury after 3 courses. GnP was stopped, and chemoradiation therapy with S-1 was performed. After chemoradiation therapy, the tumor shrank to 14 mm, while no change of the abutment around SMA was observed. After 8 months from the initial diagnosis, total pancreatectomy and resection of the PV/SMV were performed. Approximately 70 mm of the PV/SMV was surgically removed and was reconstructed using a graft from the left superficial femoral vein in consideration of the length and diameter. Although delayed gastric emptying was postoperatively observed, the patient was discharged 39 days after operation, then received adjuvant therapy with S-1. The patient is alive without recurrence and the patency of PV/SMV was well maintained.
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Affiliation(s)
- Yuichiro Umino
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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15
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Miura S, Kume K, Kikuta K, Hamada S, Takikawa T, Yoshida N, Hongo S, Tanaka Y, Matsumoto R, Sano T, Ikeda M, Furukawa T, Iseki M, Unno M, Masamune A. Focal Parenchymal Atrophy and Fat Replacement Are Clues for Early Diagnosis of Pancreatic Cancer with Abnormalities of the Main Pancreatic Duct. TOHOKU J EXP MED 2021; 252:63-71. [PMID: 32879148 DOI: 10.1620/tjem.252.63] [Citation(s) in RCA: 10] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Pancreatic cancer is one of the most dangerous solid tumors, but its early diagnosis is difficult. The abnormality of the main pancreatic duct (MPD), such as a single localized stricture and upstream dilatation, might be useful in the early detection of pancreatic cancer. However, these findings are often observed in benign inflammatory cases. This study aimed to clarify whether early pancreatic cancer presenting MPD abnormalities has characteristic features different from those of benign cases. This is a single-center, retrospective study. We analyzed 20 patients who underwent pancreatectomy presenting with a single, localized MPD stricture without identifiable masses on imaging: 10 patients with pancreatic ductal adenocarcinoma (cancer group; 6 with stage 0 and 4 with stage I) and 10 patients with benign strictures (benign group; 8 with inflammation and 2 with low-grade pancreatic intraepithelial neoplasms). Pancreatectomy was performed in these benign cases because high-grade intraepithelial neoplasm was suspected. Although the proportion of patients with diabetes mellitus tended to be higher in the cancer group (6/10) than that in the benign group (1/10) (P = 0.058), other clinical characteristics were not different between the groups. Preoperative cytological malignancies were detected in four patients in the cancer group (4/10) but not in the benign group (P = 0.09). Focal parenchymal atrophy and fat replacement were more frequently detected on computed tomography in the cancer group (7/10) than in the benign group (1/10) (P = 0.02). In conclusion, focal parenchymal atrophy and fat replacement may provide clues for the early diagnosis of pancreatic cancer.
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Affiliation(s)
- Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Naoki Yoshida
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Seiji Hongo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Yu Tanaka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Takanori Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Mio Ikeda
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
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16
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Maemoto R, Noda H, Ichida K, Tamaki S, Kanemitsu R, Machida E, Kikuchi N, Sakio R, Aizawa H, Fukui T, Kakizawa N, Muto Y, Iseki M, Fukuda R, Watanabe F, Kato T, Saito M, Tsujinaka S, Miyakura Y, Rikiyama T. Superiority trial comparing intraoperative wound irrigation with aqueous 10% povidone-iodine to saline for the purpose of reducing surgical site infection after elective gastrointestinal surgery: study protocol for a randomised controlled trial. BMJ Open 2021; 11:e051374. [PMID: 34135056 PMCID: PMC8211046 DOI: 10.1136/bmjopen-2021-051374] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
INTRODUCTION Surgical site infection (SSI) is one of the most common complications after gastrointestinal surgery, with a reported incidence of approximately 10%-25%, which is higher than the rates after other types of surgery. Intraoperative wound irrigation (IOWI) is a simple intervention for SSI prevention, and recent studies have reported that IOWI with aqueous povidone-iodine (PVP-I) is significantly more effective at reducing the incidence of SSI than saline. However, the evidence level of previous trials evaluating the efficacy of aqueous PVP-I solution for preventing SSI has been low. METHODS AND ANALYSES We propose a single-institute, prospective, randomised, blinded-endpoint trial to assess the superiority of IOWI with aqueous 10% PVP-I solution compared with normal saline for reducing SSI in clean-contaminated wounds after elective gastrointestinal surgery. In the study group, IOWI with 40 mL of aqueous 10% PVP-I solution is performed for 1 min before skin suture, and in the control group, IOWI with 100 mL of saline is performed for 1 min before skin suture. We hypothesise that IOWI with aqueous 10% PVP-I solution will achieve a 50% reduction in the incidence of SSIs. The target number of cases is set at 950. The primary outcome is the incidence of incisional SSI up to postoperative day 30 and will be analysed in the modified intention-to-treat set. ETHICS AND DISSEMINATION This trial was designed and is being conducted by Saitama Medical Center, Jichi Medical University, with approval from the Bioethics Committee for Clinical Research, Saitama Medical Center, Jichi Medical University. Participant recruitment began in June 2019. The final results will be reported in international peer-reviewed journals immediately after trial completion. TRIAL REGISTRATION NUMBER UMIN000036889.
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Affiliation(s)
- Ryo Maemoto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Kosuke Ichida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Sawako Tamaki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rina Kanemitsu
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Erika Machida
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nozomi Kikuchi
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Ryotaro Sakio
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Hidetoshi Aizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yuta Muto
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masahiro Iseki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Rintaro Fukuda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Takaharu Kato
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Masaaki Saito
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Shingo Tsujinaka
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yasuyuki Miyakura
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, Saitama, Japan
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17
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Hata T, Mizuma M, Iseki M, Takadate T, Ishida M, Nakagawa K, Hayashi H, Morikawa T, Motoi F, Unno M. Circulating tumor DNA as a predictive marker for occult metastases in pancreatic cancer patients with radiographically non-metastatic disease. J Hepatobiliary Pancreat Sci 2021; 28:648-658. [PMID: 34022116 DOI: 10.1002/jhbp.993] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 04/04/2021] [Accepted: 04/12/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE To elucidate the effectiveness of circulating tumor DNA (ctDNA) for predicting occult metastases in patients with pancreatic cancer without apparent metastases. METHODS Circulating tumor DNA was obtained from plasma samples of 165 patients with pancreatic cancer and analyzed using droplet digital PCR. The prevalence and allele frequencies of ctDNA were compared across different patterns and degrees of metastatic spread. RESULTS Of the 142 patients without apparent metastases who underwent abdominal exploration, 39 (27.5%) harbored occult metastases including positive peritoneal lavage cytology. The prevalence of ctDNA was significantly higher in patients with occult metastases than in those without (41.0% vs 14.6%, P = .001). A markedly high prevalence of ctDNA was observed in patients with radiographically visible metastases (78.3%). ctDNA was found to be an independent predictor of the presence of occult metastases (odds ratio: 3.113, P = .039), and its diagnostic performance in combination with tumor markers had a sensitivity of 66.7% and a specificity of 81.6%. In 62 treatment-naïve patients without metastases, multivariate analysis identified the presence of ctDNA as an independent prognostic factor (hazard ratio: 6.311, P = .001). CONCLUSION Circulating tumor DNA can help predict the presence of occult metastases in pancreatic cancer patients with radiographically non-metastatic disease.
