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Nakamura S, Tada K, Mita J, Fukuzawa K. Relaparotomy pseudoaneurysm repair after distal pancreatectomy with celiac axis resection (DP-CAR): a case report. J Surg Case Rep 2024; 2024:rjae204. [PMID: 38585177 PMCID: PMC10994857 DOI: 10.1093/jscr/rjae204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Accepted: 03/15/2024] [Indexed: 04/09/2024] Open
Abstract
A 76-year-old man underwent distal pancreatectomy with celiac axis resection (DP-CAR) after preoperative chemotherapy for pancreatic cancer with celiac artery invasion. Although postoperative pancreatic leakage and ischemia-induced bile fistula developed, the patient's condition remained stable with good drainage. On postoperative Day 47, a pseudoaneurysm developed at the junction of the gastroduodenal artery and proper hepatic artery. However, cannulation of the guidewire was difficult, and relaparotomy pseudoaneurysm repair was performed. On postoperative Day 56, a pseudoaneurysm reappeared at the same site, and relaparotomy was performed again. On postoperative Day 61, CT confirmed the disappearance of the pseudoaneurysm and preservation of the right and left hepatic arteries. The patient was discharged 107 days postoperatively. Interventional radiology (IVR) remains the best technique to achieve hemostasis for pseudoaneurysms. However, this case demonstrates that even when hemostasis by IVR is difficult, relaparotomy pseudoaneurysm repair after DP-CAR may be useful after some postoperative.
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Affiliation(s)
- Shun Nakamura
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita 870-0033, Japan
| | - Kazuhiro Tada
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita 870-0033, Japan
| | - Junya Mita
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita 870-0033, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-shi, Oita 870-0033, Japan
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Baba H, Yamada Y, Tada K, Kuboyama Y, Fukuzawa K, Iwaki K, Motomura M, Takaji R, Shimada R, Takaki H, Asayama Y. Pancreatic mixed acinar-neuroendocrine carcinoma with intraductal growth: A case report with radiologic-pathologic correlations. Radiol Case Rep 2023; 18:4422-4430. [PMID: 37929047 PMCID: PMC10624768 DOI: 10.1016/j.radcr.2023.09.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 09/09/2023] [Accepted: 09/12/2023] [Indexed: 11/07/2023] Open
Abstract
Pancreatic mixed acinar-neuroendocrine carcinomas are rare malignant tumors of the pancreas. They are composed histologically of both acinar and neuroendocrine cells. The pancreatic duct is known to be an important site of tumor growth for acinar cell carcinomas, neuroendocrine tumors, and intraductal tubulopapillary neoplasms. To the best of our knowledge, there has been only 1 report of a mixed acinar-neuroendocrine carcinoma growing into the pancreatic duct and no reports detailing imaging findings with this tumor. We here report a 69-year-old man who presented with worsening glycemic control. Multiphase contrast-enhanced computed tomography and magnetic resonance imaging revealed a well-circumscribed mass with poor contrast enhancement in the pancreatic tail region of the pancreatic duct. The intraductal mass showed diffusion restriction on magnetic resonance imaging. These imaging findings are consistent with the expansive, smooth-surfaced polypoid tumor of low vascularity and high cellularity that was diagnosed pathologically. Mixed acinar-neuroendocrine carcinomas should be included in the differential diagnosis of intraductal tumors of the pancreas with poor contrast enhancement and diffusion restriction.
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Affiliation(s)
- Hiroshi Baba
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yasunari Yamada
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kazuhiro Tada
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Yusuke Kuboyama
- Department of Pathology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita , Japan
| | - Mitsuteru Motomura
- Hepato-Biliary-Pancreatic Internal Medicine, Oita Red Cross Hospital, Chiyo-machi, Oita, 870-0033, Japan
| | - Ryo Takaji
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Ryuichi Shimada
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Yoshiki Asayama
- Department of Radiology, Oita University Faculty of Medicine, Yufu, Oita, 879-5593, Japan
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Kayashima H, Itoh S, Shimokawa M, Hayashi H, Takamori H, Fukuzawa K, Ninomiya M, Araki K, Yamashita YI, Sugimachi K, Uchiyama H, Morine Y, Utsunomiya T, Uwagawa T, Maeda T, Baba H, Yoshizumi T. Effect of duration of adjuvant chemotherapy with S-1 (6 versus 12 months) for resected pancreatic cancer: the multicenter clinical randomized phase II postoperative adjuvant chemotherapy S-1 (PACS-1) trial. Int J Clin Oncol 2023; 28:1520-1529. [PMID: 37552354 DOI: 10.1007/s10147-023-02399-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/29/2023] [Indexed: 08/09/2023]
Abstract
BACKGROUND Six-month adjuvant chemotherapy with S-1 is standard care for resected pancreatic cancer in Japan; however, the optimal duration has not been established. We aimed to evaluate the impact of duration of adjuvant chemotherapy with S-1. METHODS We performed a multicenter, randomized, open-label, phase II study. Patients with histologically proven invasive pancreatic ductal carcinoma, pathological stage I-III, and no local residual or microscopic residual tumor were eligible. Patients were randomized 1:1 to receive 6- or 12-month adjuvant chemotherapy with S-1. The primary endpoint was 2-year overall survival (OS). Secondary endpoints were disease-free survival (DFS) and feasibility. RESULTS A total of 170 patients were randomized (85 per group); the full analysis set was 82 in both groups. Completion rates were 64.7% (6-month group) and 44.0% (12-month group). Two-year OS was 71.5% (6-month group) and 65.4% (12-month group) (hazard ratio (HR): 1.143; 80% confidence interval CI 0.841-1.553; P = 0.5758). Two-year DFS was 46.4% (6-month group) and 44.9% (12-month group) (HR: 1.069; 95% CI 0.727-1.572; P = 0.6448). In patients who completed the regimen, 2-year DFS was 56.5% (6-month group) and 75.0% (12-month group) (HR: 0.586; 95% CI 0.310-1.105; P = 0.0944). Frequent (≥ 5%) grade ≥ 3 adverse events comprised anorexia (10.5% in the 6-month group) and diarrhea (5.3% vs. 5.1%; 6- vs. 12-month group, respectively). CONCLUSIONS In patients with resected pancreatic cancer, 12-month adjuvant chemotherapy with S-1 was not superior to 6-month therapy regarding OS and DFS.
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Affiliation(s)
- Hiroto Kayashima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan.
| | - Mototsugu Shimokawa
- Department of Biostatistics, Yamaguchi University, 1677-1 Yoshida, Yamaguchi, 753-8511, Japan
| | - Hiromitsu Hayashi
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Kumamoto, 861-4193, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyo-machi, Oita, 870-0033, Japan
| | - Mizuki Ninomiya
- Department of Surgery, Matsuyama Red Cross Hospital, 1 Bunkyocho, Matsuyama, Ehime, 790-8524, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, 4-2 Aramaki-machi, Maebashi, Gunma, 371-8510, Japan
| | - Yo-Ichi Yamashita
- Department of Surgery, Iizuka Hospital, 3-83 Yoshio-machi, Iizuka, Fukuoka, 820-8505, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-Pancreatic Surgery, Kyushu Cancer Center, 3-1-1 Notame, Fukuoka, 811-1395, Japan
| | - Hideaki Uchiyama
- Department of Surgery, Saiseikai Fukuoka General Hospital, 1-3-46 Tenjin, Fukuoka, 810-0001, Japan
| | - Yuji Morine
- Department of Surgery, Tokushima University, 2-24 Shinkuracho, Tokushima, 770-0855, Japan
| | - Tohru Utsunomiya
- Department of Surgery, Oita Prefectural Hospital, 2-8-1 Bunyo, Oita, 870-8511, Japan
| | - Tadashi Uwagawa
- Department of Hepato-Biliary-Pancreatic Surgery, The Jikei University School of Medicine, 3-25-8 Nishi-Shimbashi, Minato-ku, Tokyo, 105-8461, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6 Senda-machi, Hiroshima, 730-8619, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Kumamoto, 860-8556, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Fukuoka, 812-8582, Japan
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Kinoshita S, Yamashita YI, Kitano Y, Hayashi H, Sugimachi K, Nishizaki T, Fukuzawa K, Kajiyama K, Miyanari N, Yoshizumi T, Takamori H, Baba H. Survival impact of pancreatic resection for metastases in the pancreas: A retrospective multi-center study. Surg Oncol 2023; 48:101942. [PMID: 37043926 DOI: 10.1016/j.suronc.2023.101942] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/22/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Pancreatic metastases from other primary malignancies are rare. There is no clear evidence for a treatment strategy for this condition. The purpose of this study was to assess the clinical outcomes, including prognostic factors for pancreatic resection of metastatic tumors in the pancreas, through a retrospective review. METHODS Data of 35 patients who underwent pancreatic resection for pancreatic metastasis between 2005 and 2020 in eight Japanese institutions were included in this study. Survival analyses were performed using the Kaplan-Meier method, and comparisons were made using the Cox proportional hazards model. RESULTS The median follow-up period was 35 months (range, 5-102 months). Median duration from resection for primary tumor to resection for metastatic pancreatic tumor was 10.6 years (range, 0.6-29.2 years). The 3- and 5-year survival rates after resection for metastatic tumors in the pancreas were 89% and 69%, respectively. In contrast, the 3- and 5-year disease-free survival rates after resection for metastatic tumors in the pancreas were 48% and 21%, respectively. Performance status ≥1 at the time of resection for metastatic tumors in the pancreas (HR: 7.56, p = 0.036) and pancreatic metastasis tumor diameter >42 mm (HR: 6.39, p = 0.02) were significant poor prognostic factors only in the overall survival. CONCLUSIONS The prognosis of pancreatic resection for metastatic tumors in the pancreas is relatively good for selected patients. However, because it is prone to recurrence after radical surgery, it should only be considered in patients with good PS.
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Mita J, Tada K, Kuboyama Y, Hiroshige S, Nakamura S, Takahashi J, Sakata K, Mizuuchi H, Oba T, Yoshizumi F, Iwaki K, Takeuchi H, Kajiyama K, Fukuzawa K. Liver metastases 2 years after resection of a very-low-risk duodenal gastrointestinal stromal tumor: a case report. Surg Case Rep 2022; 8:195. [PMID: 36214924 PMCID: PMC9550939 DOI: 10.1186/s40792-022-01551-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 10/03/2022] [Indexed: 11/06/2022] Open
Abstract
Background Gastrointestinal stromal tumors (GISTs) are rare mesenchymal tumors, but are the most common mesenchymal tumors of the gastrointestinal tract. The risk classification of GISTs is based on the tumor size, mitotic index, tumor site, and presence of tumor rupture. Recurrence in the very-low-risk group is extremely rare. We herein report a case of liver metastases 2 years after resection of a very-low-risk duodenal GIST. Case presentation A 57-year-old woman presented to the hospital for evaluation of melena. Esophagogastroduodenoscopy showed bleeding from the exposed blood vessels at the top of a submucosal tumor approximately 20 mm in size located in the second (descending) part of the duodenum, and the bleeding was controlled with electrocoagulation. A GIST was suspected, and the patient underwent wedge resection of the duodenum. The resected specimen contained a 16- × 12-mm (< 20-mm) white submucosal tumor composed of spindle cells with a mitotic count of 4 per 50 high-power fields, and a histologically negative margin was achieved. Immunochemical analysis revealed positive tumor staining for c-kit protein and alpha-smooth muscle actin and negative staining for CD34, desmin, and S-100 protein. Therefore, the tumor was diagnosed as a very-low-risk duodenal GIST based on the Fletcher classification and modified Fletcher classification (Joensuu classification). The postoperative course was uneventful, and the patient was discharged on postoperative day 11. At the follow-up visit 2 years postoperatively, contrast-enhanced computed tomography revealed liver tumors in S8 and S6 measuring 26 × 24 and 10 × 10 mm, respectively. Both lesions showed peripheral dominant hyperenhancement with hypoenhancement inside, indicating tissue degeneration within the tumors. These imaging findings closely resembled those of the duodenal GIST. Hence, the patient was diagnosed with liver metastases of GIST 2 years postoperatively. She was subsequently started on treatment with 400 mg of imatinib. At the time of this writing (2 months after diagnosis), the patient was clinically well and asymptomatic and was continuing imatinib therapy. Conclusions Recurrence of very-low-risk GISTs is extremely rare. Even a small GIST with low mitotic activity can never be considered completely benign, and long-term follow-up is necessary.
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Affiliation(s)
- Junya Mita
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Kazuhiro Tada
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Yusuke Kuboyama
- grid.416795.80000 0004 0642 5894Department of Pathology, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Shoji Hiroshige
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Shun Nakamura
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Junichi Takahashi
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Kazuhito Sakata
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Hiroshi Mizuuchi
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Taro Oba
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Fumitaka Yoshizumi
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Kentaro Iwaki
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Hideya Takeuchi
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Kiyoshi Kajiyama
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
| | - Kengo Fukuzawa
- grid.416795.80000 0004 0642 5894Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyomachi, Oita-Shi, Oita, Japan
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Nakasone K, Nishimori M, Kiuchi K, Shinohara M, Fukuzawa K, Takami T, Nakamura T, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Iwai H, Nakanishi Y, Hirata K. Prediction of difficulty in cryoballoon ablation with a 3D deep learning model using polygonal mesh representation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Background
Cryoballoon ablation (CBA) is a useful treatment for pulmonary vein isolation (PVI). Some cases, however, are difficult to treat and may require multiple freezing procedures and/or touch-up ablation. Although several predictors of CBA difficulty have been reported, no report has been able to assess the spatial location and morphology of the left atrium (LA) and pulmonary veins (PVs). A polygonal mesh is a collection of vertices, edges, and faces that defines the shape of a polyhedral object, and is able to represent a spatial location with a small amount of information. We hypothesized that a deep learning model that learns mesh representation datasets could more accurately detect the CBA difficulty and that we could establish a novel evaluation method in CBA.
Purpose
The aim of this study was to create a model to predict CBA difficulty with a 3D deep learning model using polygonal mesh representation.
Methods and results
All the 140 patients who underwent CBA for drug-resistant atrial fibrillation between January 2015 and January 2022 were included. A 28-mm cryoballoon (Arctic Front Advance, Medtronic) was used in all cases. We defined CBA difficulty as requiring a touch-up ablation procedure to create complete PVI. We converted the volume data in DICOM format of the computed tomography images of PVs and LA to obj file format (shown in Figure 1), which supports the definition of the geometry for object surfaces using polygonal meshes. Next, we developed a deep learning model that could learn polygonal meshes and classify whether the CBA required touch-up ablation or not. Only a training dataset is used to train the deep learning model, and finally, a test dataset is used to evaluate the model metrics. The accuracy, area under the ROC curve, recall, precision, and f1-score of the deep learning model using the test dataset was 86.5%, 87.7%, 66.7%, 75.0%, 70.6%, respectively.
