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Maeda H, Endo H, Ichihara N, Miyata H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Seto Y, Yamaue H, Yamamoto M, Kitagawa Y, Uemura S, Hanazaki K. Days of the week and 90-day mortality after esophagectomy: analysis of 33,980 patients from the National Clinical Database. Langenbecks Arch Surg 2024; 409:36. [PMID: 38217701 DOI: 10.1007/s00423-023-03214-7] [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: 06/10/2023] [Accepted: 12/28/2023] [Indexed: 01/15/2024]
Abstract
PURPOSE The effect of the days of the week on the short-term outcomes after elective surgeries has been suggested; however, such data on esophagectomies remain limited. This study aimed to investigate the association between the day of the week and mortality rates after elective esophagectomy using a large-scale clinical database in Japan. METHODS The data of elective esophagectomies, registered in the National Clinical Database in Japan, for esophageal cancer treatment between 2012 and 2017 were analyzed. We hypothesized that the later days of the week could have higher odds ratios of death after elective esophagectomy. With 22 relevant clinical variables and days of surgery, 90-day mortality was evaluated using hierarchical logistic regression modeling. RESULTS Ninety-day mortality rates among 33,980 patients undergoing elective esophagectomy were 1.8% (range, 1.5-2.1%). Surgeries were largely concentrated on earlier days of the week, whereas esophagectomies performed on Fridays accounted for only 11.1% of all cases. Before risk adjustment, lower odds ratios of 90-day mortality were found on Tuesday and a tendency towards lower odds ratios on Thursday. In the hierarchical logistic regression model, 21 independent factors of 90-day mortality were identified. However, the adjusted odds ratios of 90-day mortality for Tuesday, Wednesday, Thursday, and Friday were 0.87, 1.09, 0.85, and 0.88, respectively, revealing no significant difference. CONCLUSION The results imply that the variation in 90-day mortality rates after esophagectomy on different days of the week may be attributed to differing preoperative risk factors of the patient group rather than the disparity in medical care provided.
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Affiliation(s)
- Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroshi Hasegawa
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kinji Kamiya
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Gastroenterological and Pediatric Surgery, Graduate School of Medicine, Gifu University, Gifu, 501-1193, Japan
| | - Yasuyuki Seto
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, 811-1 Kimiidera, Wakayama, Wakayama, 641-8510, Japan
| | | | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
- Department of Surgery, Keio University School of Medicine, Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
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Chikamori F, Yamada R, Ueta K, Uemura S, Onishi K, Yoshida M, Tanida N, Yamai H, Matsuoka H, Hokimoto N, Iwabu J, Mizobuchi K, Marui A, Sharma N. Identification and verification of communicating accessory bile duct associated with a biliary circuit by modified and dynamic intraoperative cholangiography during laparoscopic cholecystectomy. BJR Case Rep 2023; 9:20230037. [PMID: 37928709 PMCID: PMC10621582 DOI: 10.1259/bjrcr.20230037] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/22/2023] [Accepted: 06/02/2023] [Indexed: 11/07/2023] Open
Abstract
Communicating accessory bile duct (CABD) is a rare anatomical anomaly of the bile duct and forms a biliary circuit. It is difficult to identify during laparoscopic cholecystectomy (LC) without the use of intraoperative cholangiography (IOC). A modified IOC, in which tube insertion was performed through the infundibulum of the gallbladder, was evaluated dynamically. This procedure allowed us to accurately identify and verify the presence of CABD, a biliary circuit, and the short cystic duct. The short cystic duct could be separated safely without damaging the biliary circuit. Modified and dynamic IOC is recommended for identifying and verifying the presence of CABD during LC.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Ryo Yamada
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Mitsuteru Yoshida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Akira Marui
- Department of Surgery, Japanese Red Cross Kochi Hospital, Hadaminamimachi, Kochi, Japan
| | - Niranjan Sharma
- Adv Train Gastroint & Organ Transp Surgery, Dunedin, New Zealand
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Namikawa T, Marui A, Yokota K, Kawanishi Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Incidence, clinicopathological characteristics, and therapeutic strategy for gastric cancer patients with metastasis to the central nervous system. Asia Pac J Clin Oncol 2023; 19:e195-e201. [PMID: 35791882 DOI: 10.1111/ajco.13812] [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: 11/17/2021] [Revised: 06/07/2022] [Accepted: 06/18/2022] [Indexed: 11/30/2022]
Abstract
AIM This study aimed to analyze the clinicopathologic features and treatment outcomes of central nervous system (CNS) metastasis from gastric cancer. METHODS A total of 419 patients diagnosed with unresectable advanced or recurrent gastric cancer at Kochi Medical School between January 2007 and December 2021 were evaluated. Data of patients were reviewed, and clinicopathological information and survival outcomes of those with CNS metastases were compared to patients without CNS metastases. RESULTS In total, 12/419 (2.9%) patients (median age: 66.5 years [range, 41-82 years]) were diagnosed with CNS metastasis from gastric cancer. Eleven had diffuse-type gastric cancer which was significantly more common than in those without CNS metastasis (91% vs. 61%, p = .034). Human epidermal growth factor receptor 2 status was positive in one of the 12 patients. The median survival time was significantly lower for patients with CNS metastasis than for those without CNS metastasis (1.8 months vs. 11.4 months, p < .001). The median survival time for patients who underwent surgical resection, radiation, or chemotherapy for CNS metastasis was significantly higher than those who received only best supportive care (3.5 months vs. .6 months; p = .007). CONCLUSIONS CNS metastasis was found in 2.9% (12/419) of patients with unresectable advanced or recurrent gastric cancer. Diffuse-type histology was a risk factor for CNS metastasis. Multidisciplinary treatment, including surgical resection, radiation treatment, or chemotherapy, for CNS metastasis from gastric cancer may benefit selected patients.
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Affiliation(s)
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Hiromichi Maeda
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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Uemura S, Yamai H, Onishi K, Chikamori F, Yoshida M, Hokimoto N, Matsuoka H, Iwabu J, Ueta K, Yamada R, Mizobuchi K, Marui A, Tanida N. Robot-assisted total remnant gastrectomy for interposed jejunal pouch dysfunction 25 years after proximal gastrectomy for gastric cancer: A case report. Asian J Endosc Surg 2023. [PMID: 37221705 DOI: 10.1111/ases.13207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023]
Abstract
Proximal gastrectomy (PG) in combination with jejunal pouch interposition is a technique aimed at improving the postoperative dietary outcomes; however, some cases are reported to require surgical intervention owing to difficulty of food intake caused by pouch dysfunction. Herein, we present a case of robot-assisted surgery for interposed jejunal pouch (IJP) dysfunction in a 79-year-old male, occurring 25 years after the initial PG for gastric cancer. The patient had chronic anorexia for 2 years and was treated with medications and dietary guidance; however, 3 months prior to admission his quality of life had reduced, owing to worsening symptoms. The patient was diagnosed with pouch dysfunction due to extremely dilated IJP identified using computed tomography and underwent robot-assisted total remnant gastrectomy (RATRG) with IJP resection. After an uneventful course of intraoperative and postoperative treatment, he was discharged with sufficient food intake on postoperative day 9. RATRG can, thus, be considered in patients with IJP dysfunction after PG.