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Affiliation(s)
- Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Tatsuyuki Takadate
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Surgery, Sendai Medical Center, Sendai, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.,Department of Surgery I, Yamagata University Graduate School of Medical Science, Yamagata, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
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18
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Fukui T, Noda H, Watanabe F, Kato T, Endo Y, Aizawa H, Kakizawa N, Iseki M, Rikiyama T. Drain output volume after pancreaticoduodenectomy is a useful warning sign for postoperative complications. BMC Surg 2021; 21:279. [PMID: 34082725 PMCID: PMC8176603 DOI: 10.1186/s12893-021-01285-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction The drain output volume (DOV) after pancreaticoduodenectomy (PD) is an easily assessable indicator in clinical settings. We explored the utility of the DOV as a possible warning sign of complications after PD. Methods A total of 404 patients undergoing PD were considered for inclusion. The predictability of the DOV for overall morbidity, major complications, intraabdominal infection (IAI), clinically relevant (CR) postoperative pancreatic fistula (POPF), CR delayed gastric emptying (DGE), CR chyle leak (CL), and CR post-pancreatectomy hemorrhaging (PPH) was evaluated. Results One hundred (24.8%) patients developed major complications, and 131 (32.4%) developed IAI. Regarding CR post-pancreatectomy complications, 75 (18.6%) patients developed CR-POPF, 23 (5.7%) developed CR-DGE, 20 (5.0%) developed CR-CL, and 28 (6.9%) developed CR-PPH. The median DOV on postoperative day (POD) 1 and POD 3 was 266 and 234.5 ml, respectively. A low DOV on POD 1 was an independent predictor of CR-POPF, and a high DOV on POD 3 was an independent predictor of CR-CL. A receiver operating characteristics (ROC) analysis revealed that the DOV on POD 1 had a negative predictive value (area under the curve [AUC] 0.655, sensitivity 65.0%, specificity 65.3%, 95% confidence interval [CI]: 0.587–0.724), with a calculated optimal cut-off value of 227 ml. An ROC analysis also revealed that the DOV on POD 3 had a positive predictive value (AUC 0.753, sensitivity 70.1%, specificity 75.0%, 95% CI: 0.651–0.856), with a calculated optimal cut-off value of 332 ml. Conclusion A low DOV on POD 1 might be a postoperative warning sign for CR-POPF, similar to high drain amylase (DA) on POD 1, high DA on POD 3, and high CRP on POD 3. When the DOV on POD 1 after PD was low, surgeons should evaluate the reasons of a low DOV. A high DOV on POD 3 was a postoperative warning sign CR-CL, and might require an appropriate management of protein loss.
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Affiliation(s)
- Taro Fukui
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Hiroshi Noda
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan.
| | - Fumiaki Watanabe
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Takaharu Kato
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Yuhei Endo
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Hidetoshi Aizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Nao Kakizawa
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Masahiro Iseki
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
| | - Toshiki Rikiyama
- Department of Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama, 330-8503, Japan
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19
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Iseki M, Mizuma M, Aoki Y, Aoki S, Hata T, Takadate T, Kawaguchi K, Masuda K, Ishida M, Ohtsuka H, Nakagawa K, Hayashi H, Morikawa T, Kamei T, Kume K, Kanno A, Masamune A, Omori Y, Ono Y, Mizukami Y, Furukawa T, Unno M. Intracholecystic papillary neoplasm arising in the cystic duct and extending into common bile duct: a case report. Clin J Gastroenterol 2021; 14:668-677. [PMID: 33387260 DOI: 10.1007/s12328-020-01311-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 11/28/2020] [Indexed: 10/22/2022]
Abstract
An 83-year-old man without specific symptoms was referred to our hospital for further evaluation and treatment of apparent double primary tumors of the cystic duct and common bile duct. Computed tomography showed contrast-enhanced solid tumors in the cystic duct and common bile duct. Magnetic resonance imaging showed that the bile duct tumor was isointense on T1-weighted images and had low intensity on T2-weighted images. In addition, the bile duct tumor showed high intensity on diffusion-weighted images. Endoscopic ultrasonography revealed the tumor of the common bile duct and endoscopic retrograde cholangiopancreatography demonstrated a filling defect in the bile duct. The cystic duct was not identified on endoscopic ultrasonography or endoscopic retrograde cholangiopancreatography. Transpapillary biopsy of the bile duct tumor showed adenocarcinoma. The patient was diagnosed with double primary tumors of the cystic duct and the common bile duct and underwent subtotal stomach-preserving pancreaticoduodenectomy. Microscopic examination with molecular profiling of the tumors revealed a high-grade noninvasive intracholecystic papillary neoplasm of the cystic duct extending into the common bile duct and forming a tubulopapillary neoplasm with invasion of the common bile duct.
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Affiliation(s)
- Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Yasutaka Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.,Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tatsuyuki Takadate
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Kawaguchi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kunihiro Masuda
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Kanno
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yuko Omori
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yusuke Ono
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan
| | - Yusuke Mizukami
- Institute of Biomedical Research, Sapporo Higashi Tokushukai Hospital, Sapporo, Japan.,Cancer Genetics, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan
| | - Toru Furukawa
- Department of Investigative Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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20
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Takadate T, Morikawa T, Ishida M, Aoki S, Hata T, Iseki M, Miura T, Ariake K, Maeda S, Kawaguchi K, Masuda K, Ohtsuka H, Mizuma M, Hayashi H, Nakagawa K, Motoi F, Kamei T, Naitoh T, Unno M. Staging laparoscopy is mandatory for the treatment of pancreatic cancer to avoid missing radiologically negative metastases. Surg Today 2020; 51:686-694. [PMID: 32897517 DOI: 10.1007/s00595-020-02121-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2020] [Accepted: 08/14/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Staging laparoscopy is considered useful for determining treatment plans for advanced pancreatic cancer. However, the indications for staging laparoscopy are not clear. This study aimed to evaluate the safety of staging laparoscopy and its usefulness for detecting distant metastases in patients with pancreatic cancer. METHODS A total of 146 patients with pancreatic cancer who underwent staging laparoscopy between 2013 and 2019 were analyzed. Staging laparoscopy was performed in all pancreatic cancer patients in whom surgery was considered possible. RESULTS In this cohort, 42 patients (29%) were diagnosed with malignant cells on peritoneal lavage cytology, 9 (6%) had peritoneal dissemination, and 11 (8%) had liver metastases. A total of 48 (33%) had radiologically negative metastases. On a multivariate analysis, body and tail cancer [odds ratio (OR) 5.00, 95% confidence interval (CI) 2.15-11.6, p < 0.001], high CA19-9 level [OR 4.04, 95% CI 1.74-9.38, p = 0.001], and a resectability status of unresectable (OR 2.31, 95% CI 1.03-5.20, p = 0.04) were independent risk factors for radiologically negative metastases. CONCLUSIONS Staging laparoscopy can be safely performed and is useful for the diagnosis of radiologically negative metastases. Staging laparoscopy should be routinely performed for the accurate diagnosis of pancreatic cancer patients before pancreatectomy and/or local treatment, such as radiotherapy.