Conclusions
We developed a 3D deep learning model that can detect a difficulty in CBA using polygonal mesh representation. By predicting difficult cases in advance, we will be able to develop strategies to increase the success rate.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - K Tani
- Kobe University , Kobe , Japan
| | - H Iwai
- Kobe University , Kobe , Japan
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7
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Hara A, Yamada Y, Fukuzawa K, Motomura M, Kuboyama Y, Sakata K, Takaji R, Asayama Y, Takaki H. “Honeycomb” appearance in large-duct type pancreatic ductal adenocarcinoma: Case report with radiologic–pathologic correlation. Radiol Case Rep 2022; 17:3439-3445. [PMID: 35909928 PMCID: PMC9334827 DOI: 10.1016/j.radcr.2022.06.047] [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: 05/28/2022] [Revised: 06/11/2022] [Accepted: 06/13/2022] [Indexed: 11/26/2022] Open
Abstract
Large-duct type pancreatic ductal adenocarcinoma (PDA) is a rare morphologic variant forming large duct elements. This case report, to our knowledge, is the first report of a large-duct type PDA with a “honeycomb” appearance resembling a serous cystic neoplasm (SCN) on CT and MRI. The patient is an 82-year-old woman who presented with upper abdominal pain. Dynamic contrast-enhanced CT revealed a multilocular cyst with honeycomb loculi, in which the cyst walls showed gradual enhancement. On T2-weighted MRI, the mass displayed inhomogeneous hyperintensity characterized by a honeycomb appearance with irregular and thick hypointense cyst walls. The patient underwent distal pancreatectomy; histopathological diagnosis was large-duct type PDA. Although the imaging features of large-duct type PDA may resemble those of SCN, this distinction between PDA and SCN is important because the treatment options are very different.
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8
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Lan C, Kitano Y, Yamashita YI, Yamao T, Kajiyama K, Yoshizumi T, Fukuzawa K, Sugimachi K, Ikeda Y, Takamori H, Miyanari N, Hirota M, Baba H. Correction: Cancer-associated fibroblast senescence and its relation with tumour-infiltrating lymphocytes and PD-L1 expressions in intrahepatic cholangiocarcinoma. Br J Cancer 2021; 126:311-312. [PMID: 34931043 DOI: 10.1038/s41416-021-01615-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Chuan Lan
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.,Department of Hepatobiliary Surgery and Center of Severe Acute Pancreatitis, The Affiliated Hospital of North Sichuan Medical College, 637100, Nanchong, P. R. China
| | - Yuki Kitano
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Yo-Ichi Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Takanobu Yamao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Kiyoshi Kajiyama
- Department of Surgery, Iizuka Hospital, 3-83 Yoshiomachi, Iizuka City, Fukuoka, 820-8505, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812‑8582, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, 3-2-37, Chiyo-machi, Oita, 870-0033, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, 3-1-1 Notame, Minami-ku, Fukuoka, 811-1395, Japan
| | - Yasuharu Ikeda
- Department of Surgery, Fukuoka City Hospital, 13-1 Yoshizuka-honmachi, Hakata-ku, Fukuoka, 812‑0046, Japan
| | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, 5-3-1 Chikami, Minami-ku, Kumamoto, 861-4193, Japan
| | - Nobutomo Miyanari
- Department of Surgery, National Hospital Organization Kumamoto Medical Center, 1-5 Ninomaru, Chuo-ku, Kumamoto, 860-0008, Japan
| | - Masahiko Hirota
- Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjyo, Chuo-cho, Kumamoto, 860-8556, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan.
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9
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Nakasone K, Fukuzawa K, Kiuchi K, Takami M, Takemoto M, Sakai J, Nakamura T, Yatomi A, Sonoda Y, Takahara H, Yamamoto K, Suzuki Y, Tani K, Hirata K. VT recurrence and predictors in patients with VT inducibility at the end of VT ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A successful Radiofrequency (RF) ablation of ventricular tachycardia (VT) can prevent VT recurrence. It has been reported that VT non-inducibility at the end of RF ablation is associated with less likely VT recurrence in ischemic cardiomyopathy (ICM) and non-ICM (NCIM). However, it is not clear whether we should use VT non-inducibility as routine end point in RF ablation of VT.
Purpose
The aim of this study was to evaluate VT recurrence in patients who couldn't be achieved VT non-inducibility at the end of RF ablation and the factors attributed to VT recurrence in ICM and NICM patients.
Methods
Between January 2009 and April 2020, 84 consecutive patients (ICM: 34, NICM: 50) underwent RF ablation for drug-resistant VT in our hospital. VT non-inducibility was defined as any ventricular tachy-arrhythmia, including clinical VT, non-clinical VT, and VF, was not induced by programed stimuli at the end of session. Non-inducibility was achieved in 37 patients but it was not achieved in 47 patients (ICM: 18, NICM: 29). To evaluate the validity of “non-inducibility” as an end point of VT ablation, 47 patients (male: 40, mean age: 66±15 years) in whom non-inducibility of any ventricular tachyarrhythmia was not achieved were studied. The primary endpoint was recurrence of any sustained VT and VF during follow up period (mean follow-up period was 1.4 (range, 0.0, 2.0) years.)
Results
Mean left ventricular ejection fraction (LVEF) was 36±13%. Epicardial ablation was required in 8 patients. 32 patients had electrical storm at the time of ablation. Among them, 21 patients had VT recurrence and 26 patients had non-VT recurrence during follow-up period. VT recurrence rate was significantly lower in patients with LVEF≥35% than those with LVEF<35% (HR=0.31, 95% CI 1.25–9.92). Multivariate survival analysis identified LVEF≥35% (HR=0.34, 95% CI 0.10–0.98) and ablation of VT isthmus (HR=0.18, 95% CI 0.02–0.78) as independent predictors of non-VT recurrence.
Conclusions
Even if non-inducibility of any ventricular tachyarrhythmia wasn't achieved at the end of ablation, the patients with LVEF≥35% or who had ablated of VT isthmus might prevent VT recurrence. The validity of non-inducibility of any ventricular tachyarrhythmia should be evaluated in each patient's background.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Abbott, Medtronic
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Affiliation(s)
| | | | | | | | | | - J Sakai
- Kobe University, Kobe, Japan
| | | | | | | | | | | | | | - K Tani
- Kobe University, Kobe, Japan
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10
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Itoh S, Tsujita E, Fukuzawa K, Sugimachi K, Iguchi T, Ninomiya M, Maeda T, Kajiyama K, Adachi E, Uchiyama H, Utsunomiya T, Ikeda Y, Maekawa S, Toshima T, Harada N, Yoshizumi T, Mori M. Prognostic significance of preoperative PNI and CA19-9 for pancreatic ductal adenocarcinoma: A multi-institutional retrospective study. Pancreatology 2021; 21:1356-1363. [PMID: 34426076 DOI: 10.1016/j.pan.2021.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [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: 12/30/2020] [Revised: 08/14/2021] [Accepted: 08/17/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND The aim of this study was to investigate the clinical value of nutritional and immunological prognostic scores as predictors of outcomes and to identify the most promising scoring system for patients with pancreatic ductal adenocarcinoma (PDAC) in a multi-institutional study. METHODS Data were retrospectively collected for 589 patients who underwent surgical resection for PDAC. Prognostic analyses were performed for overall (OS) and recurrence-free survival (RFS) using tumor and patient-related factors, namely neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, Prognostic Nutritional Index (PNI), Glasgow Prognostic Score (GPS), modified GPS, C-reactive protein-to-albumin ratio, Controlling Nutritional Status score, and the Geriatric Nutritional Risk Index. RESULTS Compared with PDAC patients with high PNI values (≥46), low PNI (<46) patients showed significantly worse overall survival (OS) (multivariate hazard ratio (HR), 1.432; 95% CI, 1.069-1.918; p = 0.0161) and RFS (multivariate HR, 1.339; 95% CI, 1.032-1.736; p = 0.0277). High carbohydrate antigen 19-9 (CA19-9) values (≥450) were significantly correlated with shorter OS (multivariate HR, 1.520; 95% CI, 1.261-2.080; p = 0.0002) and RFS (multivariate HR, 1.533; 95% CI, 1.199-1.961; p = 0.0007). Stratification according to PNI and CA19-9 was also significantly associated with OS and RFS (log rank, P < 0.0001). CONCLUSIONS Our large cohort study showed that PNI and CA19-9 were associated with poor clinical outcomes in PDAC patients following surgical resection. Additionally, combining PNI with CA19-9 enabled further classification of patients according to their clinical outcomes.
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Affiliation(s)
- Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Eiji Tsujita
- Department of Surgery, Fukuoka Higashi Medical Center, Fukuoka, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-pancreatic Surgery, Kyushu Cancer Center, Fukuoka, Japan
| | - Tomohiri Iguchi
- Department of Hepatobiliary-pancreatic Surgery, Kyushu Cancer Center, Fukuoka, Japan
| | - Mizuki Ninomiya
- Department of Surgery, Matsuyama Red Cross Hospital, Ehime, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan
| | | | - Eisuke Adachi
- Department of Surgery, Kyushu Central Hospital, Fukuoka, Japan
| | - Hideaki Uchiyama
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Yasuharu Ikeda
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Soichirou Maekawa
- Department of Surgery, Munakata Medical Association Hospital, Fukuoka, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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11
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Yamada S, Fujii T, Sonohara F, Kawai M, Shibuya K, Matsumoto I, Fukuzawa K, Baba H, Aoki T, Unno M, Satoi S, Kishi Y, Hatano E, Uemura K, Horiguchi A, Sho M, Takeda Y, Shimokawa T, Kodera Y, Yamaue H. Safety of Combined Division vs Separate Division of the Splenic Vein in Patients Undergoing Distal Pancreatectomy: A Noninferiority Randomized Clinical Trial. JAMA Surg 2021; 156:418-428. [PMID: 33656542 PMCID: PMC7931136 DOI: 10.1001/jamasurg.2021.0108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Question In distal pancreatectomy, is combined division of the splenic vein safe compared with separate division of the splenic vein? Findings In this noninferiority randomized clinical trial, the proportion of grade B/C pancreatic fistula in the separate division group was 27.1% vs 28.6% in the combined division group, demonstrating noninferiority of the combined division of the splenic vein against separate division. Meaning The safety of combined division of the splenic vein in distal pancreatectomy was established, such that the approach could be recommended with more confidence. Importance In distal pancreatectomy (DP), the splenic vein is isolated from the pancreatic parenchyma prior to being ligated and divided to prevent intra-abdominal hemorrhage from the splenic vein stump with pancreatic fistula (PF). Conversely, dissecting the splenic vein with the pancreatic parenchyma is easy and time-saving. Objective To establish the safety of combined division of the splenic vein compared with separate division of the splenic vein. Design, Setting, and Participants This study was designed as a multicenter prospective randomized phase 3 trial. All results were analyzed using the modified intent-to-treat set. Patients undergoing DP for pancreatic body and tail tumors were eligible for inclusion. Patients were randomly assigned between August 10, 2016, and July 30, 2019. Interventions Patients were centrally randomized (1:1) to either separate division of the splenic vein or combined division of the splenic vein. Main Outcomes and Measures The primary end point was the incidence of grade B/C PF, and the incidence of intra-abdominal hemorrhage was included as one of the secondary end points. Results A total of 318 patients were randomly assigned, and 2 patients were excluded as ineligible. Of the 316 remaining patients, 150 (50.3%) were male. The modified intent-to-treat population constituted 159 patients (50.3%) in the separate division group and 157 patients (49.7%) in the combined division group. In the modified intent-to-treat set, the proportion of grade B/C PF in the separate division group was 27.1% (42 of 155) vs 28.6% (44 of 154) in the combined division group (adjusted odds ratio, 1.108; 95% CI, 0.847-1.225; P = .047), demonstrating noninferiority of the combined division of the splenic vein against separate division. The incidence of postoperative intra-abdominal hemorrhage in the 2 groups was identical at 1.3%. Conclusions and Relevance This study demonstrated noninferiority of the combined division of the splenic vein compared with separate division of the splenic vein regarding safety. Thus, isolating the splenic vein from the pancreatic parenchyma is deemed unnecessary. Trial Registration ClinicalTrials.gov Identifier: NCT02871804
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Affiliation(s)
- Suguru Yamada
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Tsutomu Fujii
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Sugitani, Toyama, Japan
| | - Fuminori Sonohara
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Manabu Kawai
- Second Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Kazuto Shibuya
- Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Sugitani, Toyama, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Ono-higashi, Osaka-Sayama, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Chiyo-machi, Oita, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Science, Honjo, Chuo-ku, Kumamoto, Japan
| | - Takeshi Aoki
- Department of Gastroenterological and General Surgery, Showa University School of Medicine, Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Michiaki Unno
- Division of Hepato-Biliary Pancreatic Surgery, Tohoku University Graduate School of Medicine, Seiryo-cho, Aoba-ku, Sendai, Japan
| | - Sohei Satoi
- Department of Surgery, Kansai Medical University, Shinmachi, Hirakata, Japan
| | - Yoji Kishi
- Department of Surgery, National Defense Medical College, Namiki, Tokorozawa, Saitama, Japan
| | - Etsuro Hatano
- Department of Gastroenterological Surgery, Hyogo College of Medicine, Mukogawa, Nishinomiya, Hyogo, Japan
| | - Kenichiro Uemura
- Department of Surgery, Hiroshima University Graduate School of Biomedical and Health Sciences, Kasumi, Minami-ku, Hiroshima, Japan
| | - Akihiko Horiguchi
- Department of Gastroenterological Surgery, Fujita Health University Bantane Hospital, Otobashi, Nakagawa-ku, Nagoya, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University School of Medicine, Shijo-cho, Kashihara, Nara, Japan
| | - Yutaka Takeda
- Department of Surgery, Japan Organization of Occupational Health and Safety, Kansai Rosai Hospital, Inabaso, Amagasaki, Japan
| | - Toshio Shimokawa
- Clinical Study Support Center, Wakayama Medical University, Kimiidera, Wakayama, Japan
| | - Yasuhiro Kodera
- Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, Kimiidera, Wakayama, Japan
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12
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Dokuni K, Matsumoto K, Tatsumi K, Shono A, Suzuki M, Sumimoto K, Tanaka Y, Yamashita K, Shibata N, Yokota S, Sutou M, Tanaka H, Kiuchi K, Fukuzawa K, Hirata K. Cardiac resynchronization therapy improves left atrial reservoir function through resynchronization of the left atrium in patients with heart failure. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
The structural remodeling of the left atrium (LA) has been proposed as an important determinant of adverse outcomes in patients with heart failure (HF). However, little is known about the potential impact of LA mechanical dyssynchrony on its reservoir function and the prognosis of patients with HF. In addition, it has not been fully investigated whether cardiac resynchronization therapy (CRT) is also beneficial to LA function.