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Affiliation(s)
- Sunao Uemura
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Mitsuteru Yoshida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Ryo Yamada
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Akira Marui
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, Kochi, Japan
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5
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Tanioka N, Maeda H, Uemura S, Munekage M, Kitagawa H, Namikawa T, Kuroiwa H, Fujimoto S, Seo S, Hanazaki K. What is the optimal range of glycemic control for non-diabetic patients undergoing gastroenterological surgery? A single-center randomized controlled trial using an artificial pancreas. Artif Organs 2023. [PMID: 37084125 DOI: 10.1111/aor.14547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 03/26/2023] [Accepted: 04/10/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND This study aimed to determine the optimal target range of perioperative glycemic control for gastroenterological surgery. A closed-loop-type artificial pancreas (AP) was used to diminish the negative impact of hypoglycemia and glycemic variability during tight glycemic control. METHODS In this single-center randomized trial, non-diabetic patients were assigned to tight (80-110 mg/dL) or moderate glycemic control (110-140 mg/dL) groups between August 2017 and May 2021. AP was used from the intraoperative period until discharge from the intensive care unit. The primary endpoint was the serum interleukin (IL)-6 level on the third postoperative day (3POD), and the secondary endpoints included clinical outcomes. RESULTS Recruitment was closed before reaching the planned number of patients due to slow enrollment. Tight glycemic control (n = 62) resulted in lower mean glucose levels than moderate glycemic control (n = 66) (121.3 ± 10.8 mg/dL vs. 133.5 ± 12.0 mg/dL, p < 0.001). Insulin was administered at a 65% higher rate for tight glycemic control, achieving appropriate glucose control more than 70% of the treatment time. No hypoglycemia occurred during the AP treatment. No significant difference was observed in serum IL-6 levels on 3POD (23.4 ± 31.1 vs. 32.1 ± 131.0 pg/mL, p = 0.64), morbidity rate, surgical mortality rate, or length of hospital stay between the two groups. CONCLUSIONS Clinically relevant short-term results did not differ, implying that 80-110 and 110-140 mg/dL are permissible glycemic control ranges when using AP in non-diabetic patients undergoing gastroenterological surgery. (Registered in UMIN; UMIN000028036).
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Sunao Uemura
- Department of Gastrointestinal Surgery, Kochi Red Cross Hospital, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Hajime Kuroiwa
- Integrated Center for Advanced Medical Technologies (ICAM-Tech), Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Shimpei Fujimoto
- Department of Endocrinology, Metabolism and Nephrology, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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Atagi K, Karashima T, Mizutani K, Fukuhara H, Fukata S, Miura Y, Mitsuishi A, Hanazaki K, Uemura S, Miyazaki R, Anayama T, Yamane M, Sakai M, Iguchi M, Yorita K, Inoue K. Primary adrenal Ewing's sarcoma family of tumors with tumor thrombus of the inferior vena cava: a case report. J Med Case Rep 2023; 17:108. [PMID: 36959631 PMCID: PMC10037830 DOI: 10.1186/s13256-023-03837-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Accepted: 02/22/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Ewing's sarcoma is a malignant neoplasm that mainly occurs in skeletal tissue but can rarely arise in soft tissues. Recently, small round cell tumors (including Ewing's sarcoma) caused by chromosomal translocations have been collectively termed Ewing's sarcoma family of tumors. We report a rare case of primary adrenal Ewing's sarcoma family of tumors with tumor thrombus. CASE PRESENTATION A 22-year-old Asian woman was referred to our hospital with a left retroperitoneal tumor 19 cm in diameter. Tumor thrombus was identified from the left adrenal vein to the inferior vena cava, infiltrating the right atrium. Total tumor excision with left adrenalectomy, nephrectomy, and thrombectomy was performed under hypothermic circulatory arrest, followed by seven courses of adjuvant chemotherapy. The patient has shown no signs of recurrence as of 26 months postoperatively. CONCLUSION Radical surgery combined with systemic chemotherapy may contribute to good prognosis in patients with primary adrenal Ewing's sarcoma family of tumors.
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Affiliation(s)
- Kaya Atagi
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan.
- Department of Urology, Kochi Medical School, Kochi University, Kohasu, Oko, Nankoku, Kochi, 783-8505, Japan.
| | - Keisuke Mizutani
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Hideo Fukuhara
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Satoshi Fukata
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Yujiro Miura
- Department of Cardiovascular Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Atsuyuki Mitsuishi
- Department of Cardiovascular Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Digestive Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Sunao Uemura
- Department of Digestive Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Ryohei Miyazaki
- Department of Respirator Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Takashi Anayama
- Department of Respirator Surgery, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mayuka Yamane
- Department of Respiratory Medicine, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mizu Sakai
- Department of Respiratory Medicine, Kochi Medical School, Nankoku, 783-8505, Japan
| | - Mitsuko Iguchi
- Laboratory of Diagnostic Pathology, Kochi Medical School Hospital, Nankoku, 783-8505, Japan
| | - Kenji Yorita
- Department of Diagnostic Pathology, Japanese Red Cross Kochi Hospital, Kochi, 780-8562, Japan
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Nankoku, 783-8505, Japan
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Chikamori F, Yamada R, Ueta K, Onishi K, Yoshida M, Tanida N, Yamai H, Matsuoka H, Hokimoto N, Uemura S, Iwabu J, Mizobuchi K, Marui A, Sharma N. Navigation by modified and dynamic intraoperative cholangiography during laparoscopic subtotal cholecystectomy for difficult gallbladder. Radiol Case Rep 2023; 18:1585-1591. [PMID: 36845284 PMCID: PMC9947179 DOI: 10.1016/j.radcr.2023.01.026] [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: 12/31/2022] [Revised: 01/05/2023] [Accepted: 01/07/2023] [Indexed: 02/13/2023] Open
Abstract
We used modified and dynamic intraoperative cholangiography (IOC) navigation during laparoscopic subtotal cholecystectomy for difficult gallbladders. We have defined an IOC that does not open the cystic duct as a modified IOC. Modified IOC methods include the percutaneous transhepatic gallbladder drainage (PTGBD) tube method, the infundibulum puncture method, and the infundibulum cannulation method. Case 1 was chronic cholecystitis after PTGBD for acute cholecystitis with pericholecystic abscess. In this case, modified IOC was performed via PTGBD, and biliary anatomy and incarcerated stone were confirmed. Case 2 was chronic cholecystitis after endoscopic sphincterotomy for cholecystocholedocholithiasis. In this case, modified IOC was performed via gallbladder puncture needle, and biliary anatomy and incision line were confirmed. The target point on the laparoscopic image was determined by moving the tip of the grasping forceps under modified IOC, which we call modified and dynamic IOC. We conclude that the navigation by the modified and dynamic IOC via PTGBD tube or puncture needle is useful to identify biliary anatomy, incarcerated gallbladder stone, and safe incision line during laparoscopic subtotal cholecystectomy .
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan,Corresponding author.
| | - Ryo Yamada
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Koji Ueta
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Kazuhisa Onishi
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Mitsuteru Yoshida
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Hiromichi Yamai
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Norihiro Hokimoto
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Sunao Uemura
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Jun Iwabu
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Akira Marui
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Niranjan Sharma
- Adv Train Gastroint & Organ Transp Surgery, 12 Scotland St, Dunedin, 9016, New Zealand
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8
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Chikamori F, Mizobuchi K, Hamada R, Ito S, Uemura S, Yamada R, Matsuoka H, Tanida N, Sharma N. Emergency transileocolic vein obliteration for life-threatening bleeding from gastric varices. Radiol Case Rep 2023; 18:1570-1575. [PMID: 36824993 PMCID: PMC9941876 DOI: 10.1016/j.radcr.2023.01.045] [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: 12/31/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 02/12/2023] Open
Abstract
We report a case of life-threatening bleeding from gastric varices in a patient with alcoholic cirrhosis, which was treated by emergency transileocolic vein obliteration (TIO). A 46-year-old male with a massive hematemesis was transported to our hospital by ambulance. Contrast-enhanced computed tomography demonstrated large gastric varices. Temporary hemostasis using balloon tamponade was attempted, however, bleeding could not be controlled, and his vital signs were unstable despite massive blood transfusions. First, endoscopic treatment was attempted, but the visual field could not be secured due to massive bleeding. Therefore, emergency TIO under general anesthesia was attempted. After laparotomy, 5 Fr. sheath was inserted into the ileocolic vein. Posterior and left gastric veins, which were the blood supply routes of gastric varices, were identified and embolized using microcoils and a 50% glucose solution. Hemostasis was achieved and vital signs recovered. Three days after TIO, transjugular retrograde obliteration was attempted successfully to embolize the residual gastric varices. After the procedures, his condition improved. We conclude that emergency TIO is a useful rescue option for life-threatening bleeding from gastric varices if endoscopic treatment or balloon tamponade is ineffective.