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Affiliation(s)
- Tatsuyuki Takadate
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan.
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masaharu Ishida
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takayuki Miura
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kyohei Ariake
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Shimpei Maeda
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Kawaguchi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kunihiro Masuda
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, 980-8574, Japan
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21
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Takikawa T, Kikuta K, Kume K, Hamada S, Miura S, Yoshida N, Hongo S, Tanaka Y, Matsumoto R, Sano T, Ikeda M, Iseki M, Unno M, Masamune A. New-Onset or Exacerbation of Diabetes Mellitus Is a Clue to the Early Diagnosis of Pancreatic Cancer. TOHOKU J EXP MED 2020; 252:353-364. [PMID: 33342915 DOI: 10.1620/tjem.252.353] [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] [Indexed: 11/18/2022]
Abstract
Pancreatic ductal adenocarcinoma (PDAC), which accounts for majority of pancreatic cancers, is one of the most lethal human malignancies. Most patients are diagnosed at an advanced stage after symptom development. Early diagnosis of PDAC in asymptomatic subjects is important to improve prognosis. Diabetes mellitus (DM) is a risk factor for PDAC, and DM, especially new-onset DM, has attracted attentions as a diagnostic clue to PDAC. However, the impact of DM as a diagnostic opportunity on the prognosis of PDAC is unclear. We here retrospectively reviewed 489 PDAC patients and compared the clinical characteristics and prognosis according to the opportunities for PDAC diagnosis. PDAC was diagnosed upon presentation of symptoms, such as pain and jaundice, in 318 cases including 151 DM patients, upon new-onset or exacerbation of long-standing DM in 53 asymptomatic patients, and upon incidental detection by medical check-up or follow-up/work-up of other diseases in 118 asymptomatic patients. Asymptomatic patients including those with DM had smaller tumors, earlier disease stage, and higher resectability rates than symptomatic patients. Asymptomatic patients diagnosed in association with DM had better prognosis (median survival time, 771 days) than those diagnosed due to symptoms (343 days, P < 0.001), and similar to those diagnosed by incidental detection (869 days). The survival advantage was not evident in symptomatic patients with DM-associated signs. In conclusion, patients diagnosed in association with DM at asymptomatic stages had better prognosis than those diagnosed with symptoms. DM-associated signs might provide a clue to the early diagnosis of PDAC among asymptomatic subjects.
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Affiliation(s)
- Tetsuya Takikawa
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kazuhiro Kikuta
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Kiyoshi Kume
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Shin Hamada
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Shin Miura
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Naoki Yoshida
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Seiji Hongo
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Yu Tanaka
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Ryotaro Matsumoto
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Takanori Sano
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Mio Ikeda
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine
| | - Atsushi Masamune
- Division of Gastroenterology, Tohoku University Graduate School of Medicine
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22
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Umino Y, Mizuma M, Iseki M, Hata T, Takadate T, Kawaguchi K, Aoki T, Motoi F, Naito T, Kamei T, Masamune A, Ishioka C, Ono T, Murakami M, Unno M. [Conversion Surgery for Locally Advanced Unresectable Pancreatic Cancer Treated with FOLFIRINOX Therapy and Proton Beam Therapy Combined with S-1 Chemotherapy-A Case Report]. Gan To Kagaku Ryoho 2019; 46:1928-1930. [PMID: 32157015] [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: 06/10/2023]
Abstract
We report a case of locally advanced unresectable(UR-LA)pancreatic cancer in a patient who underwent conversion surgery after FOLFIRINOX and proton beam therapy(PBT)combined with S-1. A 68-year-old woman was referred to our hospital for a pancreatic tumor. The abdominal CT scan revealed a 40mm pancreatic body tumor with an abutment(>180°) of the celiac artery and the superior mesenteric artery. Moreover, the tumor was classified as UR-LA with a contact to the abdominal aorta. The tumor was histologically diagnosed as adenocarcinoma via an endoscopic ultrasound-guided fine-nee- dle aspiration. After 2 courses of FOLFIRINOX, PBT(50 GyE/25 Fr)combined with S-1 were administered. The tumor shrunk to 30mm at the CT scan. After 5 courses of FOLFIRINOX, the tumor reduced to 20 mm. No distant metastasis or malignant cells in abdominal washing cytology was detected using staging laparoscopy. Then, distal pancreatectomy with celiac axis resection(DP-CAR)was performed. According to the General Rules for the Study of Pancreatic Cancer(7th edition)from Japan Pancreas Society, the histological findings were suggestive of ypT3, ypN0, R0, and Grade 3 histological effect. The patient had a Grade A delayed gastric emptying post-operation. He was discharged 35 days after the surgery and has been alive without recurrence on imaging for 11 months post-operation.
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Affiliation(s)
- Yuichiro Umino
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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23
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Maeda S, Ariake K, Iseki M, Ohtsuka H, Mizuma M, Nakagawa K, Morikawa T, Hayashi H, Motoi F, Kamei T, Naitoh T, Unno M. Prognostic indicators in pancreatic cancer patients undergoing total pancreatectomy. Surg Today 2019; 50:490-498. [PMID: 31768656 DOI: 10.1007/s00595-019-01924-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [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: 08/05/2019] [Accepted: 10/24/2019] [Indexed: 02/06/2023]
Abstract
PURPOSE To evaluate the long-term outcomes of total pancreatectomy in a modern cohort of pancreatic cancer patients and to establish whether any factors identified prior to pancreatic resection were related to poor survival. METHODS We analyzed, retrospectively, patients who underwent total pancreatectomy for pancreatic cancer between 2007 and 2016. The short- and long-term outcomes were investigated and Cox regression analysis was used to evaluate the prognostic factors identified before resection. RESULTS The subjects were 49 patients with a mean age of 65 years, who underwent total pancreatectomy in our hospital during the study period. Peritoneal washing cytology was performed in 48 patients, with positive results in 4 (8.3%). There was no 30-day mortality. The median overall survival was 22.5 months, with a 5-year survival rate of 28.5%. Univariate analyses of the pre-resection variables revealed that overall survival was associated with tumor location, resectability classification, maximum standardized uptake value of positron emission tomography, the preoperative carbohydrate antigen 19-9 level, and peritoneal washing cytology status. Multivariate analysis revealed that positive peritoneal washing cytology status and the maximum standardized uptake value were independent predictors of poor survival. CONCLUSION Total pancreatectomy for pancreatic cancer is appropriate for selected patients, but peritoneal washing cytology and positron emission tomography should be performed preoperatively.