Purposes
The purposes of this study were to test whether left ventricular (LV) dyssynchrony may negatively affect LA synchronicity and reservoir function, and to assess whether residual LA dyssynchrony after CRT affects the prognosis in patients with HF with reduced ejection fraction (HFrEF).
Methods
This study included total of 90 subjects: 40 HFrEF with a wide-QRS complex (≧130 ms), 28 HFrEF with a narrow-QRS, and 22 age- and sex-matched normal controls. LA global longitudinal strain (LA-GLS) and LA dyssynchrony were quantified using speckle-tracking strain analysis. LA dyssynchrony was defined as the maximal difference of time-to-peak strain (LA time-diff). All wide-QRS HFrEF received CRT, and event-free survival was tracked for 24 months.
Results
At baseline, HFrEF patients showed significant LA remodeling coupled with the reduced LA reservoir function, as evidenced by larger LA volume index (LAVi: 46 ± 16 vs. 30 ± 14 mL/m², P < 0.01) and smaller LA-GLS (13.0 ± 4.8 vs. 30.6 ± 10.7%, P < 0.01). Of note was that, not only LV dyssynchrony (381 ± 178 vs. 177 ± 62 ms, P < 0.01) but also LA dyssynchrony (298 ± 136 vs. 186 ± 78 ms, P < 0.01) were significantly larger in patients with HFrEF compared to normal subjects and this applied even more to patients with a wide-QRS complex. All patients with a wide-QRS complex underwent CRT, and only responders exhibited the significant decrease in LA time-diff (from 338 ± 123 to 245 ± 141 ms, P < 0.05) and increase in LA-GLS (from 11.9 ± 4.7 to 19.6 ± 10.1%, P < 0.05) in parallel with the reduction in LAVi (from 48 ± 17 to 37 ± 18 mL/m², P < 0.05) at 6 months after CRT. Receiver operating characteristic curve analysis identified the optimal cut-off value of LA time-diff at 6 months after CRT as 202 ms (P < 0.05) and that of LA-GLS as 14.6% (P < 0.05) for predicting adverse cardiac events. The patients whose LA time-diff reduced <202 ms after CRT showed significantly favorable event-free survival than the others. Similarly, the patients whose LA-GLS improved >14.6% after CRT exhibited significantly favorable event-free survival than the others (P < 0.05, respectively). Of note was that, when the patients were restricted to CRT responders only, those who showed LA time-diff less than 202 ms at 6 months after CRT almost never experienced cardiac events (P < 0.05).
Conclusions
The improved LV coordination by CRT also resulted in resynchronization of discoordinated LA wall motion and a consecutive improvement of LA reservoir function, which ultimately lead to the favorable outcome for HFrEF patients with wide-QRS complex.
Abstract Figure.
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Affiliation(s)
| | | | | | - A Shono
- Kobe University, Kobe, Japan
| | | | | | | | | | | | | | - M Sutou
- Kobe University, Kobe, Japan
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13
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Yoshiya S, Itoh S, Yoshizumi T, Yugawa K, Kurihara T, Toshima T, Harada N, Hashisako M, Yonemasu H, Fukuzawa K, Oda Y, Mori M. Impact of Capicua on Pancreatic Cancer Progression. Ann Surg Oncol 2020; 28:3198-3207. [PMID: 33216264 DOI: 10.1245/s10434-020-09339-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 10/17/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND The transcription factor capicua (CIC) regulates mammalian development and homeostasis. Growing evidence shows that CIC suppresses various human cancers by directly repressing the downstream cancer-related target genes. This study investigated the clinical and biologic significance of CIC expression in pancreatic cancer (PC). METHODS The study reviewed 132 patients with PC who underwent curative resection. The patients were divided into two groups according to CIC immunoreactivity score by immunohistochemistry, and the associations between CIC expression, clinicopathologic characteristics, and postoperative prognosis were investigated. Moreover, the influence of CIC expression on the malignant potential of PC cells was assessed with cell proliferation, motility assays, and use of quantitative real time-polymerase chain reaction and Western blot on the downstream target genes of CIC in knockdown experiments. RESULTS The low-CIC expression group showed a higher proportion of lymphatic invasion (72.9% vs. 53.1%; p = 0.024), intrapancreatic neural invasion (94.1% vs. 81.3%; p = 0.021), and extrapancreatic plexus invasion (30.9% vs. 7.8%; p = 0.0006) than the high-CIC expression group as well as significantly worse overall survival (p = 0.0002) and recurrence-free survival (p = 0.0041) rates. Low CIC expression was an independent risk factor for poor prognosis (p = 0.038). Pancreatic cancer cells with knockdown CIC significantly enhanced cell motilities and cell cycle progression, promoted expression levels of ETV4 and MMP-9, and induced EMT. CONCLUSIONS The study elucidated the association of low CIC expression with a poor prognosis for patients with PC and suggested that the CIC-ETV4-MMP-9 axis might control PC progression.
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Affiliation(s)
- Shohei Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kyohei Yugawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Kurihara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Mikiko Hashisako
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Department of Anatomic Pathology, Oita Red Cross Hospital, Oita, Japan
| | | | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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14
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Shiraki H, Tanaka H, Yamashita K, Tanaka Y, Sumimoto K, Shono A, Suzuki M, Yokota S, Suto M, Mukai J, Takada H, Matsumoto K, Fukuzawa K, Hirata K. Consideration of non-valvular atrial fibrillation with left atrial appendage thrombus formation despite under appropriate oral anticoagulation therapy. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0071] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) is the most frequently sustained cardiac arrhythmia, with a prevalence of about 2–3% in the general population. In accordance with CHADS2 or CHA2DS2-VASc score, appropriate oral anticoagulation therapy such as warfarin or direct oral anticoagulants (DOAC) significantly reduced the risk of thromboembolic events. However, left atrial (LA) thrombus can be detected in the LA appendage (LAA) in AF patients despite appropriate oral anticoagulation therapy.
Purpose
Our purpose was to investigate the associated factors of LAA thrombus formation in non-valvular atrial fibrillation (NVAF) patients despite under appropriate oral anticoagulation therapy.
Methods
We retrospectively studied consecutive 286 NVAF patients for scheduled catheter ablation or electrical cardioversion for AF in our institution between February 2017 and September 2019. Mean age was 67.1±9.4 years, 79 patients (29.5%) were female, and 140 (52.2%) were paroxysmal AF. All patients underwent transthoracic and transesophageal echocardiography before catheter ablation or electrical cardioversion. All patients received appropriate oral anticoagulation therapy including warfarin or DOAC for at least 3 weeks prior to transesophageal echocardiography based on the current guidelines. LAA thrombus was defined as an echodense intracavitary mass distinct from the underlying endocardium and not caused by pectinate muscles by at least three senior echocardiologists.
Results
Of 286 NVAF patients with under appropriate oral anticoagulation therapy, LAA thrombus was observed in 9 patients (3.3%). Univariate logistic regression analysis showed that age, paroxysmal AF, CHADS2 score ≥3, left ventricular end-diastolic volume index (LVEDVI), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMI), LA volume index (LAVI), mitral inflow E and mitral e' annular velocities ratio (E/e'), and LAA flow were associated with LAA thrombus formation. It was noteworthy that multivariate logistic regression analysis showed that LAA flow was independent predictor of LAA thrombus (OR: 0.72, 95% CI: 0.59–0.89, p<0.005) as well as LVEF. Furthermore, receiver operating characteristic (ROC) curve analysis identified the optimal cutoff value of LAA flow for predicting LAA thrombus as ≤15cm/s, with a sensitivity of 88%, specificity of 93%, and area under the curve (AUC) of 0.95.
Conclusions
LAA flow was strongly associated with LAA thrombus formation even in NVAF patients with appropriate oral anticoagulation therapy. According to our findings, further strengthen of oral anticoagulation therapy or percutaneous transcatheter closure of the LAA may be considered in NVAF patients with appropriate oral anticoagulation therapy but low LAA flow, especially <15cm/s.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
| | | | | | | | | | - A Shono
- Kobe University, Kobe, Japan
| | | | | | - M Suto
- Kobe University, Kobe, Japan
| | - J Mukai
- Kobe University, Kobe, Japan
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15
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Inokuchi S, Itoh S, Yoshizumi T, Yugawa K, Yoshiya S, Toshima T, Takeishi K, Iguchi T, Sanefuji K, Harada N, Sugimachi K, Ikegami T, Kohashi K, Taguchi K, Yonemasu H, Fukuzawa K, Oda Y, Mori M. Mitochondrial expression of the DNA repair enzyme OGG1 improves the prognosis of pancreatic ductal adenocarcinoma. Pancreatology 2020; 20:1175-1182. [PMID: 32741713 DOI: 10.1016/j.pan.2020.07.011] [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: 02/29/2020] [Revised: 07/05/2020] [Accepted: 07/17/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND/OBJECTIVES 8-Hydroxydeoxyguanosine (8-OHdG) is an indicator of oxidative stress and causes transversion mutations and carcinogenesis. 8-OHdG is excision repaired by 8-OHdG DNA glycosylase 1 (OGG1), which is classified as nuclear and mitochondrial subtypes. We aimed to clarify the role of OGG1 in pancreatic ductal adenocarcinoma (PDAC). METHODS Ninety-two patients with PDAC who had undergone surgical resection at multiple institutions were immunohistochemically analyzed. The OGG1 and 8-OHdG expression levels were scored using the Germann Immunoreactive Score. The cutoff values of OGG1, as well as that of 8-OHdG, were determined. RESULTS The low nuclear OGG1 expression group (n = 41) showed significantly higher carbohydrate antigen (CA)19-9 (p = 0.026), and higher s-pancreas antigen (SPAN)-1 (p = 0.017) than the high expression group (n = 51). Nuclear OGG1 expression has no effect on the prognosis. The low mitochondrial OGG1 expression group (n = 40) showed higher CA19-9 (p = 0.041), higher SPAN-1 (p = 0.032), and more histological perineural invasion (p = 0.037) than the high expression group (n = 52). The low mitochondrial OGG1 expression group had a significantly shorter recurrence-free survival (p = 0.0080) and overall survival (p = 0.0073) rates. The Cox proportional hazards model revealed that low mitochondrial OGG1 expression is an independent risk factor of the PDAC prognosis. OGG1 expression was negatively correlated with 8-OHdG expression (p = 0.0004), and high 8-OHdG expression shortened the recurrence-free survival of patients with PDAC. CONCLUSIONS Low mitochondrial OGG1 expression might aggravate the PDAC prognosis.
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Affiliation(s)
- Shoichi Inokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Kyohei Yugawa
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan; Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 812-8582, Japan
| | - Shohei Yoshiya
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Takeo Toshima
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Kazuki Takeishi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Tomohiro Iguchi
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Kensaku Sanefuji
- Department of Surgery, Oita Red Cross Hospital, 870-0033, Oita, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
| | - Kenichi Kohashi
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 812-8582, Japan
| | - Kenichi Taguchi
- Department of Pathology, National Hospital Organization Kyushu Cancer Center, Fukuoka, 811-1395, Japan
| | - Hirotoshi Yonemasu
- Department of Anatomic Pathology, Oita Red Cross Hospital, 870-0033, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, 870-0033, Oita, Japan
| | - Yoshinao Oda
- Department of Anatomic Pathology, Pathological Sciences, Graduate School of Medical Sciences, Kyushu University, 812-8582, Japan
| | - Masaki Mori
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 812-8582, Fukuoka, Japan
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16
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Yamashita YI, Itoh S, Shimokawa M, Takamori H, Fukuzawa K, Ninomiya M, Araki K, Kajiyama K, Sugimachi K, Uchiyama H, Morine Y, Utsunomiya T, Uwagawa T, Maeda T, Adachi E, Ikeda Y, Yoshizumi T, Baba H, Mori M. A multicenter clinical randomized phase II study of investigating duration of adjuvant chemotherapy with S-1 (six versus 12 months) for patients with resected pancreatic cancer: PACS-1 study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.4_suppl.669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
669 Background: Although adjuvant chemotherapy with S-1 has improved overall survival and progression-free survival (PFS) in patients with resected pancreatic cancer, the duration evaluation of adjuvant chemotherapy with S-1 have not established yet. Methods: We did a randomized, multicenter, phase 2 trial undertaken at 15 hospitals in Japan. Patients who were Eastern Cooperative Oncology Group performance states of 0 or 1 and aged 20 years or older were eligible. Patients with resected pancreatic cancer were randomly assigned (in a 1:1 ratio) to receive S-1 [40 mg, 50 mg, or 60 mg according to body-surface area, orally administered twice a day for 28 days followed by a 14 day rest, every 6 weeks [one cycle], for up to four cycles (6 months)] or up to eight cycles (12 months). The primary end point was overall survival rate. Secondary endpoints included PFS and safety. Results: The population consisted of 82 patients in the S-1 for 6 months group and 82 patients in the S-1 for 12 months group. The 2-year overall survival rate was 71.4% in the S-1 for 6 months group and 65.4% in the S-1 for 12 months, and the median overall survival was 31.0 months in the S-1 for 6 months group and 26.3 months in the S-1 for 12 months group [hazard ratio (HR) 1.23, 95% confidence interval (CI) 0.76-1.99, p = 0.377]. The PFS at 2 years was 56.8% in the S-1 for 6 months group, and 51.2% in the S-1 for 12 months. The HR for recurrence of S-1 for 6 months, compared with S-1 for 12 months, was 1.23 (95%CI 0.76-1.99, p = 0.392). Twenty-nine (35.3%) patients in the S-1 for 6 months group and 46 (56.0%) in the S-1 for 12 months group discontinued treatment before completion. In regard to patients completed treatment, the S-1 for 12 months group showed tendency to favorable prognosis on PFS compared with the S-1 for 6 months group (log-rank test; p = 0.175). Conclusions: In patients with resected pancreatic cancer, adjuvant chemotherapy with S-1 for 12 months is not superior to that for 6 months in terms of median overall survival and PFS. For patients who can tolerate adjuvant chemotherapy with S-1 for 6 months well, continuing treatment for up to 12 months may improve the prognosis.