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Affiliation(s)
- Fumio Chikamori
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan,Corresponding author.
| | - Kai Mizobuchi
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Ryo Hamada
- Department of Radiology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Satoshi Ito
- Department of Radiology, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Sunao Uemura
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Ryo Yamada
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Hisashi Matsuoka
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Nobuyuki Tanida
- Department of Surgery, Japanese Red Cross Kochi Hospital, 1-4-63-11 Hadaminamimachi, Kochi, 780-8562 Japan
| | - Niranjan Sharma
- Adv Train Gastroint & Organ Transp Surgery, 12 Scotland St., Dunedin, 9016, New Zealand
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9
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Namikawa T, Utsunomiya M, Yokota K, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K, Seo S. Staple Line Reinforcement for Intracorporeal Anastomosis Reduces Time for Reconstruction During Laparoscopic Gastrectomy for Gastric Cancer. Anticancer Res 2023; 43:175-181. [PMID: 36585189 DOI: 10.21873/anticanres.16147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/09/2022] [Accepted: 11/14/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND/AIM Despite the widespread use of laparoscopic surgery, intracorporeal anastomosis remains a complicated procedure that often prolongs the operation time. This study aimed to investigate the efficacy of a novel staple line reinforcement (SLR) during laparoscopic gastrectomy for gastric cancer. PATIENTS AND METHODS The study included 30 patients who underwent laparoscopic gastrectomy for gastric cancer at the Kochi Medical School between November 2021 and May 2022. A review of these patients was conducted, and perioperative outcomes were compared according to the use of SLR. RESULTS The reconstruction time using SLR was significantly shorter compared to when SLR was not used (20.5 min vs. 32.0 min, p=0.048). The incidence of hemostasis during anastomosis was significantly lower in the SLR group than in the non-SLR group (0 vs. 3 times, p=0.041). There were no significant differences in the operating time and estimated blood loss after surgery between the two groups. Furthermore, there were no significant differences in postoperative complications or nutritional status between the two groups. CONCLUSION The usefulness of SLR in reducing the time for intracorporeal reconstruction and archiving the best interaction between device and tissue during laparoscopic gastrectomy for gastric cancer, was herein demonstrated.
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Affiliation(s)
| | | | | | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi, Japan
| | - Satoru Seo
- Department of Surgery, Kochi Medical School, Kochi, Japan
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10
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Namikawa T, Utsunomiya M, Yokota K, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Association between Serum Zinc Levels and Clinicopathological Characteristics in Patients with Gastric Cancer. Gastrointest Tumors 2023; 10:6-13. [PMID: 37035095 PMCID: PMC10080202 DOI: 10.1159/000529707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/09/2023] [Indexed: 04/11/2023] Open
Abstract
Introduction Although it was reported that serum zinc levels were lower in patients with various malignancies, serum zinc levels of patients with gastric cancer were not well documented. Objectives This study aimed to evaluate the association between clinicopathologic features and serum zinc levels in preoperative patients with gastric cancer. Methods The study enrolled 83 patients scheduled for gastric cancer surgery at the Kochi Medical School. Clinical data were obtained to investigate associations between clinicopathological features, including nutritional indicators and serum zinc levels. Serum zinc deficiency was defined as serum zinc level <80 μg/dL. Results The median zinc level of the 83 patients was 73 μg/dL (range, 20-152 μg/dL), and serum zinc deficiency was present in 66.3% of patients. Albumin was significantly lower in the zinc low level group than in the normal group (3.9 g/dL vs. 4.4 g/dL, p < 0.001), and the median serum zinc level was significantly lower in the albumin <4.1 g/dL group than in the albumin ≥4.1 g/dL group (69 μg/dL vs. 82 μg/dL, p < 0.001). Lymphocyte count was significantly lower in the zinc low level group than in the normal group (1,500 vs. 1810 years, p = 0.041). The median serum zinc level was significantly lower in the age ≥74 group than in the age <74 (71 μg/dL vs. 76 μg/dL, p = 0.002). Serum zinc levels showed a significant positive correlation with serum albumin (r = 0.637, p = 0.009). Conclusion Serum zinc deficiency was found in 66.3% of preoperative patients with gastric cancer, which was highly correlated with serum albumin.
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Affiliation(s)
| | | | | | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School, Kochi, Japan
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11
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Namikawa T, Yokota K, Munekage M, Uemura S, Maeda H, Kitagawa H, Tamura T, Karashima T, Inoue K, Kobayashi M, Hanazaki K. Ureteral rupture with retroperitoneal urinoma caused by peritoneal metastases of gastric cancer. Int Cancer Conf J 2023; 12:53-58. [PMID: 36605840 PMCID: PMC9807697 DOI: 10.1007/s13691-022-00578-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/23/2022] [Indexed: 01/09/2023] Open
Abstract
We describe the rare case of a patient with ureteric rupture during systemic drug treatment for peritoneal metastases of gastric cancer, who underwent double-J stent placement. A 66-year-old man with gastric cancer was referred to the authors' hospital. Esophagogastroduodenoscopy showed an irregular elevated lesion with thickened gastric folds, and biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography (CT) revealed extensive wall thickening with homogeneous enhancement of the stomach, enlarged lymph nodes in the perigastric area, and nodules in the peritoneal cavity, suggesting peritoneal metastases. The clinical diagnosis was cT4N2M1 with peritoneal metastases, and the patient received chemotherapy (S-1 plus oxaliplatin). After six courses of chemotherapy, the patient presented to the emergency outpatient department with a complaint of acute severe pain in the left lower back. Emergency abdominal contrast-enhanced CT showed extravasation of the contrast medium from the left upper ureter in the periureter area along with the retroperitoneum, and there was no mass lesion or stone in the kidney, ureter, or bladder. A double-J stent was placed under cystoscopic guidance, and no resistance was felt when the stent was inserted. The patient's postprocedural course was uneventful, and he received ramucirumab in combination with paclitaxel after double-J stent placement. However, 2 months later, systemic drug treatment was discontinued because of loss of appetite and increased general fatigue and changed to the best supportive care. His general condition gradually deteriorated, and he died 3 months after the ureteral rupture. Prompt interventions, including retrograde placement of ureteral stents with concurrent use of antibiotics, will reduce mortality and morbidity in this rare entity.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi 783-8505 Japan
| | - Takahiko Tamura
- Department of Anesthesiology, Hata Prefectural Hospital, Kochi, Japan
| | | | - Keiji Inoue
- Department of Urology, Kochi Medical School Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi Japan
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12
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Uemura S, Namikawa T, Uchida K, Hanazaki K. Gastrointestinal: Giant gallbladder. J Gastroenterol Hepatol 2022; 37:2206. [PMID: 35535652 DOI: 10.1111/jgh.15858] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 04/04/2022] [Indexed: 12/16/2022]
Affiliation(s)
- S Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - T Namikawa
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - K Uchida
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
| | - K Hanazaki
- Department of Surgery, Kochi Medical School, Kochi, Japan
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13
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Namikawa T, Marui A, Yokota K, Kawanishi Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Nagata Y, Kobayashi M, Hanazaki K. [Brain Metastasis Arising from Gastric Cancer during Long-Term Treatment Using Nivolumab]. Gan To Kagaku Ryoho 2022; 49:1544-1546. [PMID: 36733129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Metastasis to the central nervous system from gastric cancer is exceedingly uncommon. We report a gastric cancer patient with cerebral metastasis during the period when durable response was obtained by systemic drug treatment using nivolumab. A 78-year-old male was referred to our hospital for further examination following diagnosis of gastric cancer by a local medical doctor. Esophagogastroduodenoscopy showed a slightly elevated lesion with central depressed area in the upper-third of the stomach, and analysis of biopsy specimens revealed an adenocarcinoma. The patient underwent laparoscopic total gastrectomy with lymph nodes dissection followed by Roux-en-Y reconstruction, resulting in submucosal invasive carcinoma and no lymph node metastasis. The patient developed solitary splenic metastasis measuring 4.2 cm after 28 months later, and the patient underwent a splenectomy, since there was no evidence of further metastatic lesions in any other organs. Subsequently, the patient was received S-1 plus oxaliplatin chemotherapy based on negative immunohistochemical staining of the resected specimens for human epidermal growth factor receptor 2. Four months after the splenectomy, the patient developed multiple liver metastases and was treated with ramucirumab plus paclitaxel. Because of disease progression, the patient was administered 3 mg/kg, iv, nivolumab every 2 weeks. After 4 courses of systemic treatment using nivolumab, abdominal computed tomography revealed marked shrinkage of the liver metastases. After 12 courses of nivolumab, the liver metastases had disappeared completely. The patient developed hypothyroidism, which could be controlled by thyroid hormone replacement treatment. The patient continues to receive nivolumab, and there is no evidence of disease recurrence in the 33 month period since starting nivolumab. However, he developed cerebral metastases after 69 months after surgery, complaining of articulation disorder. The patient underwent tumor resection by craniotomy followed by radiation therapy; however, he died 3 months after the operation. Although brain metastasis arising from gastric cancer is rare, future identification of risk factors and development of novel treatments are desired by further investigations and accumulation of these cases.