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Affiliation(s)
- Shimpei Maeda
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan.
| | - Kyohei Ariake
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi Aoba-ku, Sendai, 980-8574, Japan
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24
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Miura T, Aoki T, Ohtsuka H, Aoki S, Hata T, Iseki M, Takadate T, Ariake K, Kawaguchi K, Masuda K, Ishida M, Mizuma M, Hayashi H, Nakagawa K, Morikawa T, Motoi F, Sasano H, Naitoh T, Kamei T, Unno M. Preoperative neutrophil‐to‐lymphocyte ratio (NLR) predicts recurrence after surgery in patient with pancreatic neuroendocrine neoplasm (PanNEN). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz422.049] [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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25
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Sato N, Motoi F, Iseki M, Kawaguchi K, Katayose Y, Sato F, Unno M. Chronological evaluation of health-related quality of life and physical symptoms in postoperative pancreatic cancer patients up to 12 months. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz276.007] [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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26
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Tsuji S, Matsuzaki H, Iseki M, Nagasu A, Hirano H, Ishihara K, Ueda N, Honda Y, Horiuchi T, Nishikomori R, Morita Y, Mukai T. Functional analysis of a novel G87V TNFRSF1A mutation in patients with TNF receptor-associated periodic syndrome. Clin Exp Immunol 2019; 198:416-429. [PMID: 31429073 DOI: 10.1111/cei.13365] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/14/2019] [Indexed: 12/17/2022] Open
Abstract
Tumor necrosis factor (TNF) receptor-associated periodic syndrome (TRAPS) is an autoinflammatory disease that is caused by heterozygous mutations in the TNFRSF1A gene. Although more than 150 TNFRSF1A mutations have been reported to be associated with TRAPS phenotypes only a few, such as p.Thr79Met (T79M) and cysteine mutations, have been functionally analyzed. We identified two TRAPS patients in one family harboring a novel p.Gly87Val (G87V) mutation in addition to a p.Thr90Ile (T90I) mutation in TNFRSF1A. In this study, we examined the functional features of this novel G87V mutation. In-vitro analyses using mutant TNF receptor 1 (TNF-R1)-over-expressing cells demonstrated that this mutation alters the expression and function of TNF-R1 similar to that with the previously identified pathogenic T79M mutation. Specifically, cell surface expression of the mutant TNF-R1 in transfected cells was inhibited with both G87V and T79M mutations, whereas the T90I mutation did not affect this. Moreover, peripheral blood mononuclear cells (PBMCs) from TRAPS patients harboring the G87V and T90I mutations showed increased mitochondrial reactive oxygen species (ROS). Furthermore, the effect of various Toll-like receptor (TLR) ligands on inflammatory responses was explored, revealing that PBMCs from TRAPS patients are hyper-responsive to TLR-2 and TLR-4 ligands and that interleukin (IL)-8 and granulocyte-macrophage colony-stimulating factor (GM-CSF) are likely to be involved in the pathogenesis of TRAPS. These findings suggest that the newly identified G87V mutation is one of the causative mutations of TRAPS. Our findings based on unique TRAPS-associated mutations provide novel insight for clearer understanding of inflammatory responses, which would be basic findings of developing a new therapeutic and prophylactic approach to TRAPS.
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Affiliation(s)
- S Tsuji
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - H Matsuzaki
- Department of Life Sciences, Faculty of Life and Environmental Sciences, Prefectural University of Hiroshima, Shobara, Hiroshima, Japan
| | - M Iseki
- Department of Immunology and Molecular Genetics, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - A Nagasu
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - H Hirano
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - K Ishihara
- Department of Immunology and Molecular Genetics, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - N Ueda
- Department of Internal Medicine, Miyazaki Prefectural Miyazaki Hospital, Miyazaki, Japan
| | - Y Honda
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Horiuchi
- Department of Internal Medicine, Kyushu University Beppu Hospital, Beppu, Oita, Japan
| | - R Nishikomori
- Department of Pediatrics, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Pediatrics and Child Health, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Y Morita
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
| | - T Mukai
- Department of Rheumatology, Kawasaki Medical School, Kurashiki, Okayama, Japan
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27
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Morikawa T, Ishida M, Takadate T, Hata T, Iseki M, Kawaguchi K, Ohtsuka H, Mizuma M, Hayashi H, Nakagawa K, Motoi F, Kamei T, Naitoh T, Unno M. The superior approach with the stomach roll-up technique improves intraoperative outcomes and facilitates learning laparoscopic distal pancreatectomy: a comparative study between the superior and inferior approach. Surg Today 2019; 50:153-162. [DOI: 10.1007/s00595-019-01855-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Accepted: 07/15/2019] [Indexed: 12/11/2022]
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28
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Sato N, Motoi F, Iseki M, Kawaguchi K, Sato F, Katayose Y, Unno M. Effect of neoadjuvant chemotherapy using gemcitabine and S1 before surgery for pancreatic cancer on quality of life. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e15719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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
e15719 Background: To improve the poor prognosis of patients with pancreatic cancer, we examined the effect of 6 months of neoadjuvant chemotherapy (NAC) using gemcitabine and S1 before surgery and found significantly prolonged survival. Clinical use of this treatment is expected in the future. However, preoperative NAC may increase the physical burden on patients as well as their psychological burden due to the longer waiting time. Thus, it is necessary to confirm that the treatment does not reduce quality of life (QOL). Methods: In this observational study of patients who underwent resection after this NAC, a QOL questionnaire survey was administered preoperatively and at postoperative months 3, 6, and 12, to consenting patients from those enrolled in randomized controlled trials (RCTs). The intervention group (planned surgery and NAC) had added pre- and post-treatment QOL surveys. We used the Short Form 36 Health Survey version 2 (SF-36v2 Standard, Japanese) to measure health-related QOL. Overall differences among the groups were evaluated by paired t test and two- and three-way ANOVA. All statistical analyses were performed using SPSS (ver. 21) software. Results: In total, 55 patients (mean age 66.0 years), about 15% of those enrolled in the RCTs, responded to the questionnaire (NAC group, n = 22; control group, n = 33). QOL was not significantly reduced in the NAC group pre- and post-treatment ( p= 0.19-0.96). Notably, there were no significant differences in post-treatment QOL, with improvement in the Physical Functioning (75.9→79.4), Bodily Pain (70.5→72.5), Vitality (59.6→59.9), and Mental Health (66.5→69.7) SF-36 domains compared with before preoperative treatment. This suggests that patients had good preoperative physical and mental QOL. QOL at each time point did not differ significantly in the 8 domains with or without NAC; the Mental component summary score was significantly higher in the NAC group compared with the control group at 3 months (54.9 vs 49.3, p= 0.04). NAC and QOL did not differ significantly by time, sex, and operation type. Conclusions: NAC using gemcitabine and S1 before surgery for pancreatic cancer does not reduce QOL. Improved prognosis can be expected with no adverse effect on QOL.