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Affiliation(s)
- Yo-ichi Yamashita
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | - Hiroshi Takamori
- Department of Surgery, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Mizuki Ninomiya
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Kenichiro Araki
- Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University, Maebashi, Japan
| | | | | | - Hideaki Uchiyama
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | | | - Tadashi Uwagawa
- Department of Hepato-Biliary-Pancreatic Surgery, the Jikei University School of Medicine, Minato-Ku, Tokyo, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital & Atomic-Bomb Survivors Hospital, Hiroshima, Japan
| | - Eisuke Adachi
- Department of Surgery, Kyushu Central Hospital, Fukuoka, Japan
| | - Yasuharu Ikeda
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | | | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masaki Mori
- Department of Surgery and Science, Kyushu University, Fukuoka, Japan
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17
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Ohtsuka T, Nagakawa Y, Toyama H, Takeda Y, Maeda A, Kumamoto Y, Nakamura Y, Hashida K, Honda G, Fukuzawa K, Toyoda E, Tanabe M, Gotohda N, Matsumoto I, Ryu T, Uyama I, Kojima T, Unno M, Ichikawa D, Inoue Y, Matsukawa H, Sudo T, Takaori K, Yamaue H, Eguchi S, Tahara M, Shinzeki M, Eguchi H, Kurata M, Morimoto M, Hayashi H, Marubashi S, Inomata M, Kimura K, Amaya K, Sho M, Yoshida R, Murata A, Yoshitomi H, Hakamada K, Yasunaga M, Abe N, Hioki M, Tsuchiya M, Misawa T, Seyama Y, Noshiro H, Sakamoto E, Hasegawa K, Kawabata Y, Uchida Y, Kameyama S, Ko S, Takao T, Kitahara K, Nakahira S, Baba H, Watanabe M, Yamamoto M, Nakamura M. A multicenter prospective registration study on laparoscopic pancreatectomy in Japan: report on the assessment of 1,429 patients. J Hepatobiliary Pancreat Sci 2019; 27:47-55. [PMID: 31665567 DOI: 10.1002/jhbp.695] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Prospective studies are needed to understand the safety and feasibility of laparoscopic pancreatectomy. The aim of the present study was to describe laparoscopic pancreatectomy currently undertaken in Japan, using a prospective registration system. METHODS Patient characteristics and planned operations were registered preoperatively, and then the performed operation and outcomes were reported using an online system. Collected data were also compared between institutions based on their level of experience. This study was registered with UMIN000022836. RESULTS Available data were obtained from 1,429 patients at 100 Japanese institutions, including 1,197 laparoscopic distal pancreatectomies (LDPs) and 232 laparoscopic pancreatoduodenectomies (LPDs). The rates of completion for planned operations were 92% for LDP and 91% for LPD. Postoperative complication rates after LDP and LPD were 17% and 30%, and 90-day mortality rates were 0.3% and 0.4%, respectively. Shorter operation time, less blood loss, and lower incidence of pancreatic fistula were observed in institutions experienced in LDP. A higher rate of pure laparoscopic procedure and shorter operation time were noted in institutions experienced with LPD. CONCLUSION LDPs and LPDs are performed safely in Japan, especially in experienced institutions. Our data could support the next challenges in the field of laparoscopic pancreatectomy.
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Affiliation(s)
- Takao Ohtsuka
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yuichi Nagakawa
- Department of Gastrointestinal and Pediatric Surgery, Tokyo Medical University, Tokyo, Japan
| | - Hirochika Toyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan
| | - Atsuyuki Maeda
- Department of Surgery, Ogaki Municipal Hospital, Ogaki, Gifu, Japan
| | - Yusuke Kumamoto
- Department of General, Pediatric and Hepato-Biliary-Pancreatic Surgery, Kitasato University Hospital, Sagamihara, Kanagawa, Japan
| | - Yoshiharu Nakamura
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Kazuki Hashida
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Okayama, Japan
| | - Goro Honda
- Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Eiji Toyoda
- Department of Surgery, Otsu Red Cross Hospital, Otsu, Shiga, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Ippei Matsumoto
- Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan
| | - Tomoki Ryu
- Department of Hepato-Biliary-Pancreatic Surgery, Clinical Research Institute, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Ichiro Uyama
- Department of Surgery, Fujita Health University, Toyoake, Aichi, Japan
| | - Toru Kojima
- Department of Surgery, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Michiaki Unno
- Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Miyagi, Japan
| | - Daisuke Ichikawa
- First Department of Surgery, Faculty of Medicine, University of Yamanashi, Kofu, Yamanashi, Japan
| | - Yosuke Inoue
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hiroyoshi Matsukawa
- Department of Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - Takeshi Sudo
- Department of Surgery National Hospital Organization Kure Medical Center Chugoku Cancer Center, Kure, Hiroshima, Japan
| | - Kyoichi Takaori
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Susumu Eguchi
- Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Munenori Tahara
- Department of Surgery, Hokkaido P.W.F.A.C Sapporo Kosei General Hospital, Sapporo, Hokkaido, Japan
| | - Makoto Shinzeki
- Department of Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Masanao Kurata
- Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Aichi, Japan
| | | | - Shigeru Marubashi
- Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Fukushima Medical University, Fukushima, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kenjiro Kimura
- Department of Surgical Oncology, Osaka City University School of Medicine, Osaka, Japan
| | - Koji Amaya
- Department of Surgery, Toyama Prefectural Central Hospital, Toyama, Japan
| | - Masayuki Sho
- Department of Surgery, Nara Medical University, Kashihara, Nara, Japan
| | - Ryuichi Yoshida
- Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan
| | - Akihiro Murata
- Department of Hepatobiliary Pancreatic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Hideyuki Yoshitomi
- Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan
| | - Kenichi Hakamada
- Department of Gastroenterological Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Masafumi Yasunaga
- Department of Surgery, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Nobutsugu Abe
- Department of Surgery, Kyorin University School of Medicine, Mitaka, Tokyo, Japan
| | - Masayoshi Hioki
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Hiroshima, Japan
| | - Masaru Tsuchiya
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University School of Medicine, Omori, Tokyo, Japan
| | - Takeyuki Misawa
- Department of Surgery, The Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Yasuji Seyama
- Department of Surgery, Tokyo Metropolitan Bokutoh Hospital, Tokyo, Japan
| | - Hirokazu Noshiro
- Department of Surgery, Faculty of Medicine, Saga University, Saga, Japan
| | - Eiji Sakamoto
- Department of Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Aichi, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division and Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yasunari Kawabata
- Department of Digestive and General Surgery, Shimane University Faculty of Medicine, Izumo, Shimane, Japan
| | - Yoichiro Uchida
- Department of Gastroenterological Surgery and Oncology, Tazuke Kofukai Medical Research Institute, Kitano Hospital, Osaka, Japan
| | - Shinichiro Kameyama
- Department of Surgery, Center for Gastroenterology, Urasoe General Hospital, Urasoe, Okinawa, Japan
| | - Saiho Ko
- Department of Surgery, Nara Prefecture General Medical Center, Nara, Japan
| | - Takashi Takao
- Department of Surgery, Shin Koga Hospital, Kurume, Fukuoka, Japan
| | - Kenji Kitahara
- Department of Surgery, Saga Medical Center Koseikan, Saga, Japan
| | - Shin Nakahira
- Department of Surgery, Sakai City Medical Center, Sakai, Osaka, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Masahiko Watanabe
- Kitasato University Kitasato Institutional Hospital, Sagamihara, Kanagawa, Japan.,Japan Society for Endoscopic Surgery, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.,Japanese Society of Hepato-Biliary-Pancreatic Surgery, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.,Japanese Society for Endoscopic and Robotic Pancreatic Surgery, Tokyo, Japan
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Takaji R, Yamada Y, Matsumoto S, Kiyonaga M, Hongo N, Mori H, Hijiya N, Ohta M, Inomata M, Takaki H, Fukuzawa K, Yonemasu H. Small pancreatic ductal carcinomas on triple-phase contrast-enhanced computed tomography: enhanced rims and the pathologic correlation. Abdom Radiol (NY) 2018; 43:3374-3380. [PMID: 29796845 DOI: 10.1007/s00261-018-1645-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To reveal the prevalence of small (≤ 20 mm) pancreatic ductal carcinomas with enhanced rims on triple-phase contrast-enhanced CT and correlate the CT images with the pathologic findings. MATERIALS AND METHODS Between April 2005 and April 2016, 45 patients underwent preoperative triple-phase contrast-enhanced CT and were pathologically diagnosed with small pancreatic ductal carcinoma. CT images were independently reviewed by two radiologists. The attenuation values of the enhanced rims, internal areas of the tumors, and surrounding pancreatic parenchyma were compared using Mann-Whitney U test. These areas were also correlated with the pathologic findings. Tumor invasiveness was compared between the tumors with and without enhanced rims using Fisher's exact test. RESULTS Enhanced rims were identified in 18 tumors (40%) by consensus between the two reviewers. The enhanced rims showed significantly higher mean attenuation values compared with the internal areas of the tumors (p < 0.001) and surrounding pancreatic parenchyma (p < 0.0086), and were most clearly visualized on equilibrium phase. The enhanced rims pathologically reflected the abundant fibrotic stroma with cancer cells in all tumors. There was no statistically significant difference in tumor invasiveness between the tumors with and without enhanced rims (anterior peripancreatic invasion, p = 0.137; posterior peripancreatic invasion, p = 0.758; portal vein invasion, p = 0.639; and lymph node metastases, p = 0.359). CONCLUSIONS Enhanced rims were detected at a rate of 40% in small pancreatic ductal carcinomas and could be an important finding for diagnosis on CT images, but did not suggest a less aggressive nature.
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Affiliation(s)
- Ryo Takaji
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan.
| | - Yasunari Yamada
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Shunro Matsumoto
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Maki Kiyonaga
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Norio Hongo
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Hiromu Mori
- Department of Radiology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Naoki Hijiya
- Department of Molecular Pathology, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masayuki Ohta
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Masafumi Inomata
- Department of Gastroenterological and Pediatric Surgery, Faculty of Medicine, Oita University, Yufu, Oita, 879-5593, Japan
| | - Hajime Takaki
- Department of Radiology, Oita Red Cross Hospital, Oita, 870-0033, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, 870-0033, Japan
| | - Hirotoshi Yonemasu
- Department of Anatomic Pathology, Oita Red Cross Hospital, Oita, 870-0033, Japan
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Ioka T, Ueno M, Ueno H, Park JO, Chang HM, Sasahira N, Kanai M, Chung IJ, Ikeda M, Nakamori S, Mizuno N, Omuro Y, Yamaguchi T, Hara H, Sugimori K, Furuse J, Maguchi H, Furukawa M, Fukuzawa K, Kim JS, Yukisawa S, Takeuchi M, Okusaka T, Boku N, Hyodo I. TAS-118 (S-1 plus leucovorin) versus S-1 in patients with gemcitabine-refractory advanced pancreatic cancer: a randomised, open-label, phase 3 study (GRAPE trial). Eur J Cancer 2018; 106:78-88. [PMID: 30471651 DOI: 10.1016/j.ejca.2018.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 10/09/2018] [Accepted: 10/11/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND In our previous randomised phase 2 study for patients with gemcitabine-refractory advanced pancreatic cancer, S-1 plus leucovorin improved progression-free survival compared with S-1 alone. Here, we evaluated the efficacy of TAS-118 (S-1 plus leucovorin) versus S-1 in overall survival (OS). PATIENTS AND METHODS This randomised, open-label, phase 3 study was conducted at 58 centres in Japan and Korea. Patients with metastatic pancreatic cancer that progressed during first-line gemcitabine-based chemotherapy or recurred during or after post-operative gemcitabine-based adjuvant treatment were randomly assigned (1:1) to receive either S-1 (40-60 mg, twice daily for 4 weeks in a 6-week cycle) or TAS-118 (S-1 40-60 mg plus leucovorin 25 mg, twice daily for 1 week in a 2-week cycle). The primary end-point was OS. RESULTS A total of 603 patients were randomised, and 300 and 301 patients received TAS-118 and S-1, respectively. There was no difference in OS between groups (median OS for TAS-118 versus S-1, 7.6 months versus 7.9 months; hazard ratio [HR], 0.98 [95% confidence interval (CI), 0.82-1.16]; P = 0.756). Progression-free survival was significantly longer with TAS-118 than S-1 (median, 3.9 months versus 2.8 months; HR, 0.80 [95% CI, 0.67-0.95]; P = 0.009). There were interactions between Japan and Korea (P = 0.004) and between unresectable and recurrent disease (P = 0.025) in OS. Incidence, profile and severity of adverse events were similar between groups. CONCLUSION TAS-118 did not improve OS in patients with gemcitabine-refractory advanced pancreatic cancer compared to S-1. Further studies are needed to find patients who have benefit from adding leucovorin to S-1.