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14
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Uemura S, Maeda H, Fujisawa K, Uchida K, Hanazaki K. Gastrointestinal: Abdominal eggshell sign in a young woman with a pancreatic solid pseudopapillary neoplasm. J Gastroenterol Hepatol 2022; 38:682. [PMID: 36217777 DOI: 10.1111/jgh.16016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 12/09/2022]
Affiliation(s)
- S Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - H Maeda
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - K Fujisawa
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - K Uchida
- Department of Gastroenterology and Hepatology, Kochi Medical School, Kochi, Japan
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15
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Namikawa T, Utsunomiya M, Yokota K, Kawanishi Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Laparoscopic total gastrectomy for concurrent gastric cancer and complete agenesis of the dorsal pancreas. Asian J Endosc Surg 2022; 16:266-270. [PMID: 36148900 DOI: 10.1111/ases.13129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 09/08/2022] [Accepted: 09/10/2022] [Indexed: 11/27/2022]
Abstract
We present an unusual case of laparoscopic total gastrectomy with lymph node dissection in a 56-year-old woman with gastric cancer and agenesis of the dorsal pancreas (ADP). Esophagogastroduodenoscopy revealed erosive lesions with thickened gastric folds; biopsy specimens revealed a poorly differentiated adenocarcinoma. Abdominal contrast-enhanced computed tomography showed a thickened wall of the gastric body; the distal pancreas was not visualized. Under the clinical diagnosis of gastric cancer with ADP, the patient underwent laparoscopic total gastrectomy with standard lymphadenectomy. The absence of a pancreatic neck, body, and tail was confirmed; lymph nodes along the splenic artery were dissected. Pathological analysis demonstrated a poorly differentiated adenocarcinoma invading the serosa, with five lymph node metastases. The postoperative course was unremarkable; postoperative adjuvant chemotherapy was performed using S-1 plus oxaliplatin. No symptom recurrence was observed at the 6-month follow-up. Laparoscopic surgery, with careful preoperative anatomic evaluation, can be considered for concurrent gastric cancer and ADP.
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Affiliation(s)
| | | | | | | | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Integrated Center for Advanced Medical Technologies, Kochi Medical School Hospital, Nankoku, Kochi, Japan
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16
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Uemura S, Maeda H, Tanioka N, Yamaguchi S, Munekage M, Kitagawa H, Namikawa T, Yamamoto S, Kohsaki T, Iguchi M, Uchida K, Hanazaki K. Successful conversion surgery after FOLFIRINOX therapy in a patient with advanced pancreatic acinar cell carcinoma with a solitary peritoneal dissemination: A case report. Cancer Rep (Hoboken) 2022; 5:e1648. [PMID: 35668046 PMCID: PMC9458499 DOI: 10.1002/cnr2.1648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/02/2022] [Accepted: 05/26/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Pancreatic acinar cell carcinoma is rare; it accounts for 1% of all malignant pancreatic exocrine tumors. Although surgical resection is an option for curative treatment, the safety and efficacy of conversion surgery in patients with pancreatic acinar cell carcinoma with metastasis remain unknown. CASE A 67-year-old man with epigastric pain and a pancreatic tumor was referred to our hospital. Computed tomography revealed a large tumor with a maximum diameter of 67 mm at the pancreatic head and a 23-mm mass in the left upper abdominal cavity. Because a definitive diagnosis could not be made based on endoscopic ultrasonography-guided fine needle aspiration biopsy findings, a diagnostic laparoscopy was performed. The tumor in the greater omentum at the left upper abdomen, resected under laparoscopy, was histopathologically diagnosed as pancreatic acinar cell carcinoma. Therefore, the pancreatic tumor was diagnosed as an unresectable pancreatic acinar cell carcinoma with a solitary peritoneal dissemination. The size of the main pancreatic tumor decreased to 15 mm after 18 courses of FOLFIRINOX (5-fluorouracil, leucovorin, irinotecan, and oxaliplatin). Subsequently, the patient underwent conversion surgery, and the initial diagnosis of pancreatic acinar cell carcinoma was confirmed on pathological examination. The patient was discharged 31 days postoperatively, following which he received adjuvant chemotherapy with S-1. No sign of recurrence has been observed for 32 months after surgical resection. CONCLUSION FOLFIRINOX may be effective in patients with pancreatic acinar cell carcinoma, and conversion surgery after FOLFIRINOX may be applicable to selective patients.
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Affiliation(s)
- Sunao Uemura
- Department of SurgeryKochi Medical SchoolNankokuJapan
| | | | | | | | | | | | | | - Shota Yamamoto
- Department of Gastroenterology and HepatologyKochi Medical SchoolNankokuJapan
| | | | | | - Kazushige Uchida
- Department of Gastroenterology and HepatologyKochi Medical SchoolNankokuJapan
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17
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Uemura S, Endo H, Ichihara N, Miyata H, Maeda H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Yasuyuki S, Yamaue H, Yamamoto M, Kitagawa Y, Hanazaki K. Day of surgery and mortality after pancreatoduodenectomy: A retrospective analysis of 29 270 surgical cases of pancreatic head cancer from Japan. J Hepatobiliary Pancreat Sci 2022; 29:778-784. [PMID: 34496150 DOI: 10.1002/jhbp.1043] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND/PURPOSE The day of the week can impact medical treatment outcomes; however, few large-scale, disease-specific studies have focused on the association between the day of the week and mortality in patients after pancreatoduodenectomy for pancreatic head cancer. METHODS Data were obtained from the National Clinical Database. Twenty-two clinical variables were adopted for hierarchal logistic regression modeling to determine adjusted odds ratios (ORs) for surgical mortality after elective pancreatoduodenectomy. RESULTS The 30-day mortality and surgical mortality rates were 1.0% and 1.7%, respectively (n = 29 720). Surgeries were performed the least on Fridays (13.4%) compared with other weekdays. Crude rates of severe postoperative complications (mean, 14.1%; range, 13.5%-14.8%) and pancreatic fistulas (mean, 10.0%; range, 9.6%-10.3%) remained stable throughout the week. Unadjusted/adjusted ORs did not significantly differ between Friday and Monday (0.868, 95% CI: 0.636-1.173, P = .365, and 0.928, 95% CI: 0.668-1.287, P = .653, respectively), and results were similar for the remaining weekdays. Nineteen independent factors were associated with surgical mortality. CONCLUSIONS The rate of perioperative mortality for elective pancreatoduodenectomy is low in Japan, with no evidence of disparities in surgical mortality rates between weekdays.