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Affiliation(s)
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | | | | | | | - Yu Katayose
- Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Michiaki Unno
- Tohoku University Graduate School of Medicine, Sendai, Japan
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29
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Toyama S, Mizuma M, Hayashi H, Iseki M, Takadate T, Ariake K, Masuda K, Ishida M, Ohtsuka H, Nakagawa K, Morikawa T, Motoi F, Kamei T, Naitoh T, Unno M. [Conversion Surgery Combined with Preoperative Coil Embolization of Hepatic Artery for Locally Advanced Unresectable Pancreatic Head Cancer with Hepatic Artery Invasion-A Case Report]. Gan To Kagaku Ryoho 2018; 45:2309-2311. [PMID: 30692447] [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
Here we report a case treated with conversion surgery combined with preoperative coil embolization of the hepatic artery after chemoradiation therapy for locally advanced unresectable pancreatic head cancer with hepatic artery invasion. A 63- year-old man was referred to our hospital for treatment of pancreatic cancer. Abdominal CT scan revealed a 30mm pancreatic head tumor with involvement of the common hepatic artery(CHA)and proper hepatic artery(PHA). The left hepatic artery diverged from the left gastric artery. Although S-1 with concurrent radiation therapy was performed, a follow-up CT scan revealed the progression of soft tissue shadow around the CHA. Subsequently, gemcitabine plus nab-paclitaxel(GnP)was administered 13 times. GnP helped achieve normalization of the tumor markers and long stable disease(SD)based on the Response Evaluation Criteria in Solid Tumors(RECIST). For the conversion surgery, embolization of the middle hepatic artery (MHA)was performed. Twelve days after, the right hepatic artery was embolized. Subtotal stomach-preserving pancreaticoduodenectomy was performed with resection of the CHA and PHA without arterial reconstruction 16 days after the hepatic arterial embolization. The patient was discharged from our hospital 33 days after surgery without complications related to hepatic ischemia. The patient is alive without recurrence 42 months after the initial diagnosis and 26 months after surgery.
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Affiliation(s)
- Shingo Toyama
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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30
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Shimura M, Mizuma M, Takadate T, Katoh Y, Suzuki T, Iseki M, Hata T, Aoki S, Suzuki Y, Sakata N, Ohtsuka H, Hayashi H, Morikawa T, Nakagawa K, Motoi F, Naitoh T, Igarashi K, Sasano H, Unno M. A novel liver metastasis-correlated protein of pancreatic neuroendocrine neoplasm (PanNEN) discovered by proteomic analysis. Oncotarget 2018; 9:24291-24303. [PMID: 29849941 PMCID: PMC5966250 DOI: 10.18632/oncotarget.25110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 10/11/2017] [Accepted: 03/17/2018] [Indexed: 01/13/2023] Open
Abstract
The aim of this study was to identify novel liver metastasis-correlated proteins of PanNEN by proteomics to compare pancreatic tumor (PT) with paired metastatic liver tumor (LT). Of 118 surgical cases with PanNEN, 7 cases with formalin-fixed paraffin-embedded (FFPE) tissues of both PT and paired LT were evaluated by proteomics. Tumor cells were selectively collected from FFPE tissues by laser capture microdissection. A total of 3,722 proteins were detected from extracted peptides by mass spectrometry-based shotgun analysis. Selection of the candidate proteins expressed differently between PT and LT were performed by semi-quantitative comparison in silico and confirmation with immunohistochemistry. We focused on ANXA6, CNPY2, RAB11B and TUBB3, all of which had higher expressions in LT. In all surgical cases with FFPE samples, liver recurrence-free survival (RFS) was evaluated in correlation to the expression of the candidate proteins in PT by immunohistochemistry. Liver RFS was significantly poorer in CNPY2 positive patients than in negative patients (10-year liver RFS; 39.8% vs. 92.3%, p = 0.012). Also, liver RFS tended to be poorer in ANXA6 positive patients than in those who were negative (10-year liver RFS; 51.4% vs. 95.0%, p = 0.099). In the multivariate analysis, the independent predictors of liver RFS were CNPY2 positivity (HR: 6.19, 95 % CI: 1.47-42.79, p = 0.011) and tumor size ≥ 42 mm (HR: 4.63, 95 % CI: 1.03-23.23, p = 0.045). In conclusion, CNPY2 is a novel liver metastasis-correlated protein of PanNEN.
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Affiliation(s)
- Mitsuhiro Shimura
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Tatsuyuki Takadate
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Yasutake Katoh
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan.,Center for Regulatory Epigenome and Diseases, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Takashi Suzuki
- Pathology and Histotechnology, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Tatsuo Hata
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Shuichi Aoki
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Yukie Suzuki
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Naoaki Sakata
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Hiroki Hayashi
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Kazuhiko Igarashi
- Department of Biochemistry, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan.,Center for Regulatory Epigenome and Diseases, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Hironobu Sasano
- Department of Pathology, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Aobaku, Sendai 980-8574, Japan
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31
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Hatsuzawa Y, Mizuma M, Motoi F, Hata T, Iseki M, Takadate T, Ohtsuka H, Sakata N, Morikawa T, Nakagawa K, Hayashi H, Naitoh T, Kanno A, Shimosegawa T, Unno M. [Conversion Surgery for Pancreatic Head Cancer with Peritoneal Dissemination Following Chemotherapy for Two Years - A Case Report]. Gan To Kagaku Ryoho 2018; 45:347-349. [PMID: 29483443] [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
Here we report a case of pancreatic cancer(PC)with peritoneal dissemination, underwent conversion surgery following chemotherapy for 2 years. A5 5-year-old woman was referred to our hospital for treatment of PC. Abdominal CT scan revealed 3.0 cm of a pancreatic head tumor with abutment of the portal vein and the hepatic artery, classified as borderline resectable. Staging laparoscopy(SL)showed positive peritoneal cytology(CY). Gemcitabine(Gem)plus S-1 therapy(GS) was performed. Ten months after initial GS, SL revealed the disseminated nodule and positive CY. The regimen was changed to Gem plus nab-paclitaxel therapy(Gem plus nab-PTX). Since right ovarian tumor was detected by CT scan 6 months after initial Gem plus nab-PTX, laparoscopic oophorectomy was performed. Histological findings showed positive CY and ovarian metastasis of PC. Afterward, Gem plus nab-PTX has been continued for 8 months. Since SL after 2 years from initial chemotherapy showed negative CY and no metastatic lesion, pancreaticoduodenectomy with portal vein resection was performed as conversion surgery. According to General Rules for the Study of Pancreatic Cancer the 7th edition by Japan Pancreas Society, histological findings showed ypT3, ypN0, R0, and Grade 1b of histological effect. The patient is alive without recurrence 6 months after the resection.