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Affiliation(s)
- Tatsuya Ioka
- Department of Cancer Survey and Gastrointestinal Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Makoto Ueno
- Department of Gastroenterology, Hepatobiliary and Pancreatic Medical Oncology Division, Kanagawa Cancer Center, Yokohama, Japan
| | - Hideki Ueno
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Joon Oh Park
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Heung-Moon Chang
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Naoki Sasahira
- Department of Gastroenterology, Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Masashi Kanai
- Department of Clinical Oncology, Kyoto University Hospital, Kyoto, Japan
| | - Ik Joo Chung
- Department of Hematology-Oncology, Chonnam National University Hwasun Hospital, Hwasun, South Korea
| | - Masafumi Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Shoji Nakamori
- Department of Hepatobiliary and Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Nobumasa Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Yasushi Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - Taketo Yamaguchi
- Department of Gastroenterology, Chiba Cancer Center, Chiba, Japan
| | - Hiroki Hara
- Department of Gastroenterology, Saitama Cancer Center Hospital, Saitama, Japan
| | - Kazuya Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama, Japan
| | - Junji Furuse
- Department of Medical Oncology, Kyorin University Faculty of Medicine, Tokyo, Japan
| | - Hiroyuki Maguchi
- Center of Gastroenterology, Teine-Keijinkai Hospital, Sapporo, Japan
| | - Masayuki Furukawa
- Department of Hepato-Biliary-Pancreatology, National Hospital Organization Kyushu Cancer Center, Fukuoka, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Jun-Suk Kim
- Department of Oncology and Hematology, Korea University Guro Hospital, Seoul, South Korea
| | - Seigo Yukisawa
- Department of Medical Oncology, Tochigi Cancer Center, Utsunomiya, Japan
| | - Masahiro Takeuchi
- Department of Clinical Medicine, School of Pharmacy (Biostatistics), Kitasato University, Tokyo, Japan
| | - Takuji Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Narikazu Boku
- Division of Gastrointestinal Medical Oncology, National Cancer Center Hospital, Tokyo, Japan
| | - Ichinosuke Hyodo
- Department of Gastroenterology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
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20
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Silman C, Matsumoto S, Mori H, Yamada Y, Otsuka A, Hongo N, Ohta M, Inomata M, Takaki H, Fukuzawa K. Evaluation of the fat plane of the pancreatic groove using multidetector CT. Clin Radiol 2018; 73:910.e7-910.e13. [DOI: 10.1016/j.crad.2018.06.009] [Citation(s) in RCA: 1] [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] [Received: 02/07/2018] [Accepted: 06/04/2018] [Indexed: 01/28/2023]
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21
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Harimoto N, Yoshizumi T, Inokuchi S, Itoh S, Adachi E, Ikeda Y, Uchiyama H, Utsunomiya T, Kajiyama K, Kimura K, Kishihara F, Sugimachi K, Tsujita E, Ninomiya M, Fukuzawa K, Maeda T, Shirabe K, Maehara Y. Prognostic Significance of Preoperative Controlling Nutritional Status (CONUT) Score in Patients Undergoing Hepatic Resection for Hepatocellular Carcinoma: A Multi-institutional Study. Ann Surg Oncol 2018; 25:3316-3323. [PMID: 30051372 DOI: 10.1245/s10434-018-6672-6] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Indexed: 12/14/2022]
Abstract
BACKGROUND The Controlling Nutritional Status (CONUT) score is an objective tool that is widely used to assess the nutritional status in patients, including those with cancer. The relationship between the CONUT score and prognosis in patients who have undergone hepatic resection has not been evaluated in a multi-institutional study. METHODS Data were retrospectively collected for 2461 consecutive patients with hepatocellular carcinoma (HCC) who had undergone hepatic resection with curative intent at 13 institutions between January 2004 and December 2015. Patients were assigned to two groups: preoperative CONUT scores ≤ 3 (low CONUT score) and ≥ 4 (high CONUT score). Clinicopathological characteristics, surgical outcomes, and long-term survival were compared using propensity score matching analysis. RESULTS Of the 2461 patients, 540 (21.9%) had high (≥ 4) and 1921 (78.1%) had low (≤ 3) preoperative CONUT scores. Overall, a high CONUT score was significantly associated with older age, female sex, low body mass index, low serum albumin, high serum total bilirubin, low lymphocyte count, low serum cholesterol, shorter prothrombin time, higher indocyanine green retention test at 15 min, Child-Pugh B (vs. A), liver cirrhosis, minor resection, shorter operation time, massive blood loss, blood transfusion, and postoperative complications. After propensity score matching, a higher CONUT score was significantly associated with poor overall survival (OS) and recurrence-free survival (RFS) using multivariate analysis. CONCLUSIONS This retrospective, multi-institutional analysis showed that, in patients who undergo curative hepatectomy for HCC, the preoperative CONUT score is predictive of worse OS and RFS, even after propensity score matching analysis.
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Affiliation(s)
- Norifumi Harimoto
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan. .,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoichi Inokuchi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eisuke Adachi
- Department of Surgery, Kyushu Central Hospital, Fukuoka, Japan
| | - Yasuharu Ikeda
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Hideaki Uchiyama
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | | | - Koichi Kimura
- Department of Surgery, Munakata Medical Association Hospital, Fukuoka, Japan
| | - Fumiaki Kishihara
- Department of Gastroenterological Surgery, Steel Memorial Yawata Hospital, Fukuoka, Japan
| | - Keishi Sugimachi
- Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Eiji Tsujita
- Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Mizuki Ninomiya
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Ehime, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Gunma University, Maebashi, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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22
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Yoshiya S, Iwaki K, Sakai A, Fujita S, Kawasaki T, Yoshizumi F, Hiroshige S, Okamoto M, Fukuzawa K, Motohiro A, Maehara Y. Laparoscopic Left Hepatectomy for Ruptured Hepatocellular Carcinoma Controlled After Transcatheter Arterial Embolization: Case Report and Review of the Literature. ACTA ACUST UNITED AC 2018; 32:659-662. [PMID: 29695575 DOI: 10.21873/invivo.11290] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2017] [Revised: 01/30/2018] [Accepted: 02/06/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although spontaneous tumour rupture is a life-threatening complication of hepatocellular carcinoma (HCC), staged hepatectomy for HCC controlled after transcatheter arterial embolization (TAE) could provide a better prognosis. Laparoscopic liver resection (LLR) has been accepted worldwide and has been expanded from minor resection to anatomical major resection. We herein report the first case of pure laparoscopic left hepatectomy for ruptured HCC controlled after TAE. CASE REPORT A 66-year-old man was transferred to our Institute because of abdominal pain and decreased consciousness. Ruptured HCC in segment IV and massive intra-abdominal haemorrhage were diagnosed. Emergency TAE was performed, achieving haemostasis. Reduction of intra-abdominal haemorrhage was confirmed at the 3-month follow-up, and no intrahepatic metastasis or peritoneal dissemination was present. Therefore, we performed elective laparoscopic left hepatectomy for the remaining HCC 110 days after TAE. Although dense adhesion was found in the upper right peritoneal cavity and greater omentum enveloping the remaining haemorrhage on the underside of the liver, there was no disseminated involvement in the peritoneal cavity. The operative time was 194 minutes, and intraoperative blood loss was 100 g. The postoperative course was uneventful, and the patient was discharged on postoperative day 6. CONCLUSION Major LLR may be an option for staged hepatectomy in patients with ruptured HCC controlled after TAE.
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Affiliation(s)
- Shohei Yoshiya
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan .,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Akihiro Sakai
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | | | - Shoji Hiroshige
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masahiro Okamoto
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Akira Motohiro
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan.,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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23
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Akita T, Kiuchi K, Fukuzawa K, Mori S, Taniguchi Y, Izawa Y, Hyogo K, Imada H, Kurose J, Suehiro H, Nagamatsu Y, Takemoto M, Hirata K, Shimoyama S. 743The lesion width and gap assessed by late-gadolinium enhancement magnetic resonance imaging after hotballoon ablation as compared to cryoballoon and conventional radiofrequency ablation. Europace 2018. [DOI: 10.1093/europace/euy015.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- T Akita
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - K Kiuchi
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - K Fukuzawa
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - S Mori
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - Y Taniguchi
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - Y Izawa
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - K Hyogo
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - H Imada
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - J Kurose
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - H Suehiro
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - Y Nagamatsu
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - M Takemoto
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - K Hirata
- Kobe University, Section of Arrhythmia, Division of Cardiovascular Medicine, Department of Internal Medicine, Kobe Un, Kobe, Japan
| | - S Shimoyama
- Kobe University, Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Japan
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24
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Tagawa T, Ito K, Fukuzawa K, Okamoto T, Fujinaga A, Kawasaki T, Masuda T, Iwaki K, Terashi T, Okamoto M, Shiromizu A, Motohiro A, Maehara Y. Surgical Outcomes of Non-small Cell Lung Cancer in Patients with a History of Pancreaticobiliary Cancer. Anticancer Res 2017; 37:3307-3309. [PMID: 28551682 DOI: 10.21873/anticanres.11698] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 05/06/2017] [Accepted: 05/11/2017] [Indexed: 11/10/2022]
Abstract
AIM To determine the efficacy of surgery for non-small cell lung cancer in patients who had previously undergone surgery for pancreaticobiliary cancer. PATIENTS AND METHODS Seven patients who underwent pulmonary resection for primary lung cancer after curative surgery for pancreaticobiliary cancer at our Institution from 2006 to 2016 were retrospectively evaluated. RESULTS Five patients had metachronous and two patients had synchronous cancer of pancreaticobiliary and lung origin. The median time between surgeries for the two cancers was 35 months. All patients underwent complete resection of both cancers. The 5-year survival was 68.6% after pulmonary resection. Two patients had recurrence after lung surgery, with a mean recurrence-free interval of 6.5 months. CONCLUSION Surgery should be considered for lung cancer in patients who have undergone curative surgery for pancreaticobiliary cancer.
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Affiliation(s)
- Tetsuzo Tagawa
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan .,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kensaku Ito
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Takashi Masuda
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | | | | | - Akio Shiromizu
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Akira Motohiro
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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25
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Tagawa T, Ito K, Fukuzawa K, Okamoto T, Yoshimura A, Kawasaki T, Masuda T, Iwaki K, Terashi T, Okamoto M, Shiromizu A, Motohiro A, Maehara Y. Surgical Resection for Pulmonary Metastasis from Pancreatic and Biliary Tract Cancer. Anticancer Res 2017; 37:1413-1416. [PMID: 28314312 DOI: 10.21873/anticanres.11464] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Revised: 02/25/2017] [Accepted: 02/25/2017] [Indexed: 11/10/2022]
Abstract
AIM To determine the efficacy of pulmonary metastasectomy for pancreatic and biliary tract cancer. PATIENTS AND METHODS Ten patients who underwent therapeutic pulmonary metastasectomy after resection for pancreatic and biliary tract cancer at our Institution from 2006 to 2016 were retrospectively evaluated. RESULTS The primary site was the pancreas in four patients and biliary tract in six. Nine patients had single metastasis, and one patient had bilateral multiple metastases. The median time from surgery for the primary tumor to pulmonary resection was 23.3 months (range= 0-47.1 months). One patient underwent lobectomy, while nine patients underwent partial resection. One patient had incomplete resection due to pleural dissemination. There were no postoperative mortalities or major morbidities. The mean follow-up period was 26.0 months. The median survival time was 38.5 months, and the estimated 5-year overall survival was 38.9% after pulmonary resection. Five patients had recurrent disease after pulmonary resection, with a median recurrence-free interval of 6.0 months. One patient underwent second pulmonary resection for a solitary lung recurrence. CONCLUSION Despite the poor prognoses of these cancer types, pulmonary metastasectomy can significantly prolong survival in selected patients with pancreatic and biliary tract cancer.
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Affiliation(s)
- Tetsuzo Tagawa
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan .,Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kensaku Ito
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Tatsuro Okamoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | | | | | - Takashi Masuda
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kentaro Iwaki
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | | | | | - Akio Shiromizu
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Akira Motohiro
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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26
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Nitta H, Shimose T, Emi Y, Imamura T, Ohnishi K, Kusumoto T, Yamamoto M, Fukuzawa K, Takahashi I, Higashi H, Tsuji A, Akagi Y, Oki E, Maehara Y, Baba H. Expression of the anaphylatoxin C5a receptor in gastric cancer: implications for vascular invasion and patient outcomes. Med Oncol 2016; 33:118. [DOI: 10.1007/s12032-016-0834-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 09/24/2016] [Indexed: 02/06/2023]
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27
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Tagawa T, Ito K, Fukuzawa K, Motohiro A. Pulmonary Resection for a Residual Tumor after Definitive Radiation in Locally Advanced Non-Small Cell Lung Cancer. Thorac Cardiovasc Surg 2016; 66:170-173. [PMID: 27575277 DOI: 10.1055/s-0036-1588059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE AND METHODS To clarify the benefits of surgery for a persistent tumor following definitive radiation in locally advanced non-small cell lung cancer, five patients were retrospectively reviewed. RESULTS All patients received definitive radiation, and three received concurrent chemotherapy followed by anatomical lung resection for a residual local tumor. The median time from the radiation to surgery was 8.2 weeks. There were no postoperative mortalities. Four patients developed distant metastasis with a mean recurrence-free interval of 7.5 months. CONCLUSIONS Distant metastasis frequently occurred within a relatively short period after surgery. Further studies with a larger sample size are needed.
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Affiliation(s)
- Tetsuzo Tagawa
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kensaku Ito
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Akira Motohiro
- Department of General Thoracic Surgery, Oita Red Cross Hospital, Oita, Japan
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28
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Oki E, Tokunaga S, Emi Y, Kusumoto T, Yamamoto M, Fukuzawa K, Takahashi I, Ishigami S, Tsuji A, Higashi H, Nakamura T, Saeki H, Shirabe K, Kakeji Y, Sakai K, Baba H, Nishimaki T, Natsugoe S, Maehara Y. Surgical treatment of liver metastasis of gastric cancer: a retrospective multicenter cohort study (KSCC1302). Gastric Cancer 2016; 19:968-76. [PMID: 26260876 DOI: 10.1007/s10120-015-0530-z] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [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: 04/26/2015] [Accepted: 07/28/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND The necessity of surgical treatment of liver metastases of gastric cancer is still controversial. PATIENTS AND METHODS We conducted a multicenter retrospective cohort study of liver-limited metastasis of gastric cancer treated surgically between 2000 and 2010. In this study, 103 patients were registered, with nine patients excluded from the analysis as they did not meet the eligibility criteria. RESULTS Of the 94 patients, 69 underwent surgical resection, 11 underwent surgical resection combined with radiofrequency ablation or microwave coagulation therapy for small or deep tumors, and 14 underwent radiofrequency ablation or microwave coagulation therapy only. Synchronous and metachronous metastases were found in 37 and 57 patients, respectively. The 3- and 5-year overall survival rates of all the patients were 51.4 and 42.3 %, respectively. The 3- and 5-year relapse-free survival rates were 29.2 and 27.7 %, respectively. No significant difference in prognosis was observed between the patients who underwent surgical resection and those who underwent ablation therapy. The patients with hepatic solitary lesions and low-grade lymph node metastases of primary gastric cancer had significantly better overall survival and relapse-free survival. CONCLUSIONS To our knowledge, this study is the largest series and first multicenter cohort study of liver-limited metastasis of gastric cancer. The study indicated that patients with a single liver metastasis with a grade lower than N2 lymph node metastasis of the primary lesion are the best candidates for liver resection.