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Affiliation(s)
- Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Hideki Endo
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Nao Ichihara
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | | | - Hiroshi Hasegawa
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kinji Kamiya
- Project Management Subcommittee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Yoshihiro Kakeji
- Database Committee, The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
| | - Kazuhiro Yoshida
- Department of Surgical Oncology, Graduate School of Medicine, Gifu University, Gifu, Japan
| | - Seto Yasuyuki
- Department of Gastrointestinal Surgery, Graduate School of Medicine, The University of Tokyo, Bunkyo-ku, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, School of Medicine, Wakayama Medical University, Wakayama, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Shinjuku-ku, Japan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological Surgery, Tokyo, Japan
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18
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Uemura S, Maeda H, Hanazaki K. Unexpected gastrointestinal bleeding from the ileocolic artery penetrating the duodenum after hilar cholangiocarcinoma surgery. Clin Case Rep 2022; 10:e05764. [PMID: 35449771 PMCID: PMC9014701 DOI: 10.1002/ccr3.5764] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 03/23/2022] [Accepted: 04/04/2022] [Indexed: 01/19/2023] Open
Abstract
Cases of bleeding from the ileocolic artery penetrating the duodenum are uncommon, as bleeding from the colonic diverticulum usually spontaneously stops. Herein, this case depicts sudden gastrointestinal bleeding in a patient whose only relevant history was hepaticojejunostomy for hilar cholangiocarcinoma and a previous abdominal surgery for a traffic accident.
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Affiliation(s)
- Sunao Uemura
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | - Hiromichi Maeda
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
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19
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Tanioka N, Maeda H, Shimizu S, Munekage M, Uemura S, Hanazaki K. Indocyanine green fluorescence-guided laparoscopic deroofing of a liver cyst: A case report. Asian J Endosc Surg 2022; 15:359-362. [PMID: 34643051 DOI: 10.1111/ases.12999] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 08/15/2021] [Accepted: 09/27/2021] [Indexed: 12/23/2022]
Abstract
In performing laparoscopic deroofing (LD) of liver cysts, indocyanine green (ICG) fluorescent imaging is particularly useful for delineating adequate margins for the procedure and for avoiding duct injuries. However, the optimal timing of ICG injection has not yet been clarified. Herein, we describe a patient who had a large liver cyst, in whom safe and efficient LD was performed under sharp fluorescent imaging obtained by intravenous injection of ICG 1 hour before cyst fenestration.
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Affiliation(s)
- Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School Hospital, Kochi University, Nankoku, Japan
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20
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Namikawa T, Shimizu S, Maeda M, Yokota K, Tanioka N, Munekage M, Uemura S, Maeda H, Kitagawa H, Kumon T, Kumon M, Kobayashi M, Hanazaki K. [Curative Resection for Advanced Gastric Cancer with Lymph Node Metastasis along the Middle Colic Artery]. Gan To Kagaku Ryoho 2022; 48:1564-1566. [PMID: 35046257 DOI: pmid/35046257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Mesenteric lymph node metastasis of gastric cancer is extremely rare. We report the case of a patient with advanced gastric cancer having lymph node metastasis in the transverse mesocolon who underwent gastrectomy with lymph node dissection followed by chemotherapy. A 74-year-old male complaining of tarry stool was referred to our hospital for further examination following a diagnosis of gastric cancer by a local medical doctor. Esophagogastroduodenoscopy revealed an irregular and ulcerated lesion in the lower third of the stomach, and analyses of biopsy specimens revealed adenocarcinoma. Abdominal computed tomography revealed abdominal wall thickening in the lower third of the stomach, with enlarged lymph nodes in the perigastric area and the left side area of the middle colic artery. With a clinical diagnosis of gastric cancer, the patient underwent distal gastrectomy with lymph node dissection followed by Billroth Ⅰ reconstruction. During surgery, the enlarged lymph node along with the middle colic artery in the transverse mesocolon was dissected. The gross appearance of the resected specimen shows a large and ulcerated tumor measuring 6.0×5.5 cm in the lesser curvature side of the lower third of the stomach. The pathological examination of the resected specimen showed solid-type poorly-differentiated adenocarcinoma with lymph nodes metastases, which was detected in the perigastric area and transverse mesocolon. The final diagnosis according to the Japanese classification of gastric carcinoma by the Japanese Gastric Cancer Association was L, Less-Post-Ant, Type 2, 6.0×5.5 cm, T3(SS), N2(5/19), M1(LYM), P0, H0, CY0, por1, Ly0, V1a, Stage Ⅳ, R0. Subsequently, the patient received S-1 plus oxaliplatin chemotherapy; however, he developed para-aortic lymph node metastases 18 months after surgery. Therefore, the patient was treated with ramucirumab plus nab-paclitaxel and was alive 20 months after the operation. Although mesocolonic lymph node metastasis of gastric cancer is rare, future identification of risk factors and the development of novel treatments should be achieved through further investigations and the accumulation of 3 cases.
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21
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Mukaiyama K, Irie K, Takeda M, Yamashita R, Uemura S, Kanazawa S, Nagai-Tanima M, Aoyama T. Load distribution and forearm muscle activity during cylinder grip at various grip strength values. Hand Surgery and Rehabilitation 2022; 41:176-182. [DOI: 10.1016/j.hansur.2021.12.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 12/20/2021] [Accepted: 12/31/2021] [Indexed: 10/19/2022]
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22
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Namikawa T, Marui A, Yokota K, Yamaguchi S, Fukudome I, Uemura S, Munekage M, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Gastric Eosinophilic Granuloma Related to Anisakiasis Resected by Laparoscopic and Endoscopic Cooperative Surgery. Cancer Diagn Progn 2021; 1:507-512. [PMID: 35403157 PMCID: PMC8962874 DOI: 10.21873/cdp.10068] [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] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 09/15/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Anisakiasis-related gastric eosinophilic granuloma is rare. CASE REPORT Herein, we report a patient with anisakiasis-related gastric eosinophilic granuloma who was treated with laparoscopic and endoscopic cooperative surgery (LECS). A 59-year-old woman was presented to our hospital for further examination of a gastric lesion that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed a submucosal tumor-like lesion in the lower body of the stomach. Endoscopic ultrasonography showed a heterogeneous hypoechoic submucosal mass lesion in the submucosal layer measuring 10 mm, without evidence of deep involvement. Under a clinical diagnosis of gastrointestinal stromal tumor, the patient underwent LECS. Gross appearance of the resected specimen revealed a 1.5×1.0 cm submucosal tumor-like lesion. Microscopic examination revealed necrosed insects consistent with the characteristics of gastric anisakiasis, around which prominent eosinophilic infiltration and granulomas were observed. This prompted a diagnosis of gastric eosinophilic granuloma related to anisakiasis. CONCLUSION To the best of our knowledge, this is the second case of gastric eosinophilic granuloma related to anisakiasis resected by LECS in the English medical literature. LECS might be a useful procedure for minimally invasive therapeutic diagnosis.