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Affiliation(s)
- Yuuri Hatsuzawa
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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32
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Shimura M, Mizuma M, Hayashi H, Mori A, Tachibana T, Hata T, Iseki M, Takadate T, Ariake K, Maeda S, Ohtsuka H, Sakata N, Morikawa T, Nakagawa K, Naitoh T, Kamei T, Motoi F, Unno M. A long-term survival case treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis. Surg Case Rep 2017; 3:132. [PMID: 29285651 PMCID: PMC5746493 DOI: 10.1186/s40792-017-0409-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/18/2017] [Indexed: 12/11/2022] Open
Abstract
Background Pancreatic cancer with distant metastases is classified as “unresectable,” for which the standard treatment is systemic chemotherapy. The effectiveness of radical resection for pancreatic cancer with distant metastases is unknown. Here, we report a case of long term survival treated with conversion surgery following chemotherapy after diagnostic metastasectomy for pancreatic cancer with synchronous liver metastasis. Case presentation A 73-year-old man was referred to our hospital to examine and treat for cancer of the pancreatic body. Computed tomography (CT) scan revealed a 26-mm hypovascular tumor in contact with the common hepatic artery (CHA) (> 180°), the celiac artery (< 180°), and portal vein at the pancreatic body. Resectability was determined as “borderline resectable.” Two courses of gemcitabine plus S-1 combination therapy (GS) were administered as neoadjuvant chemotherapy (NAC). CT scan showed tumor shrinkage (21 mm), determined as stable disease (SD) according to Response Evaluation Criteria in Solid Tumors (RECIST). Although the abdomen was opened for radical resection, a small nodule on the liver was detected and removed. Since the nodule was diagnosed as adenocarcinoma by intraoperative frozen section, resection of the primary tumor was not performed. After three subsequent courses of GS therapy, no distant metastases were detected under radiological findings. Distal pancreatectomy with celiac artery resection (DP-CAR) was performed as radical surgery 6 months after the initial diagnosis. Histological diagnosis was well-differentiated tubular adenocarcinoma, showing ypT1 ypN1 M1 stage IV, negative surgical margin (R0), and grade III in the Evans classification. S-1 was administered every other day from 6 months after resection up to the present. The patient has been alive with no recurrence for 5 years after the initial diagnosis and 4.5 years after the resection. Conclusion There is a case that received survival benefits from conversion surgery following chemotherapy after diagnostic metastasectomy in pancreatic cancer with synchronous liver metastasis.
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Affiliation(s)
- Mitsuhiro Shimura
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Masamichi Mizuma
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan.
| | - Hiroki Hayashi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Akiko Mori
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Tomoyoshi Tachibana
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Tatsuo Hata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Masahiro Iseki
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Tatsuyuki Takadate
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Kyohei Ariake
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Shimpei Maeda
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Hideo Ohtsuka
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Naoaki Sakata
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takanori Morikawa
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Kei Nakagawa
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takeshi Naitoh
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Takashi Kamei
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Fuyuhiko Motoi
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
| | - Michiaki Unno
- Department of Surgery, Graduate School of Medicine, Tohoku University, 1-1 Seiryomachi, Aobaku, Sendai, 980-8574, Japan
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33
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Kyakumoto Y, Takadate T, Mizuma M, Hata T, Iseki M, Ohtsuka H, Sakata N, Nakagawa K, Morikawa T, Hayashi H, Motoi F, Naitoh T, Kanno A, Shimosegawa T, Unno M. [A Case of Successful Adjuvant Surgery for the Pancreas Head Cancer with Peritoneal Metastasis]. Gan To Kagaku Ryoho 2017; 44:1880-1882. [PMID: 29394807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
We report a case of the pancreas head cancer with peritoneal metastasis, which was resected curatively after chemotherapy. A6 6-year-old male was referred to our hospital for the treatment of biliary stenosis. The serum CA19-9 level was elevated and abdominal CT scan showed stenosis of distal bile duct. By laparotomy, we noticed mass in the head of the pancreas with 8mm of the seeding nodule in a diameter at jejunal mesentery which was diagnosed as adenocarcinoma by intraoperative frozen sections. Therefore, the patient was diagnosed as pancreas head cancer with peritoneal metastasis. After hepaticojejunostomy, we started chemotherapy planning adjuvant surgery if the clinical response was observed. Systemic chemotherapy with gemcitabine and nab-paclitaxel was administrated on days 1, 8 and 15 every 4 weeks. After 5 courses, therapeutic effect was stable disease(SD)in response evaluation criteria in solid tumor(RECIST). All of tumor markers were normalized. Subtotal stomach-preserving pancreatoduodenectomy(SSPPD)was performed 6 months after the initial surgery. Histopathologically, most cancer cells showed degeneration and eliminated in the head of the pancreas. R0 resection was achieved with diagnosis of ypT3, ypN1, pM1(PER), Stage IV . Histological therapeutic effect was Grade III according to the Evans classification. The patient is alive, with no sign of recurrence 8 months after surgery. Adjuvant surgery was suggested to be one of the therapeutic options for pancreatic cancer with peritoneal metastasis.
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Affiliation(s)
- Yukie Kyakumoto
- Dept. of Surgery, Tohoku University Graduate School of Medicine
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34
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Iseki M, Kushida Y, Wakao S, Akimoto T, Mizuma M, Motoi F, Asada R, Shimizu S, Unno M, Chazenbalk G, Dezawa M. Muse Cells, Nontumorigenic Pluripotent-Like Stem Cells, Have Liver Regeneration Capacity Through Specific Homing and Cell Replacement in a Mouse Model of Liver Fibrosis. Cell Transplant 2016; 26:821-840. [PMID: 27938474 DOI: 10.3727/096368916x693662] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Muse cells, a novel type of nontumorigenic pluripotent-like stem cells, reside in the bone marrow, skin, and adipose tissue and are collectable as cells positive for pluripotent surface marker SSEA-3. They are able to differentiate into cells representative of all three germ layers. The capacity of intravenously injected human bone marrow-derived Muse cells to repair an immunodeficient mouse model of liver fibrosis was evaluated in this study. The cells exhibited the ability to spontaneously differentiate into hepatoblast/hepatocyte lineage cells in vitro. They demonstrated a high migration capacity toward the serum and liver section of carbon tetrachloride-treated mice in vitro. In vivo, they specifically accumulated in the liver, but not in other organs except, to a lesser extent, in the lungs at 2 weeks after intravenous injection in the liver fibrosis model. After homing, Muse cells spontaneously differentiated in vivo into HepPar-1 (71.1 ± 15.2%), human albumin (54.3 ± 8.2%), and anti-trypsin (47.9 ± 4.6%)-positive cells without fusing with host hepatocytes, and expressed mature functional markers such as human CYP1A2 and human Glc-6-Pase at 8 weeks after injection. Recovery in serum, total bilirubin, and albumin and significant attenuation of fibrosis were recognized with statistical differences between the Muse cell-transplanted group and the control groups, which received the vehicle or the same number of a non-Muse cell population of MSCs (MSCs in which Muse cells were eliminated). Thus, unlike ESCs and iPSCs, Muse cells are unique in their efficient migration and integration into the damaged liver after intravenous injection, nontumorigenicity, and spontaneous differentiation into hepatocytes, rendering induction into hepatocytes prior to transplantation unnecessary. They may repair liver fibrosis by two simple steps: expansion after collection from the bone marrow and intravenous injection. A therapeutic strategy such as this is feasible and may provide significant advancements toward liver regeneration in patients with liver disease.