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Affiliation(s)
- Eiji Oki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan.
| | - Shoji Tokunaga
- Medical Information Center, Kyushu University Hospital, Fukuoka, Japan
| | - Yasunori Emi
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | - Tetsuya Kusumoto
- Department of Gastroenterological Surgery/Clinical Research Institute Cancer Research Division, National Kyushu Medical Center, Fukuoka, Japan
| | - Manabu Yamamoto
- Department of Gastroenterological Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Ikuo Takahashi
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Sumiya Ishigami
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Akihito Tsuji
- Department of Medical Oncology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hidefumi Higashi
- Department of Surgery, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Toshihiko Nakamura
- Department of Surgery, Kyushu Central Hospital of the Mutual Aid Association of Public School Teachers, Fukuoka, Japan
| | - Hiroshi Saeki
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Ken Shirabe
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
| | - Yoshihiro Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Sakai
- Department of Medical Oncology, Saiseikai Kumamoto Hospital, Kumamoto, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Tadashi Nishimaki
- Division of Digestive and General Surgery, Faculty of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shoji Natsugoe
- Department of Digestive Surgery, Breast and Thyroid Surgery, Graduate School of Medical and Dental Sciences, Kagoshima University, Kagoshima, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, Fukuoka, 812-8582, Japan
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29
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Yamashita YI, Yoshizumi T, Fukuzawa K, Nishizaki T, Tsujita E, Kajiyama K, Soejima Y, Yamagata M, Yamamoto K, Adachi E, Sugimachi K, Ikeda Y, Uchiyama H, Maeda T, Itoh S, Harimoto N, Ikegami T, Maehara Y. Surgical Results of Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: a Multi-institutional Retrospective Study of 174 patients. Anticancer Res 2016; 36:2407-2412. [PMID: 27127150] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 04/12/2016] [Indexed: 06/05/2023]
Abstract
BACKGROUND Postoperative pancreatic fistula (POPF) remains a major complication after pancreaticoduodenectomy (PD), and the prognosis of patients with pancreatic ductal adenocarcinoma (PDAC) after PD is poor. PATIENTS AND METHODS A multi-institutional retrospective study was performed in 174 patients who underwent PD for PDAC from 2007 to 2012. The details of clinical data were examined, and risk factors for POPF and poor prognostic factors after PD were identified. RESULTS POPF occured in 26 patients (15%), and 18 patients (10%) were diagnosed as Grade B/C POPF. The independent risk factors for Grade B/C POPF were body mass index (BMI) ≥25 (Odds Ratio [OR]=21.1, p=0.006) and absence of post-operative enteral nutrition (EN) (OR=10.2, p=0.04). The 1-, 3-, and 5-year overall survivals of patients with PDAC after PD were 76%, 35%, and 18%, respectively. R1/2 operation was identified as the only independent poor prognostic factor (Hazard Ratio=3.66; p=0.0002). CONCLUSION Patients with BMI ≥25 should be closely monitored for POPF after PD. Post-operative EN might help prevent POPF. Performing R0 resection is an important goal for ensuring patient survival after PD for PDAC.
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Affiliation(s)
- Yo-Ichi Yamashita
- Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita, Japan
| | - Takashi Nishizaki
- Department of Surgery, Matsuyama Red Cross Hospital, Matsuyama, Japan
| | - Eiji Tsujita
- Department of Hepato-Biliary-Pancreatic Surgery, National Kyushu Cancer Center, Fukuoka, Japan
| | | | - Yuji Soejima
- Department of Surgery, Saiseikai Fukuoka General Hospital, Fukuoka, Japan
| | | | - Kazuharu Yamamoto
- Department of Surgery, Munakata Medical Association Hospital, Munakata, Japan
| | - Eisuke Adachi
- Department of Surgery, Oita Prefectural Hospital, Oita, Japan
| | - Keishi Sugimachi
- Department of Surgery, Steal Memorial Yawata Hospital, Kitakyushu, Japan
| | - Yasuharu Ikeda
- Department of Surgery, Fukuoka Higashi Medical Center, Koga, Japan
| | | | - Takashi Maeda
- Department of Surgery, Hiroshima Red Cross Hospital and AtomicBomb Survivors Hospital, Hiroshima, Japan
| | - Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Toru Ikegami
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan
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30
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Ueno M, Okusaka T, Omuro Y, Isayama H, Fukutomi A, Ikeda M, Mizuno N, Fukuzawa K, Furukawa M, Iguchi H, Sugimori K, Furuse J, Shimada K, Ioka T, Nakamori S, Baba H, Komatsu Y, Takeuchi M, Hyodo I, Boku N. A randomized phase II study of S-1 plus oral leucovorin versus S-1 monotherapy in patients with gemcitabine-refractory advanced pancreatic cancer. Ann Oncol 2015; 27:502-8. [PMID: 26681680 PMCID: PMC4769993 DOI: 10.1093/annonc/mdv603] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Accepted: 12/01/2015] [Indexed: 12/27/2022] Open
Abstract
This is the first phase II trial in which adding oral leucovorin (LV) to S-1 (SL) significantly prolonged progression-free survival (PFS) when compared with S-1 monotherapy (S) in patients with gemcitabine-refractory advanced pancreatic cancer (PC). The significantly better PFS and disease control rate with SL than with S suggest that the antitumor activity of S-1 is enhanced by LV in advanced PC. Background We evaluated the efficacy and toxicity of adding oral leucovorin (LV) to S-1 when compared with S-1 monotherapy in patients with gemcitabine-refractory pancreatic cancer (PC). Patients and methods Gemcitabine-refractory PC patients were randomly assigned in a 1:1 ratio to receive S-1 at 40, 50, or 60 mg according to body surface area plus LV 25 mg, both given orally twice daily for 1 week, repeated every 2 weeks (SL group), or S-1 monotherapy at the same dose as the SL group for 4 weeks, repeated every 6 weeks (S-1 group). The primary end point was progression-free survival (PFS). Results Among 142 patients enrolled, 140 were eligible for efficacy assessment (SL: n = 69 and S-1: n = 71). PFS was significantly longer in the SL group than in the S-1 group [median PFS, 3.8 versus 2.7 months; hazard ratio (HR), 0.56; 95% confidence interval (CI), 0.37–0.85; P = 0.003]). The disease control rate was significantly higher in the SL group than in the S-1 group (91% versus 72%; P = 0.004). Overall survival (OS) was similar in both groups (median OS, 6.3 versus 6.1 months; HR, 0.82; 95% CI, 0.54–1.22; P = 0.463). After adjusting for patient background factors in a multivariate analysis, OS tended to be better in the SL group (HR, 0.71; 95% CI, 0.47–1.07; P = 0.099). Both treatments were well tolerated, although gastrointestinal toxicities were slightly more severe in the SL group. Conclusion The addition of LV to S-1 significantly improved PFS in patients with gemcitabine-refractory advanced PC, and a phase III trial has been initiated in a similar setting. Clinical trials number Japan Pharmaceutical Information Center: JapicCTI-111554.
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Affiliation(s)
- M Ueno
- Division of Hepatobiliary and Pancreatic Medical Oncology, Kanagawa Cancer Center, Yokohama
| | - T Okusaka
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital, Tokyo
| | - Y Omuro
- Department of Medical Oncology, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo
| | - H Isayama
- Department of Gastroenterology, The University of Tokyo, Graduate School of Medicine, Tokyo
| | - A Fukutomi
- Division of Gastrointestinal Oncology, Shizuoka Cancer Center, Shizuoka
| | - M Ikeda
- Department of Hepatobiliary and Pancreatic Oncology, National Cancer Center Hospital East, Kashiwa
| | - N Mizuno
- Department of Gastroenterology, Aichi Cancer Center Hospital, Nagoya
| | - K Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, Oita
| | - M Furukawa
- Department of Gastroenterology, National Kyushu Cancer Center, Fukuoka
| | - H Iguchi
- Department of Gastroenterology, National Hospital Organization Shikoku Cancer Center, Matsuyama
| | - K Sugimori
- Gastroenterological Center, Yokohama City University Medical Center, Yokohama
| | - J Furuse
- Department of Medical Oncology, Kyorin University School of Medicine, Tokyo
| | - K Shimada
- Department of Medical Oncology, Saitama Medical University International Medical Center, Saitama
| | - T Ioka
- Department of Hepatobiliary and Pancreatic Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka
| | - S Nakamori
- Hepato-biliary-pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka
| | - H Baba
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto
| | - Y Komatsu
- Department of Cancer Chemotherapy, Hokkaido University Hospital Cancer Center, Sapporo
| | - M Takeuchi
- Department of Clinical Medicine (Biostatistics and Pharmaceutical Medicine), Kitasato University School of Pharmacy, Tokyo
| | - I Hyodo
- Division of Gastroenterology, University of Tsukuba, Tsukuba
| | - N Boku
- Department of Clinical Oncology, St Marianna University School of Medicine, Kawasaki, Japan
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31
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Sagami R, Nagamatsu H, Togou K, Yanai Y, Takahashi K, Ueo T, Narita R, Ishida T, Fukuzawa K, Yonemasu H. [A case of serous cystic neoplasm with atypical imaging results suggestive of a prismatic internal structure]. Nihon Shokakibyo Gakkai Zasshi 2015; 112:1067-74. [PMID: 26050731 DOI: 10.11405/nisshoshi.112.1067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The patient was a 67-year-old man with a 39-mm unilocular pancreatic tumor detected by computed tomography (CT). Further examinations with contrast-enhanced CT, magnetic resonance imaging, endoscopic ultrasonography, and endoscopic retrograde cholangiopancreatography revealed an internal heterogeneous structure attributed to bleeding or necrosis. Consequently, we expected either a pancreatic neuroendocrine tumor or a solid pseudopapillary neoplasm and performed pancreaticoduodenectomy. Pathological examination showed that the tumor had a denatured structure with evidence of internal bleeding and cubic epithelial cysts of various sizes. The final diagnosis was a macrocystic-type serous cystic neoplasm.
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Affiliation(s)
- Ryota Sagami
- Department of Gastroenterology, Oita Red Cross Hospital
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Komori Y, Yada K, Ohta M, Uchida H, Iwashita Y, Fukuzawa K, Kashima K, Yokoyama S, Inomata M, Kitano S. Mammalian target of rapamycin signaling activation patterns in pancreatic neuroendocrine tumors. J Hepatobiliary Pancreat Sci 2013; 21:288-95. [PMID: 24002888 DOI: 10.1002/jhbp.26] [Citation(s) in RCA: 22] [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] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Phosphatidylinositol 3-kinase/Akt/mammalian target of rapamycin (mTOR) pathway dysregulation has been implicated in the development of various human cancers. However, expression of mTOR cascade components in pancreatic neuroendocrine tumors (PNETs) has not been fully explored. The aim of this study was to assess the expression of mTOR pathway in PNETs using immunohistochemistry. METHODS From December 1984 to April 2012, we surgically treated 42 patients with PNETs. We used immunohistochemistry to evaluate expression of mTOR, phosphorylated mTOR (p-mTOR), p70S6 kinase (S6K), phosphorylated S6 ribosomal protein (p-S6rp), eukaryotic initiation factor 4E-binding protein 1 (4E-BP1), and phosphorylated 4E-BP1 (p-4E-BP1) in the resected specimens. The relation between the expression of these molecules and clinicopathological characteristics was investigated. RESULTS We identified the expression of mTOR (28.6%), p-mTOR (52.4%), S6K (52.4%), p-S6rp (40.5%), 4E-BP1 (81.0%), and p-4E-BP1 (26.2%) in PNETs. The expression of mTOR, p-mTOR, S6K, and p-S6rp was significantly associated with tumor invasion, proliferation, and an advanced-stage. Particularly, the expression of p-mTOR was related to clinically relevant factors such as tumor size, vascular invasion, extrapancreatic invasion, lymph node and/or distant metastasis, mitotic count, and European Neuroendocrine Tumor Society TNM staging as well as the 2004 and 2010 World Health Organization (WHO) classification. In addition, p-S6rp expression was related to vascular invasion, extrapancreatic invasion, lymph node and distant metastasis, mitotic count, and the 2010 WHO classification. In contrast, no significant relation between 4E-BP1 activation and clinicopathological factors was observed. The expression of p-mTOR was strongly correlated with that of p-S6rp (r = 0.474, P = 0.002). CONCLUSIONS Our results suggest that activation of the mTOR/S6K signaling pathway plays a significant role in tumorigenesis and progression of PNET.
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Affiliation(s)
- Yoko Komori
- Department of Gastroenterological and Pediatric Surgery, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita, 879-5593, Japan.
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Itoh M, Yoshida A, Fukuzawa K, Kiuchi K, Imamura K, Fujiwara R, Suzuki A, Nakanishi T, Yamashita S, Matsumoto A, Hirata KI. Time-dependent effect of cardiac resynchronization therapy on ventricular repolarization and ventricular arrhythmias. Europace 2013; 15:1798-804. [DOI: 10.1093/europace/eut145] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Kajihara Y, Fukuzawa K, Itoh S, Watanabe R, Zhang H. Theoretical and experimental study on two-stage-imaging microscopy using ellipsometric contrast for real-time visualization of molecularly thin films. Rev Sci Instrum 2013; 84:053704. [PMID: 23742555 DOI: 10.1063/1.4804633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
A two-stage-imaging ellipsometric-contrast microscope (TIEM) has been developed to measure the distribution of film thickness over a wide area of molecularly thin liquid films with a high lateral resolution, wide field of view, high thickness resolution, and high-speed. Moreover, this ellipsometric microscope enables us to achieve simultaneous measurements with other measurement apparatuses. We present the principle used to parallelize an object image to an imaging sensor and to reduce the incident angle entering the imaging sensor. In addition, we discuss the characteristic shape deformation of the object image due to oblique observation. The performance of the actual setup for TIEM was experimentally studied. A lateral resolution of about 1 μm was obtained by measuring the modulation transfer function of the TIEM. We also found that the shape deformation approximately agreed with that from theory. Furthermore, for molecularly thin films, we confirmed linearity between the film thickness and the light intensity measured with TIEM, which enables us to quantify the thickness of the films. TIEM can open up a new field of real-time imaging of thin films such as visualization of a liquid lubricant film under shear.
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Affiliation(s)
- Y Kajihara
- Department of Micro/Nano System Engineering, Nagoya University, Furo-cho, Chikusa-ku, Nagoya 464-8603, Japan
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Matsumoto S, Mori H, Kiyonaga M, Sai M, Yamada Y, Hijiya N, Shibata K, Ohta M, Kitano S, Takaki H, Fukuzawa K, Yonemasu H. "Peripancreatic strands appearance" in pancreatic body and tail carcinoma: evaluation by multi-detector CT with pathological correlation. ACTA ACUST UNITED AC 2013; 37:602-8. [PMID: 21912989 DOI: 10.1007/s00261-011-9803-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [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: 12/21/2022]
Abstract
OBJECTIVES In pancreatic body and tail carcinoma, "peripancreatic strands appearance" is frequently seen on multidetector CT (MDCT). The purpose of this study was to clarify the pathological and clinical implications of peripancreatic strands appearance. METHODS We retrospectively evaluated MDCT images in 17 patients with pancreatic body and tail carcinoma who underwent surgical resection. Peripancreatic strands appearance was defined as the strands structure deriving from the primary lesion and associated with increased CT attenuation of surrounding adipose tissues. All CT examinations were performed by contrast-enhanced MDCT with a multiplanar reformation technique. RESULTS Peripancreatic strands appearance was detected on MDCT in 13 (76%) patients. The maximum width of the peripancreatic strands seen on MDCT was 1.55 ± 0.36 mm (range, 1.0-2.5 mm). This CT finding was well correlated with extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa, including microvessels. This pathological finding was confirmed in all 13 patients with positive CT finding whereas it was not confirmed in the 4 patients with negative CT finding. CONCLUSION Peripancreatic strands appearance on MDCT in pancreatic body and tail carcinoma reflects extrapancreatic carcinoma invasion with marked fibrotic thickening of adipose tissue septa. This CT finding would indicate the property of carcinoma aggressiveness.