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Affiliation(s)
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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23
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Neutrophil-to-lymphocyte ratio and C-reactive protein-to-albumin ratio as prognostic factors for unresectable advanced or recurrent gastric cancer. Langenbecks Arch Surg 2021; 407:609-621. [PMID: 34652563 DOI: 10.1007/s00423-021-02356-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 10/11/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE This study evaluated the prognostic value of C-reactive protein-to-albumin (CAR) and neutrophil-to-lymphocyte ratios (NLR) in conjunction with host-related factors in patients with unresectable advanced or recurrent gastric cancer. METHODS A total of 411 patients with unresectable advanced gastric cancer were treated at Kochi Medical School between 2007 and 2019. Associations between clinicopathological parameters and systemic inflammatory and nutritional markers, including CAR and NLR, with overall survival were analyzed retrospectively. RESULTS The optimal cut-off values of predicted median survival time were 0.096 (sensitivity, 74.9%; specificity, 42.5%) for CAR and 3.47 (sensitivity, 64.1%; specificity, 57.5%) for NLR, based on the results of receiver operating characteristic analysis. A weak significant positive correlation was identified between CAR and NLR (r = 0.388, P < 0.001). The median survival time was significantly higher in patients with intestinal-type than those with diffuse-type histology (18.3 months vs. 9.5 months; P = 0.001), CAR < 0.096 than those with CAR ≥ 0.096 (14.8 months vs. 9.9 months; P < 0.029), and those with NLR < 3.47 than NLR ≥ 3.47 (14.7 months vs. 8.8 months; P < 0.001). Multivariate survival analysis revealed that diffuse-type histology (hazard ratio (HR) 1.865; 95% confidence interval (CI) 1.397-2.490; P < 0.001)), 1 or more performance status (HR 11.510; 95% CI 7.941-16.683; P < 0.001), and NLR ≥ 3.47 (HR 1.341; 95% CI 1.174-1.769; P = 0.023) were significantly associated with independent predictors of worse prognosis. CONCLUSIONS High CAR and NLR are associated with poor survival in patients with unresectable and recurrent gastric cancer.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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24
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Tsujii S, Serada S, Fujimoto M, Uemura S, Namikawa T, Nomura T, Murakami I, Hanazaki K, Naka T. Glypican-1 Is a Novel Target for Stroma and Tumor Cell Dual-Targeting Antibody-Drug Conjugates in Pancreatic Cancer. Mol Cancer Ther 2021; 20:2495-2505. [PMID: 34583978 DOI: 10.1158/1535-7163.mct-21-0335] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 07/21/2021] [Accepted: 09/20/2021] [Indexed: 02/05/2023]
Abstract
Pancreatic ductal adenocarcinoma (PDAC) is a stroma-rich cancer. Extracellular matrix proteins produced by cancer-associated fibroblasts (CAFs) found in tumor stroma that impedes effective delivery of chemotherapeutic agents results in poor response in patients with PDAC. Previously, our group reported that glypican-1 (GPC1) was overexpressed in human PDAC and negatively correlated with patient survival. Immunohistochemical analysis of 25 patients with PDAC tumor specimens revealed elevated expression of GPC1 in stromal cells and pancreatic cancer cells in 80% of patients. Interestingly, GPC1 was expressed on CAFs in PDAC. We generated a GPC1 antibody-drug conjugate conjugated with monomethyl auristatin E [GPC1-ADC(MMAE)] and evaluated its preclinical antitumor activity by targeting GPC1-positive CAF and cancer cells in PDAC. GPC1-ADC(MMAE) inhibited the growth of GPC1-positive PDAC cell lines in vitro. Furthermore, GPC1-ADC(MMAE) showed a potent antitumor effect in the PDAC patient-derived tumor xenograft (PDX) model against GPC1-positive CAF and heterogeneous GPC1-expressing cancer cells. Notably, GPC1-ADC(MMAE) showed robust preclinical efficacy against GPC1 in a stroma-positive/cancer-negative PDAC PDX model. GPC1-ADC(MMAE) was delivered and internalized to CAFs. Although apoptosis was not observed in CAFs, the released MMAE from CAFs via MDR-1 induced apoptosis of cancer cells neighboring CAFs and efficiently inhibited PDAC tumor growth. GPC1-ADC(MMAE) exhibited potent and unique antitumor activity in GPC1-positive PDAC PDX models, which suggests that GPC1 is a novel therapeutic target in PDAC and other stromal GPC1-positive solid tumors. These findings show that targeting GPC1 on CAF using GPC1-ADC(MMAE) is a useful approach in case of stroma-rich tumors such as PDAC.
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Affiliation(s)
- Shigehiro Tsujii
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.,Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Satoshi Serada
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan. .,Institute for Biomedical Sciences Molecular Pathophysiology, Iwate Medical University, Yahaba, Iwate, Japan
| | - Minoru Fujimoto
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan.,Division of Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Taisei Nomura
- Animal Models of Human Diseases, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka, Japan
| | - Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Tetsuji Naka
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan. .,Institute for Biomedical Sciences Molecular Pathophysiology, Iwate Medical University, Yahaba, Iwate, Japan.,Division of Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan
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25
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Namikawa T, Marui A, Yokota K, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Solitary port-site metastasis 42 months after laparoscopic distal gastrectomy for gastric cancer. Clin J Gastroenterol 2021; 14:1626-1631. [PMID: 34537922 DOI: 10.1007/s12328-021-01519-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 09/12/2021] [Indexed: 02/05/2023]
Abstract
We report a case of solitary port-site recurrence after laparoscopy-assisted distal gastrectomy for advanced gastric cancer. A 66-year-old man had previously undergone laparoscopy-assisted gastrectomy with regional lymph-node dissection for advanced gastric cancer, which was a poorly differentiated adenocarcinoma invading the subserosal layer with lymphatic infiltration and no lymph-node metastases. He experienced dull pain in the left upper quadrant of the abdomen 42 months after the surgery. On physical examination, erythematous induration of the skin around the scar of the port insertion was observed in the left upper quadrant of the abdomen. Abdominal ultrasonography and contrast-enhanced computed tomography revealed a subcutaneous lesion with a well-defined mass measuring 3.0 cm in diameter located in the left upper quadrant of the abdomen. A skin biopsy revealed a metastatic adenocarcinoma from gastric cancer. Since there was no evidence of further metastatic lesions in other organs, the patient underwent surgical resection of the metastatic tumor arising at the port site. The abdominal wall tumor was resected with a leaf-skin incision and an adequate safety margin, and the inferior border of the tumor reached the muscular layer, which was resected with the tumor. Pathological examination confirmed the diagnosis of a poorly differentiated adenocarcinoma in the subcutaneous tissue with invasion of the muscle layer at the port site. The postoperative course was uneventful; chemotherapy using oxaliplatin plus S-1 was administered, and the patient was in good health with no evidence of the disease for 3 months postoperatively. Although port-site metastasis after laparoscopic gastrectomy for gastric cancer is a rare recurrence form, we should be aware of this issue, and further studies and assessments of additional cases are needed to establish a treatment strategy.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Shiono Y, Matsuo H, Fujita H, Tanaka N, Ogasawara Y, Kawamura I, Katayama Y, Matsuo A, Kawase Y, Kakuta T, Takashima H, Yokoi H, Ohira H, Suwa S, Oguri M, Yamamoto F, Kubo T, Akasaka T, Shiono Y, Katayama Y, Hironori K, Kubo T, Akasaka T, Tanaka N, Yamashita J, Fujita H, Matsuo A, Matsuo H, Kawase Y, Kawamura I, Kakuta T, Hoshino M, Sugano T, Takashima H, Amano T, Yokoi H, Yamamoto Y, Nozaki Y, Machida M, Kobori M, Kikuchi T, Ohira H, Yoshino H, Ishiguro H, Wakabayashi Y, Kondo T, Terai H, Suwa T, Kimura T, Kawajiri T, Hirohata A, Uemura S, Neishi Y, Sakamoto T, Yamada M, Okeie K, Hishikari K, Oguri M, Uetani T, Saegusa T, Yamamoto F, Yamada M. Diagnostic Accuracy of Diastolic Fractional Flow Reserve for Functional Evaluation of Coronary Stenosis. JACC: Asia 2021; 1:230-241. [PMID: 36338166 PMCID: PMC9627917 DOI: 10.1016/j.jacasi.2021.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 07/08/2021] [Indexed: 01/10/2023]