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Uni S, Abe M, Harada K, Kaneda K, Kimata I, Abdelmaksoud NM, Takahashi K, Miyashita M, Iseki M. New record ofGongylonema pulchrumMolin, 1857 from a new host,Macaca fuscata,in Japan. ACTA ACUST UNITED AC 2016. [DOI: 10.1051/parasite/1992676221] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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36
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Son A, Oshio T, Kawamura YI, Hagiwara T, Yamazaki M, Inagaki-Ohara K, Okada T, Wu P, Iseki M, Takaki S, Burkly LC, Dohi T. TWEAK/Fn14 pathway promotes a T helper 2-type chronic colitis with fibrosis in mice. Mucosal Immunol 2013; 6:1131-42. [PMID: 23462911 DOI: 10.1038/mi.2013.10] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2012] [Accepted: 01/30/2013] [Indexed: 02/04/2023]
Abstract
Tumor necrosis factor (TNF)-like weak inducer of apoptosis (TWEAK), a TNF superfamily member, induces damage of the epithelial cells (ECs) and production of inflammatory mediaters through its receptor Fn14 in a model of acute colitis. In our current study of chronic colitis induced by repeated rectal injection of a hapten, we found that inflammation, fibrosis, and T helper 2 (Th2)-type immunity were significantly reduced in Fn14 gene knockout (KO) mice when compared with wild-type (WT) control mice. Expression of thymic stromal lymphopoietin (TSLP) was lower in Fn14 KO colon ECs than in WT ECs. TWEAK potentiates the induction of TSLP by interleukin-13 (IL-13) in colon explants from WT but not in Fn14 KO tissue. TSLP receptor KO mice exhibit milder chronic colitis, similar to that in Fn14 KO mice. TWEAK and IL-13 synergistically promote fibroblast proliferation. Thus we propose an IL-13-TWEAK/Fn14-TSLP axis as a key mechanism underlying chronic colitis with fibrosis.
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Affiliation(s)
- A Son
- Department of Gastroenterology, Research Center for Hepatitis and Immunology, Research Institute, National Center for Global Health and Medicine, Chiba, Japan
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37
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Iseki M, Motoi F, Mizuma M, Hayashi H, Nakagawa K, Okada T, Otsuka H, Ottomo S, Sakata N, Fukase K, Yoshida H, Onogawa T, Naito T, Katayose Y, Egawa S, Unno M. [A 5-year survival case of locally advanced cancer of the pancreatic body treated by distal pancreatectomy with en bloc celiac axis resection after neoadjuvant chemoradiation therapy]. Gan To Kagaku Ryoho 2012; 39:1948-1950. [PMID: 23267939] [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: 06/01/2023]
Abstract
A 59-year-old man was diagnosed with locally advanced cancer of the pancreatic body, involving the nerve plexus around the celiac axis, the common hepatic artery, and the splenic artery. He was treated with a combination of irradiation (2 Gy/day, total 24 Gy) and 600 mg/m2 of gemcitabine(GEM)biweekly. The tumor size and the involved plexus area were not diminished, but CA19-9 was reduced by half. Distal pancreatectomy with en bloc celiac axis resection(DP-CAR)was performed. The histological findings indicated extensive invasion into the nerve plexus, including that adjacent to the stump of the pancreas, and thus the R classification was R1. After surgery, 1,000 mg/m2 of GEM was administered biweekly. The chemotherapy has been performed for 5 years to prevent local and systemic recurrence. No recurrence has been found 5 years after surgery. Multidisciplinary treatment, combined with neoadjuvant chemoradiation therapy, curative-intent resection, and postoperative chemotherapy is important for effective treatment of locally advanced pancreatic cancer.
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Affiliation(s)
- Masahiro Iseki
- Dept. of Surgery, Tohoku University Graduate School of Medicine, Japan
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39
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Deng S, Yu G, Xie S, Yu Q, Huang J, Kuwaki Y, Iseki M. Enhanced adsorption of arsenate on the aminated fibers: sorption behavior and uptake mechanism. Langmuir 2008; 24:10961-10967. [PMID: 18771297 DOI: 10.1021/la8023138] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Novel aminated polyacrylonitrile fibers (APANFs) were prepared through the reaction of polyacrylonitrile fibers (PANFs) with four multinitrogen-containing aminating reagents, and the best adsorbent was obtained after the optimization of preparation experiments. The APANFs were effective for arsenate removal from aqueous solution, and the sorption behaviors including kinetics, isotherms, effect of pH, and competitive anions were investigated. Experimental results show that the equilibrium of arsenate sorption on the fibers was achieved within 1 h, and Langmuir equation described the sorption isotherms well with a high sorption capacity of 256.1 mg/g obtained. The thermodynamic parameters calculated show that the sorption was spontaneous and exothermic under the condition applied. The zero point of zeta potential of the APANFs was at about pH = 8.2, in contrast with that of the PANFs at pH = 3.6. Fourier transform infrared (FTIR) and X-ray photoelectron spectroscopy (XPS) for the APANFs before and after arsenate adsorption revealed that the amine groups on the fiber surface played an important role in the removal of arsenate from water, attributed to the electrostatic interaction between the positive protonated amine groups and negative arsenate ions.
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Affiliation(s)
- Shubo Deng
- Department of Environmental Science and Engineering, Tsinghua University, Beijing, People's Republic of China.