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Affiliation(s)
- Shunro Matsumoto
- Department of Radiology, Faculty of Medicine, Oita University, Hasama-machi, Yufu, Japan.
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Yamada Y, Mori H, Hijiya N, Matsumoto S, Takaji R, Kiyonaga M, Ohta M, Kitano S, Moriyama M, Takaki H, Fukuzawa K, Yonemasu H. Extrahepatic bile duct cancer: invasion of the posterior hepatic plexuses--evaluation using multidetector CT. Radiology 2012; 263:419-28. [PMID: 22447852 DOI: 10.1148/radiol.12111024] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE To assess the utility of axial and coronal reformatted multidetector computed tomographic (CT) images in the evaluation of the invasion of posterior hepatic plexuses by extrahepatic bile duct cancer. MATERIALS AND METHODS This retrospective study was approved by the institutional review board, and informed consent was waived. Forty-three patients (22 men, 21 women; age range, 40-80 years; mean age, 65 years) with surgically resected cancer involving the extrahepatic bile duct between December 2004 and September 2010 were included. Posterior hepatic plexus 1 runs from the superior and middle bile duct to the right celiac ganglion, and posterior hepatic plexus 2 runs between the lower bile duct and right celiac ganglion behind the portal vein. Invasion of the posterior hepatic plexuses was elucidated by using pathologic and postoperative multidetector CT findings. Three radiologists independently evaluated the preoperative axial and coronal reformatted images with a separate viewing session for the invasion of posterior hepatic plexuses that was detected on the basis of the presence of increased attenuation of fat tissue along the nerve routes. Receiver operating characteristic analysis was performed to compare the diagnostic performance of the two image interpretations. RESULTS Invasion of posterior hepatic plexus 1 and of posterior hepatic plexus 2 was recognized in 10 (23%) and nine (21%) of 43 patients, respectively. The diagnostic performance of coronal reformatted image interpretation was significantly greater than that for axial image interpretation (mean area under the curve, 0.99 vs 0.89, P = .04; mean accuracy, 95% vs 82%, P = .003). In all reviewers, one false-positive diagnosis of the invasion of posterior hepatic plexus occurred on axial and/or coronal image display types because of fibrosis and inflammatory cell infiltration along these plexus routes. CONCLUSION Coronal reformatted images can be useful for accurate diagnosis of the invasion of posterior hepatic plexuses and may facilitate surgical decision making in regard to the resection of celiac ganglion.
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Affiliation(s)
- Yasunari Yamada
- Departments of Radiology, Oita University Faculty of Medicine, Oita, Japan.
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Nagamatsu H, Takahashi K, Ueo T, Narita R, Mukai T, Ishida T, Fukuzawa K, Wakasugi K, Takagi H, Yonemasu H, Seike M, Koba I. [A case of splenic artery aneurysm simulating a pancreas tumor]. Nihon Shokakibyo Gakkai Zasshi 2011; 108:1420-1427. [PMID: 21817846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
A 46-year-old man was admitted to our hospital for further evaluation of a hypoechogenic mass in the pancreatic body. He had no history of hypertension, pancreatitis, abdominal trauma, or portal hypertension. He had no abdominal symptoms. A contrast-enhanced CT scan demonstrated a hypodense, round shaped mass. EUS and MRI also showed it to be a pancreatic mass. Because of the tumor size of more than 30mm and the possibility of malignancy, distal pancreatectomy was performed. Microscopic findings showed the mass was the dissection of the proximal splenic artery. The true lumen of the dissecting aneurysm was occluded and the false lumen developed fusiform dilatation. Moreover, microscopic findings revealed the rupture of the false lumen complicated by pseudoaneurysm. We finally diagnosed the lesion simulating a pancreatic tumor as the pseudoaneurysm of the splenic artery.
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Itoh S, Morita K, Ueda S, Sugimachi K, Yamashita YI, Gion T, Fukuzawa K, Wakasugi K, Taketomi A, Maehara Y. Long-term results of hepatic resection combined with intraoperative local ablation therapy for patients with multinodular hepatocellular carcinomas. Ann Surg Oncol 2009; 16:3299-307. [PMID: 19826875 DOI: 10.1245/s10434-009-0721-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2009] [Indexed: 12/23/2022]
Abstract
BACKGROUND Recently, local ablation therapy has been widely used for treatment of small hepatocellular carcinoma (HCC). The present study assessed the outcome of hepatic resection combined with intraoperative local ablation therapy in patients with multinodular HCCs. METHODS Forty-one patients with initial and multinodular HCCs underwent hepatic resection combined with intraoperative local ablation therapy. The mean maximum diameter of all tumors was 3.8 cm (range 2.1-16.0 cm), and the mean number of nodules was 3.2 (range 2-11). We evaluated the survival rates and assessed the prognostic factors associated with overall survival rates using Cox proportional hazard models. RESULTS Intraoperative local ablation therapy was completed in all patients with no evidence of residual viable tumor on the first postoperative computed tomography (CT) scan. The 3-, 5- and 7-year overall survival rates were 84.3%, 61.2%, and 61.2%, respectively. Patients with preoperative des-gamma carboxyprothrombin (DCP) level >300 mAU/ml showed significantly worse overall survival than those with DCP level <or=300 mAU/ml (P < 0.01). CONCLUSIONS Hepatic resection combined with intraoperative local ablation therapy is effective for multinodular HCCs. DCP >300 mAU/ml was a significant prognostic factor of long-term overall survival.
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Affiliation(s)
- Shinji Itoh
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Nagata S, Fukuzawa K, Iwashita Y, Kabashima A, Kinoshita T, Wakasugi K, Maehara Y. Comparison of enteral nutrition with combined enteral and parenteral nutrition in post-pancreaticoduodenectomy patients: a pilot study. Nutr J 2009; 8:24. [PMID: 19519910 PMCID: PMC2703645 DOI: 10.1186/1475-2891-8-24] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2008] [Accepted: 06/11/2009] [Indexed: 12/26/2022] Open
Abstract
Background Many clinical studies have demonstrated that early postoperative enteral nutrition (EN) improved the postroperative course. Post-pancreaticoduodenectomy (PD), patients tend to suffer from postoperative nausea, abdominal distention, and diarrhoea, causing difficulty in the introduction of EN. In this pilot study, we investigated the appropriate nutritional mode post-pancreatic surgery. Methods Between October 2006 and March 2007 2 postoperative nutritional methods were implemented in 17 patients in a prospective single-centere study. Eight patients received only enteral nutrition (EN group) and 9 patients received enteral nutrition combined with parenteral nutrition (EN + PN group). Results There were no differences in the patient characteristics and postoperative morbidity between the 2 groups. The rate of discontinuance of enteral feeding was significantly high in the EN group, and the duration of enteral feeding was significantly longer in the EN + PN group. The central venous line was retained for a significantly longer period in the EN + PN group, but there was no difference in the frequency of catheter-related infection between the 2 groups. Conclusion EN combined with PN is more adequate for patients after pancreatic surgery.
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Affiliation(s)
- Shigeyuki Nagata
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Krum D, Hare J, Delavelle A, Soubelet E, Vaillant R, Belanger B, Choudhuri I, Sra J, Pandozi C, Dottori S, Ficili S, Galeazzi M, Lavalle C, Pandozi A, Russo M, Santini M, Berger T, Pehboeck D, Stuehlinger M, Dichtl W, Silye R, Takami M, Yoshida A, Fukuzawa K, Takami K, Kumagai H, Tanaka S, Itoh M, Hirata K, Ficili S, Pandozi C, Galeazzi M, Russo M, Lavalle C, Bernardi C, Amati F, Santini M, Tanaka S, Yoshida A, Fukuzawa K, Takami K, Kumagai H, Takami M, Itoh M, Hirata K, De Ponti R, Marazzi R, De Luca L, De Sanctis V, Caravati F, Panchetti L, Salerno-Uriarte JA, Luik A, Wondraschek R, Merkel M, Schmitt C, Marazzi R, De Ponti R, Lumia D, Lunardi L, Cremona V, Fugazzola C, Salerno-Uriarte JA, Pandozi C, Dottori S, Ficili S, Galeazzi M, Lavalle C, Russo M, Camastra GS, Santini M. Poster Session 1: New tools for ablation. Europace 2009. [DOI: 10.1093/europace/euq216] [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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Potpara T, Grujic M, Ostojic M, Vujisic B, Polovina M, Mujovic N, Hatzinikolaou-Kotsakou E, Reppas E, Beleveslis TH, Moschos G, Kotsakou M, Tsakiridis K, Simeonidou E, Papandreou A, Tsigas G, Michalakeas C, Tsitlakidis C, Alexopoulos D, Lekakis J, Kremastinos DT, Poci D, Backmn L, Karlsson TH, Edvardsson N, Golzio PG, Vinci M, Amellone C, Jorfida M, Veglio V, Gaido E, Trevi GP, Bongiorni MG, Ding L, Hua WEI, Zhang SHU, Chen KEPING, Wang FZ, Chen XIN, Dokumaci B, Dokumaci AS, Ozyildirim S, Yolcu M, Uyan C, Nicolas-Franco S, Rodriguez Gonzalez J, Albacete-Moreno C, Ruiz-Villa G, Sanchez-Martos A, Bixquert-Genoves D, Skoczynski P, Gajek J, Zysko D, Porebska M, Josiak K, Mazurek W, Providencia RA, Silva J, Seca L, Gomes PL, Barra S, Mota P, Nascimento J, Leitao-Marques AM, Kikuchi Y, Brady PA, Erne P, Val-Mejias J, Schwab J, Schimpf R, Orlov M, Mattioni T, Amlie J, Sacher F, Lahitton B, Laborderie J, Wright M, Haissaguerre M, Berger T, Zwick R, Dichtl W, Stuehlinger M, Pachinger O, Hintringer F, Toli K, Koutras K, Stauropoulos J, Vichos S, Mantas J, Rodriguez Artuza CR, Hidalgo L JA, Garcia A, Fumero P, Perez A, Rangel I, Providencia RA, Silva J, Seca L, Gomes PL, Nascimento J, Leitao-Marques AM, Perl S, Stiegler P, Kollmann A, Rotman B, Lercher P, Anelli-Monti M, Tscheliessnigg KH, Pieske BM, Nakamura K, Naito S, Kumagai K, Goto K, Iwamoto J, Funabashi N, Oshima S, Komuro I, Toli K, Stavropoulos J, Koutras D, Vichos S, Mantas J, Di Biase L, Beheiry S, Hongo R, Horton R, Morganti K, Hao S, Javier Sanchez J, Natale A, Digby G, Parfrey B, Morriello F, Lim L, Hopman WM, Simpson CS, Redfearn DP, Baranchuk A, Madsen T, Schmidt EB, Toft E, Christensen JH, Patel D, Shaheen M, Sonne K, Mohanty P, Dibiase L, Horton RP, Sanchez JE, Natale A, Krynski T, Stec SM, Stanke A, Baszko A, Kulakowski P, Rondano E, Bortnik M, Occhetta E, Teodori G, Caimmi PP, Marino PN, Osmancik P, Peroutka Z, Herman D, Stros P, Budera P, Straka Z, Petrac D, Radeljic V, Delic-Brkljacic D, Manola S, Pavlovic N, Inama G, Pedrinazzi C, Adragao P, Arribas F, Landolina M, Merino JL, De Sousa J, Gulizia M, Neuzil P, Holy F, Skoda J, Petru J, Sediva L, Kralovec S, Brada J, Taborsky M, Takami M, Yoshida A, Fukuzawa K, Takami K, Kumagai H, Tanaka S, Itoh M, Hirata K, Jacques F, Champagne J, Doyle D, Charbonneau E, Dagenais F, Voisine P, Dumont E, Aboelhoda A, Nawar M, Khadragui I, Loutfi M, Ramadan B, Makboul G, Gianfranchi L, Pacchioni F, Bettiol K, Alboni P, Gallardo Lobo R, Pap R, Bencsik G, Makai A, Marton G, Saghy L, Forster T, Stockburger M, Trautmann F, Nitardy A, Just-Teetzmann M, Schade S, Celebi O, Krebs A, Dietz R, Pastore CA, Douglas RA, Samesima N, Martinelli Filho M, Nishioka SAD, Pastor Fuentes A, Perea J, Tur N, Berzal B, Boldt LH, Polotzki M, Posch MG, Perrot A, Lohse M, Rolf S, Ozcelik C, Haverkamp W, Tunyan LG, Grigoryan SV, Barsheshet A, Abu Sham'a R, Kuperstein R, Feinberg MS, Sandach A, Luria D, Eldar M, Glikson M, Vatasescu RG, Berruezo A, Iorgulescu C, Fruntelata A, Dorobantu M, Chaumeil A, Philippon F, O'hara G, Blier L, Molin F, Gilbert M, Champagne J, Paslawska U, Gajek J, Zysko D, Noszczyk-Nowak A, Skrzypczak P, Nicpon J, Mazurek W, Chevallier S, Van Oosterom A, Pruvot E, Iga A, Igarashi M, Itou H, Fujino T, Tsubota T, Yamazaki J, Yoshihara K, Arsenos P, Gatzoulis K, Dilaveris P, Gialernios T, Papaioannou T, Masoura K, Archontakis S, Stefanadis C, Nasr GM, Khashaba A, Osman H, El-Barbary M, Heinke M, Heinke T, Ismer B, Kuehnert H, Surber R, Figulla HR. Poster session 3: Miscellaneous. Europace 2009. [DOI: 10.1093/europace/euq230] [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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Nagata S, Nishimura A, Iwashita Y, Kinoshita T, Fukuzawa K, Tashiro H, Wakasugi K. Primary breast lymphoma in the right breast during treatment for left breast cancer. World J Surg Oncol 2007; 5:134. [PMID: 18036261 PMCID: PMC2213664 DOI: 10.1186/1477-7819-5-134] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 11/26/2007] [Indexed: 11/18/2022] Open
Abstract
Background Primary breast lymphoma is a rare condition, and distinguishing it from breast cancer is important because their treatments differ radically. Moreover, a recent report showed that mastectomy offered no benefit in the treatment of primary breast lymphoma. Case presentation A 59-year-old woman was treated with adjuvant chemotherapy and local radiation after surgery for left breast cancer. She presented with a rapidly growing mass in the right breast at 20 months after surgery. Mammography and computed tomography revealed a massive tumour. She was diagnosed with primary breast lymphoma by aspiration cytology, and surgery was performed. Histopathological and immunohistochemical findings confirmed a diffuse large B-cell type primary breast lymphoma. Conclusion In this case, the lymphoma exhibited rapid growth despite chemotherapy for a malignancy in the contralateral breast. The patient had developed bronchiolitis obliterans organizing pneumonia due to radiation. Therefore, surgical treatment of the lymphoma was selected.