Abstract
Background In the resting conditions, narrowing the window of coronary pressure measurements from the whole cardiac cycle to diastole improves diagnostic performance of coronary pressure–derived physiological index. However, whether this also applies to the hyperemic conditions has not yet been thoroughly evaluated. Objectives The purpose of this study was to assess whether diastolic fractional flow reserve (diastolic FFR) has better diagnostic performance in identifying ischemia-causing coronary lesions than conventional FFR in a prospective, multicenter, and independent core laboratory–based environment. Methods In this prospective multicenter registry at 29 Japanese centers, we compared the diagnostic performance of FFR, diastolic FFR, resting distal to aortic coronary pressure (Pd/Pa), and diastolic pressure ratio (dPR) using myocardial perfusion scintigraphy (MPS) as the reference standard in 378 patients with single-vessel coronary disease. Results Inducible myocardial ischemia was found on MPS in the relevant myocardial territory of the target vessel in 85 patients (22%). In the receiver-operating curve analyses, diastolic FFR had comparable area under the curve (AUC) compared with FFR (AUCdiastolic FFR: 0.66; 95% confidence interval [CI]: 0.58-0.73, vs AUCFFR: 0.66; 95% CI: 0.58-0.74, P = 0.624). FFR and diastolic FFR showed significantly larger AUCs than resting Pd/Pa (0.62; 95% CI: 0.54-0.70; P = 0.033 and P = 0.046) but did not show significantly larger AUCs than dPR (0.62; 95% CI: 0.55-0.70; P = 0.102 and P = 0.113). Conclusions Diastolic FFR showed a similar diagnostic performance to FFR as compared with MPS. This result reaffirms the use of FFR as the most accurate invasive physiological lesion assessment. (Diagnostic accuracy of diastolic fractional flow reserve (d-FFR) for functional evaluation of coronary stenosis; UMIN000015906)
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27
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Namikawa T, Marui A, Yokota K, Fujieda Y, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Successful Conversion Surgery for Advanced Gastric Cancer With Multiple Liver Metastases Following Ramucirumab Plus Paclitaxel Combination Treatment. In Vivo 2021; 35:2929-2935. [PMID: 34410989 PMCID: PMC8408704 DOI: 10.21873/invivo.12584] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/11/2021] [Accepted: 06/15/2021] [Indexed: 02/07/2023]
Abstract
AIM To present the case of a patient with unresectable gastric cancer showing a remarkable effect by second-line drug treatment with ramucirumab plus paclitaxel and conversion surgery. CASE REPORT A 68-year-old woman who was diagnosed with gastric cancer was referred to us. Esophagogastroduodenoscopy showed an ulcerated lesion with an irregular nodulated border in the lower third of the stomach, and histology of biopsied specimens indicated a poorly differentiated adenocarcinoma. Enhanced computed tomography revealed extensive invasion of the liver, and the patients was treated using S-1 plus oxaliplatin as first-line chemotherapy. Because she developed liver metastases, the treatment regimen was changed to ramucirumab plus paclitaxel as the second-line treatment. After four cycles of weekly paclitaxel with ramucirumab treatment, the liver metastases had completely disappeared. Because no other metastatic lesions in other organs were detected, we performed total gastrectomy with D2 lymphadenectomy. The macroscopic findings of the surgically resected specimen revealed an ulcerated lesion with an irregularly modulated lesion measuring 9.5×4.5 cm. Pathological analysis demonstrated a poorly differentiated adenocarcinoma in the stomach, with invasion to the liver through the serosal layer, and seven lymph node metastases. The postoperative course was unremarkable, and she received ramucirumab in combination with paclitaxel treatment. However, liver metastasis appeared at 4 months after the operation, for which she was treated with irinotecan. Although the patient continued to receive irinotecan chemotherapy for 10 months, her general condition gradually deteriorated, and she was started on best supportive care 13 months after conversion surgery. CONCLUSION Conversion surgery may prolong survival not only through first-line but also second-line treatments in selected patients with unresectable advanced gastric cancer; however, assessments of additional cases and further studies are required to establish this treatment strategy.
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Affiliation(s)
| | - Akira Marui
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Yuki Fujieda
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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28
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Munekage E, Serada S, Tsujii S, Yokota K, Kiuchi K, Tominaga K, Fujimoto M, Kanda M, Uemura S, Namikawa T, Nomura T, Murakami I, Hanazaki K, Naka T. A glypican-1-targeted antibody-drug conjugate exhibits potent tumor growth inhibition in glypican-1-positive pancreatic cancer and esophageal squamous cell carcinoma. Neoplasia 2021; 23:939-950. [PMID: 34332450 PMCID: PMC8340053 DOI: 10.1016/j.neo.2021.07.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 07/10/2021] [Accepted: 07/12/2021] [Indexed: 02/08/2023]
Abstract
An antibody-drug conjugate (ADC) is a promising therapeutic modality because selective and effective delivery of an anti-cancer drug is achieved by drug-conjugated antibody-targeting cancer antigen. Glypican 1 (GPC1) is highly expressed in malignant tumors, including pancreatic ductal adenocarcinoma (PDAC) and esophageal squamous cell carcinoma (ESCC). Herein, we describe the usefulness of GPC1-targeting ADC. Humanized anti-GPC1 antibody (clone T2) was developed and conjugated with monomethyl auristatin E (MMAE) via maleimidocaproyl-valine-citrulline-p-aminobenzyloxycarbonyl (mc-vc-PABC) linkers (humanized GPC1-ADC[MMAE]). Humanized GPC1-ADC(MMAE) inhibited the growth of GPC1-positive PDAC and ESCC cell lines via inducing cycle arrest in the G2/M phase and apoptosis in vitro. The binding activity of humanized GPC1-ADC(MMAE) with GPC1 was comparable with that of the unconjugated anti-GPC1 antibody. The humanized GPC1-ADC(MMAE) was effective in GPC1-positive BxPC-3 subcutaneously xenografted mice but not in GPC1-negative BxPC-3-GPC1-KO xenografted mice. To assess the bystander killing activity of the humanized GPC1-ADC(MMAE), a mixture of GPC1-positive BxPC-3 and GPC1-negative BxPC-3-GPC1-KO-Luc cells were subcutaneously inoculated, and a heterogenous GPC1-expressing tumor model was developed. The humanized GPC1-ADC(MMAE) inhibited the tumor growth and decreased the luciferase signal, measured with an in vivo imaging system (IVIS), which suggests that the suppression of the BxPC-3-GPC1-KO-Luc population. The humanized GPC1-ADC(MMAE) also inhibited the established liver metastases of BxPC-3 cells and significantly improved the overall survival of the mice. It exhibited a potent antitumor effect on the GPC1-positive PDAC and ESCC patient-derived xenograft (PDX) models. Our preclinical data demonstrate that GPC1 is a promising therapeutic target for ADC.