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Kitsuka K, Mohammad AM, Awad MI, Kaneda K, Ikematsu M, Iseki M, Mushiake K, Ohsaka T. Simultaneous Spectrophotometric Determination of Ozone and Hydrogen Peroxide. CHEM LETT 2007. [DOI: 10.1246/cl.2007.1396] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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41
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Ikematsu M, Kaneda K, Iseki M, Yasuda M. Electrochemical treatment of human urine for its storage and reuse as flush water. Sci Total Environ 2007; 382:159-64. [PMID: 17462709 DOI: 10.1016/j.scitotenv.2007.03.028] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/24/2006] [Revised: 03/14/2007] [Accepted: 03/19/2007] [Indexed: 05/15/2023]
Abstract
We proposed the electrochemical treatment of human urine to enable its storage without the accompanying unpleasant odor. This urine can then be reused as flush water in toilets as a means to tackle water shortage problems. In laboratory-scale experiments, the time-dependent variation in the pH of human urine, after the addition of urease, could be suppressed by chlorine produced via the electrochemical treatment of diluted human urine. Ureolysis was quantified by pH increase within 100 h. This suppression occurred as a result of an irreversible change in the conformation of urease that resulted in its inactivation at an oxidation-reduction potential (ORP) of ca. 240 mV or above. Due to the electrochemical inactivation of urease during the entire storage period of urine, the hydrolysis of urea in urine, which results in the production of the unpleasant odor due to ammonia formation, can be avoided. Thus, the treatment enables the storage of urine for its reuse as flush water in toilets.
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Affiliation(s)
- Mineo Ikematsu
- Human Ecology Research Center, Sanyo Electric Co., Ltd., 1-1-1 Sakata, Oizumi, Ora, Gunma 370-0596, Japan.
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42
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Ikematsu M, Sugiyama Y, Iseki M, Muneyuki E, Mizukami A. Direct reconstitution of bacteriorhodopsin into planar phospholipid bilayers--detergent effect. Biophys Chem 2007; 54:155-64. [PMID: 17020857 DOI: 10.1016/0301-4622(94)00111-v] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/1994] [Revised: 09/12/1994] [Accepted: 09/12/1994] [Indexed: 11/25/2022]
Abstract
This paper describes how the structure and concentration level of a detergent used for substitution after bacteriorhodopsin (bR) solubilization affect the reconstitution of the bR into phospholipid planar bilayers. A direct insertion method was used for the bR reconstitution into the bilayers. Two detergents representing the two major types were used: sodium deoxycholate with a cholane-ring structure, and octylglucoside with a linear (or chain) structure. We then characterized the reconstitution for the two detergents by considering the detergent separation profiles and the photocurrent variations upon addition of lanthanum chloride and the protonophore FCCP (carbonylcyanide-p-trifluoromethoxyphenylhydrazone). We found that for successful transmembrane reconstitution of bR the detergent with the cholane-ring structure was preferable to that with the linear structure when the detergent concentration was above its critical micellar concentration. This preference was explained by the ease with which the detergent with the cholane-ring structure was removed from protein compared to that with the linear structure. Finally, we proposed a scheme for the reconstitution of the protein.
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Affiliation(s)
- M Ikematsu
- Tsukuba Research Center, Sanyo Electric Co. Ltd., Tsukuba, Ibaraki 305, Japan
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43
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Kitsuka K, Kaneda K, Ikematsu M, Iseki M, Mushiake K, Mohammad AM, Ohsaka T. A Spin-coated Si/TiOx/Pt/TaOxElectrode for Electrochemical Ozone Generation. CHEM LETT 2007. [DOI: 10.1246/cl.2007.806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Nozaki H, Iseki M, Hasegawa M, Misawa K, Nakada T, Sasaki N, Watanabe M. Phylogeny of Primary Photosynthetic Eukaryotes as Deduced from Slowly Evolving Nuclear Genes. Mol Biol Evol 2007. [DOI: 10.1093/molbev/msm164] [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: 11/15/2022] Open
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Affiliation(s)
- H Hisamatsu
- Departments of Urology, Nagasaki University School of Medicine, Nagasaki, Japan.
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Yagita K, Izumiyama S, Tachibana H, Masuda G, Iseki M, Furuya K, Kameoka Y, Kuroki T, Itagaki T, Endo T. Molecular characterization of Cryptosporidium isolates obtained from human and bovine infections in Japan. Parasitol Res 2001; 87:950-5. [PMID: 11728022 DOI: 10.1007/s004360100480] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Cryptosporidium oocysts, morphologically identified as Cryptosporidium parvum, were isolated from 22 human and 14 bovine cases in Japan, and were genotyped by means of a PCR/RFLP analysis of the polythreonine gene. DNA profiles of human isolates gave three distinct genotypes, namely an anthroponotic genotype 1, zoonotic genotype 2 and a new genotype. Isolates from bovine samples gave zoonotic genotype 2. The unusual genotype of Cryptosporidium was isolated from the feces of three immunologically healthy adults, and was further characterized by the sequence analysis of the 18S rRNA gene. The third genotype was identified as Crypto sporidium meleagridis, demonstrating that C. meleagridis, which occurs worldwide, has the potential to infect humans regardless of their immunological condition.
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Affiliation(s)
- K Yagita
- Department of Parasitology, National Institute of Infectious Diseases, Tokyo, Japan
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49
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Fukuda Y, Isomoto H, Takeshima F, Yamasaki K, Mizuta Y, Omagari K, Murase K, Yamaguchi H, Iseki M, Murata I, Kohno S. Heterotopic gastric mucosa in intrahepatic bile duct, presenting with hemobilia: a case report. Hepatogastroenterology 2001; 48:1337-9. [PMID: 11677958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
We present a 66-year-old man with unique heterotopic gastric mucosa in the intrahepatic bile duct causing hemobilia. Endoscopic retrograde cholangiography showed irregular stenosis of the left intrahepatic bile duct, and a provisional diagnosis of cholangiocarcinoma was made. Therefore, partial hepatic lobectomy and cholecystectomy were performed. Histological examination of the liver showed the presence of ectopic gastric mucosa in the intrahepatic bile duct containing mucous glands with parietal and chief cells and bile. Heterotopic gastric mucosa in the intrahepatic bile duct is a rare cause of hemobilia.
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Affiliation(s)
- Y Fukuda
- Department of Internal Medicine, Nagasaki Municipal Medical Center, Second Department of Internal Medicine, Nagasaki University School of Medicine, Nagasaki, Japan
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Iseki M, Mitsuhata H, Miyazaki T, Toriumi E, Yoshino K. [Relief of subacute herpetic pain and postherpetic neuralgia with repeated application of 10% lidocaine cream]. Masui 2000; 49:1204-9. [PMID: 11215225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
Analgesic efficacy of repeated application of a lidocaine cream formula was investigated in herpes zoster patients with subacute pain with no further improvement after continued treatment since their acute stage (S-HZ group, n = 23), and in patients to whom past treatments had not provided adequate pain relief (PHN group, n = 28). In both groups, visual analog scale (VAS) values decreased significantly from their corresponding values before the present treatment with few cases of side effects and complete disappearances of the pain in 21.6% of all the patients. The results indicate that the repeated application of the lidocaine cream is a safe and effective treatment method. Significantly higher effectiveness was achieved in the S-HZ group in terms of the difference in the VAS values between before and after the treatment, effectiveness in improving the activities of daily life, and overall efficacy evaluation.
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Affiliation(s)
- M Iseki
- Department of Anesthesiology, Juntendo University School of Medicine, Tokyo 113-0033
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