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Yamashita YI, Fukuzawa K, Taketomi A, Aishima S, Yoshizumi T, Uchiyama H, Tsujita E, Harimoto N, Harada N, Wakasugi K, Maehara Y. Mucin-hypersecreting bile duct neoplasm characterized by clinicopathological resemblance to intraductal papillary mucinous neoplasm (IPMN) of the pancreas. World J Surg Oncol 2007; 5:98. [PMID: 17725824 PMCID: PMC2000466 DOI: 10.1186/1477-7819-5-98] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2007] [Accepted: 08/28/2007] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Although intraductal papillary mucinous neoplasm (IPMN) of the pancreas is acceptable as a distinct disease entity, the concept of mucin-secreting biliary tumors has not been fully established. CASE PRESENTATION We describe herein a case of mucin secreting biliary neoplasm. Imaging revealed a cystic lesion 2 cm in diameter at the left lateral segment of the liver. Duodenal endoscopy revealed mucin secretion through an enlarged papilla of Vater. On the cholangiogram, the cystic lesion communicated with bile duct, and large filling defects caused by mucin were observed in the dilated common bile duct. This lesion was diagnosed as a mucin-secreting bile duct tumor. Left and caudate lobectomy of the liver with extrahepatic bile duct resection and reconstruction was performed according to the possibility of the tumor's malignant behavior. Histological examination of the specimen revealed biliary cystic wall was covered by micropapillary neoplastic epithelium with mucin secretion lacking stromal invasion nor ovarian-like stroma. The patient has remained well with no evidence of recurrence for 38 months since her operation. CONCLUSION It is only recently that the term "intraductal papillary mucinous neoplasm (IPMN)," which is accepted as a distinct disease entity of the pancreas, has begun to be used for mucin-secreting bile duct tumor. This case also seemed to be intraductal papillary neoplasm with prominent cystic dilatation of the bile duct.
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Affiliation(s)
- Yo-ichi Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyo-machi, Oita 870-0033, Japan
| | - Kengo Fukuzawa
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyo-machi, Oita 870-0033, Japan
| | - Akinobu Taketomi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Shinichi Aishima
- Department of Anatomic Pathology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Tomoharu Yoshizumi
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hideaki Uchiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Eiji Tsujita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Norifumi Harimoto
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Noboru Harada
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Kenzo Wakasugi
- Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyo-machi, Oita 870-0033, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Yamashita YI, Taketomi A, Fukuzawa K, Tsujita E, Harimoto N, Kitagawa D, Kuroda Y, Kayashima H, Wakasugi K, Maehara Y. Risk factors for and management of delayed intraperitoneal hemorrhage after pancreatic and biliary surgery. Am J Surg 2007; 193:454-9. [PMID: 17368288 DOI: 10.1016/j.amjsurg.2006.09.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2006] [Revised: 09/18/2006] [Accepted: 09/18/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Delayed intraperitoneal hemorrhage (DIH) is still an important cause of postoperative mortality in pancreatic and biliary surgery. METHODS Sixty-nine patients who underwent pancreatic and biliary surgery with skeletonization for lymphadenectomy of the hepatoduodenal ligament between April 2002 and March 2005 were included in this study. Statistical analyses of the risk factors for DIH were performed using both univariate and multivariate modalities. RESULTS DIH occurred in 4 patients (5.8%) within a median time of 15 days after surgery. Stepwise logistic regression analysis identified intra-abdominal abscess formation as the independent predictor of DIH. All 4 patients had a sentinel bleed before the onset of DIH. Three patients were treated by transarterial embolization and 1 patient was treated by surgical intervention. Three patients had liver abscess after hemostasis of DIH, but all 4 patients recovered and were discharged from the hospital. CONCLUSIONS A computed tomography angiography should be performed on patients with intra-abdominal abscess formation and sentinel bleed after pancreatic and biliary surgery to check if a pseudoaneurysm has formed.
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Affiliation(s)
- Yo-ichi Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
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Utsunomiya T, Okamoto M, Wakiyama S, Hashimoto M, Fukuzawa K, Ezaki T, Aishima S, Yoshikawa Y, Hanai T, Inoue H, Barnard GF, Mori M. A specific gene-expression signature quantifies the degree of hepatic fibrosis in patients with chronic liver disease. World J Gastroenterol 2007; 13:383-90. [PMID: 17230606 PMCID: PMC4065892 DOI: 10.3748/wjg.v13.i3.383] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To study a more accurate quantification of hepatic fibrosis which would provide clinically useful information for monitoring the progression of chronic liver disease.
METHODS: Using a cDNA microarray containing over 22 000 clones, we analyzed the gene-expression profiles of non-cancerous liver in 74 patients who underwent hepatic resection. We calculated the ratio of azan-stained: total area, and determined the morphologic fibrosis index (MFI), as a mean of 9 section-images. We used the MFI as a reference standard to evaluate our method for assessing liver fibrosis.
RESULTS: We identified 39 genes that collectively showed a good correlation (r > 0.50) between gene-expression and the severity of liver fibrosis. Many of the identified genes were involved in immune responses and cell signaling. To quantify the extent of liver fibrosis, we developed a new genetic fibrosis index (GFI) based on gene-expression profiling of 4 clones using a linear support vector regression analysis. This technique, based on a supervised learning analysis, correctly quantified the various degrees of fibrosis in both 74 training samples (r = 0.76, 2.2% vs 2.8%, P < 0.0001) and 12 independent additional test samples (r = 0.75, 9.8% vs 8.6%, P < 0.005). It was far better in assessing liver fibrosis than blood markers such as prothrombin time (r = -0.53), type IV collagen 7s (r = 0.48), hyaluronic acid (r = 0.41), and aspartate aminotransferase to platelets ratio index (APRI) (r = 0.38).
CONCLUSION: Our cDNA microarray-based strategy may help clinicians to precisely and objectively monitor the severity of liver fibrosis.
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Affiliation(s)
- Tohru Utsunomiya
- Department of Molecular and Surgical Oncology, Medical Institute of Bioregulation, Kyushu University, Tsurumihara 4546, Beppu 874-0838, Japan
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Nagata S, Aishima S, Fukuzawa K, Takagi H, Yonemasu H, Iwashita Y, Kinoshita T, Wakasugi K, Ishigami S, Takao S, Aikou T. Adenomatoid tumour of the liver. J Clin Pathol 2006; 61:777-80. [PMID: 18505892 PMCID: PMC2569191 DOI: 10.1136/jcp.2007.054684] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
An unusual primary adenomatoid tumour arising in the normal liver is described. Hepatectomy was performed, and the patient is alive and free of disease 1 year postsurgery. Grossly, the tumour showed a haemorrhagic cut surface with numerous microcystic structures. Histological examination revealed cystic or angiomatoid spaces of various sizes lined by cuboidal, low-columnar, or flattened epithelioid cells with vacuolated cytoplasm and round to oval nuclei. The epithelioid cells were entirely supported by proliferated capillaries and arteries together with collagenous stroma. Immunohistochemical studies showed that the epithelioid cells were strongly positive for a broad spectrum of cytokeratins (AE1/AE3, CAM5.2, epithelial membrane antigen and cytokeratin 7) and mesothelial markers (calretinin, Wilms’ tumour 1 and D2-40). These cells were negative for Hep par-1, carcinoembryonic antigen, neural cell adhesion molecule, CD34, CD31 and HMB45. Atypically, abundant capillaries were observed; however, the cystic proliferation of epithelioid cells with vacuoles and immunohistochemical profile of the epithelioid element were consistent with hepatic adenomatoid tumour.
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Affiliation(s)
- S Nagata
- Department of Surgery, Nakabaru Hospital, Fukuoka, Japan.
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Okamoto M, Utsunomiya T, Wakiyama S, Hashimoto M, Fukuzawa K, Ezaki T, Hanai T, Inoue H, Mori M. Specific gene-expression profiles of noncancerous liver tissue predict the risk for multicentric occurrence of hepatocellular carcinoma in hepatitis C virus-positive patients. Ann Surg Oncol 2006; 13:947-54. [PMID: 16788756 DOI: 10.1245/aso.2006.07.018] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [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: 07/19/2005] [Accepted: 01/04/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Hepatitis C virus (HCV) infection produces chronic hepatitis, cirrhosis, and, ultimately, hepatocellular carcinoma (HCC). A molecular analysis of the damaged liver tissues infected with HCV may identify specific gene-expression profiles associated with a risk for liver carcinogenesis. METHODS Forty patients with HCV-positive HCC were classified into two groups: single nodular HCC group (n = 28) and multicentric HCC group (n = 12). Using a complementary DNA microarray, we compared the gene-expression patterns of the noncancerous liver tissue specimens between the two groups. We also identified the differentially expressed genes related to multicentric recurrence in the liver remnant. We then evaluated whether a specific gene-expression profile can accurately estimate the risk for multicentric hepatocarcinogenesis. RESULTS We selected the 230 differentially expressed genes in the multicentric HCC group. A hierarchical clustering analysis identified a cluster that might be closely associated with the multicentric occurrence of HCC. On the basis of the gene-expression profiling of the 36 genes commonly associated with both multicentric HCC and multicentric recurrence, we created a scoring system to estimate the risk for multicentric hepatocarcinogenesis. The prediction score of patients in the multicentric HCC group with multicentric recurrence (19.9 +/- 9.2) was significantly higher (P < .05) than that in the single nodular HCC group without multicentric recurrence (-1.8 +/- 12.7). CONCLUSIONS Specific gene-expression signatures in noncancerous liver tissue may help to accurately predict the risk for developing HCC.
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Affiliation(s)
- Masahiro Okamoto
- Department of Molecular and Surgical Oncology, Medical Institute of Bioregulation, Kyushu University, Tsurumihara 4546, Beppu, 874-0838, Japan
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Yamashita YI, Taketomi A, Fukuzawa K, Yoshizumi T, Uchiyama H, Simada M, Shirabe K, Wakasugi K, Maehara Y. Gemcitabine combined with 5-fluorouracil and cisplatin (GFP) in patients with advanced biliary tree cancers: a pilot study. Anticancer Res 2006; 26:771-5. [PMID: 16739352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
BACKGROUND Advanced biliary tree cancers have poor prognosis and chemotherapy has been shown to have little impact. To date, no standard chemotherapy regimens have been established. A pilot study to evaluate gemcitabine/5-Fluorouracil(5-FU)/cisplatin(CDDP) (GFP) chemotherapy in patients with advanced biliary tree cancers was performed. PATIENTS AND METHODS Eight patients with advanced intrahepatic cholangiocarcinoma and gallbladder carcinoma with no prior chemotherapy were treated with a 4-week cycle GFP chemotherapy consisting of gemcitabine at 1000 mg/m2 on days 1, 8, and 15, and of 5-FU at 250 mg/patient and CDDP at 5 mg/patient on days 1 to 5, 8 to 12 and 22 to 26. RESULTS Of these 8 patients, no complete responses (CR) were observed, but 3 patients (37.5%) demonstrated partial responses (PR) with an additional 3 patients (37.5%) having stable diseases (SD), as assessed by RECIST. Two patients with PR and 1 patient with SD were treated by curative operation after GFP chemotherapy and all of them survived with no recurrence. The median overall survival time was 23.5 months, and median time to progression was 14.5 months. Grade 3/4 side-effects, such as leukopenia, thrombocytepenia and anemia were found in 4 patients (50%), but no patients dropped out because of toxicity. CONCLUSION This GFP chemotherapy has promising antitumor activity and is well tolerated in patients with advanced biliary tree cancers. This regimen warrants further evaluation in a phase II study including larger numbers of patients.
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Affiliation(s)
- Yo-ichi Yamashita
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
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Fukuzawa K, Yoshida A, Kitamura H, Kubo S, Takano T, Kiuchi K, Kanda G, Yokoyama M. 158 The posterior right atrial wall is a preferential site for successful ablation of atrial tachycardias in patients with tricuspid atresia. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.26-a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Affiliation(s)
- K. Fukuzawa
- Himeji Cardiovascular Center, Cardiology, Himeji, Japan
| | - A. Yoshida
- Kobe university, Cardiovascular, Kobe, Japan
| | - H. Kitamura
- Kobe university, Cardiovascular, Kobe, Japan
| | - S. Kubo
- Kobe university, Cardiovascular, Kobe, Japan
| | - T. Takano
- Kobe university, Cardiovascular, Kobe, Japan
| | - K. Kiuchi
- Kobe university, Cardiovascular, Kobe, Japan
| | - G. Kanda
- Kobe university, Cardiovascular, Kobe, Japan
| | - M. Yokoyama
- Kobe university, Cardiovascular, Kobe, Japan
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Fukuzawa K, Yoshida A, Kitamura H, Kubo S, Takano T, Kiuchi K, Kanda G, Yokoyama M. 163 Radiofrequency catheter ablation for drug refractory electrical storm in implantable cardioverter defibrillator recipients. Europace 2005. [DOI: 10.1016/eupace/7.supplement_1.27-b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Affiliation(s)
- K. Fukuzawa
- Himeji Cardiovascular Center, Cardiology, Himeji, Japan
| | - A. Yoshida
- Kobe univerity, Cardiovascular, Kobe, Japan
| | | | - S. Kubo
- Kobe univerity, Cardiovascular, Kobe, Japan
| | - T. Takano
- Kobe univerity, Cardiovascular, Kobe, Japan
| | - K. Kiuchi
- Kobe univerity, Cardiovascular, Kobe, Japan
| | - G. Kanda
- Kobe univerity, Cardiovascular, Kobe, Japan
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