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Affiliation(s)
- Eri Munekage
- Department of Surgery, Kochi University, Nankoku, Kochi, Japan; Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Satoshi Serada
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan; Institute for Biomedical Sciences Molecular Pathophysiology, Iwate Medical University, Yahaba, Iwate, Japan.
| | - Shigehiro Tsujii
- Department of Surgery, Kochi University, Nankoku, Kochi, Japan; Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi University, Nankoku, Kochi, Japan; Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Keita Kiuchi
- Department of Medical course, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Kenji Tominaga
- Department of Medical course, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan
| | - Minoru Fujimoto
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan; Division of Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan
| | - Mizuki Kanda
- Institute for Biomedical Sciences Molecular Pathophysiology, Iwate Medical University, Yahaba, Iwate, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi University, Nankoku, Kochi, Japan
| | | | - Taisei Nomura
- Animal Models of Human Diseases, National Institute of Biomedical Innovation, Health and Nutrition, Ibaraki, Osaka, Japan
| | - Ichiro Murakami
- Department of Pathology, School of Medicine, Kochi University, Nankoku, Kochi, Japan
| | | | - Tetsuji Naka
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan; Institute for Biomedical Sciences Molecular Pathophysiology, Iwate Medical University, Yahaba, Iwate, Japan; Division of Allergy and Rheumatology, Department of Internal Medicine, Iwate Medical University School of Medicine, Yahaba, Iwate, Japan.
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Serum zinc deficiency in patients after gastrectomy for gastric cancer. Int J Clin Oncol 2021; 26:1864-1870. [PMID: 34191192 DOI: 10.1007/s10147-021-01978-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Accepted: 06/24/2021] [Indexed: 02/05/2023]
Abstract
PURPOSE Zinc is an essential dietary component for humans and the second most prevalent trace element; however, serum zinc levels after gastrectomy have not been fully elucidated. This study aimed to evaluate the correlation between clinicopathologic features and serum zinc levels in patients who underwent gastrectomy for gastric cancer. METHODS The study enrolled 617 patients who underwent gastrectomy for gastric cancer at the Kochi Medical School. Clinical data were obtained to investigate associations between clinicopathological features, including nutritional indicators and serum zinc levels. Serum zinc deficiency was defined as serum zinc level < 80 μg/dL. RESULTS The median zinc level of the 617 patients was 73 μg/dL (range, 31-144 μg/dL), and serum zinc deficiency was present in 68.6% of patients. Median age was significantly higher in the zinc low level group than in the normal group (69 vs. 66 years, P < 0.001). Albumin was significantly lower in the zinc low level group than in the normal group (3.9 vs. 4.2 g/dL, P < 0.001). C-reactive protein level was significantly higher in the zinc low level group than in the normal group (0.12 vs. 0.10 mg/dL, P = 0.014). The median serum zinc level was significantly lower in the patients who received chemotherapy after gastrectomy than in those who were not received chemotherapy (72 vs. 76 μg/dL, P < 0.001). Serum zinc levels showed a significant positive correlation with serum albumin (r = 0.505, P = 0.044). Multivariate analysis showed that serum albumin level was significantly associated with serum zinc level (β = 0.489, P < 0.001). CONCLUSIONS Serum zinc deficiency was found in 68.6% of postoperative patients who underwent gastrectomy for gastric cancer, which was highly correlated with serum albumin.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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30
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Hanazaki K, Tanioka N, Munekage M, Uemura S, Maeda H. Closed-loop artificial endocrine pancreas from Japan. Artif Organs 2021; 45:958-967. [PMID: 34105784 DOI: 10.1111/aor.14008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/17/2021] [Accepted: 05/27/2021] [Indexed: 12/17/2022]
Abstract
The development of a closed-loop artificial pancreas (AP) in the Western countries and Japan is different. In Western countries, wearable AP with a closed-loop glycemic control system has been developed as a treatment for patients with type 1 and type 2 diabetes. On the contrary, in Japan, bedside closed-loop AP explored by a Japanese company (Nikkiso, Tokyo, Japan) has developed as perioperative glycemic control device in surgical patients and acute care patients with emergency. In this article, we reviewed the scientific evidence in the past and present and future prospects of perioperative glycemic control using bedside AP with a closed-loop system in Japan. Conventional perioperative strict glycemic controls have three major problems: hyperglycemia, hypoglycemia, and variability in blood glucose concentrations. In Japan, perioperative strict glycemic control using the current bedside AP STG-55 (Nikkiso, Tokyo, Japan) has been developed since 2010. This novel glycemic control method achieved not only stable glycemic control without hyperglycemia, hypoglycemia, and less variability of blood glucose concentrations but also reduced postoperative infectious complications in patients undergoing major surgeries. Among the rapidly increasing number of surgical or emergency patients with diabetes, frailty, and sarcopenia of intrinsic glucose intolerance, more sophisticated and smaller AP available easily in operating rooms and intensive care units will be warranted to promote improved therapeutic outcomes in such critically ill patients.
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Affiliation(s)
- Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kochi University, Kochi, Japan.,Japanese Society for Artificial Organs, Tokyo, Japan
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31
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Namikawa T, Maeda M, Yokota K, Tanioka N, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nagata Y, Kobayashi M, Hanazaki K. Laparoscopic Distal Gastrectomy for Synchronous Gastric Cancer and Gastrointestinal Stromal Tumor With Situs Inversus Totalis. In Vivo 2021; 35:913-918. [PMID: 33622883 DOI: 10.21873/invivo.12331] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 01/23/2021] [Accepted: 01/25/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Situs inversus totalis (SIT) is a rare congenital condition in which the thoracic and abdominal organs are inverted like a mirror image. CASE REPORT We present a case of synchronous gastric cancer and gastrointestinal stromal tumor (GIST) associated with SIT in a 74-year-old man who was admitted to our department to treat gastric cancer. Esophagogastroduodenoscopy revealed a depressed lesion and a submucosal tumor (SMT) in the middle-third of the stomach. Abdominal contrast-enhanced computed tomography revealed complete inversion of the internal organs, and the common hepatic artery branched from the superior mesenteric artery. The patient underwent laparoscopic distal gastrectomy with regional lymph node dissection and Billroth I reconstruction. The macroscopic observation of the resected specimen revealed a depressed lesion measuring 2.0×1.5 cm in diameter and an SMT measuring 2.2×1.8 cm. CONCLUSION Careful preoperative anatomic evaluation is important in SIT because the situs anomalies may be accompanied by major vascular anomalies.
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Affiliation(s)
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Yusuke Nagata
- Department of Surgery, Izumino Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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32
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Namikawa T, Maeda M, Yokota K, Tanioka N, Fukudome I, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Assessment of Systemic Inflammatory Response and Nutritional Markers in Patients With Trastuzumab-treated Unresectable Advanced Gastric Cancer. In Vivo 2021; 34:2851-2857. [PMID: 32871824 DOI: 10.21873/invivo.12112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 06/13/2020] [Accepted: 06/16/2020] [Indexed: 02/08/2023]
Abstract
AIM To determine whether markers of systemic inflammatory response and nutrition are a predictor of treatment response in patients with trastuzumab-treated unresectable advanced gastric cancer. PATIENTS AND METHODS Twenty-one patients who received chemotherapy for unresectable advanced gastric cancer at Kochi Medical School from 2013 to 2020 were enrolled. Clinicopathological information and systemic inflammatory response data were obtained retrospectively to investigate associations between baseline cancer-related prognostic variables and survival outcomes. RESULTS The median overall survival (OS) and progression-free survival (PFS) for the whole cohort were 24.5 (range=1.9-88.4) months and 7.0 (range=2.0-23.4) months, respectively. The objective response rate and disease control rate were 52.4% and 81.0%, respectively. The median PFS for patients with a neutrophil to lymphocyte ratio (NLR) <2.8 was significantly longer than that for those with NLR ≥2.8 (8.9 vs. 6.0 months; p=0.048). Although the median OS also tended to be longer for patients with NLR <2.8, the difference was not statistically significant. No significant differences in median OS and PFS were observed between patients with a prognostic nutrition index (PNI) <41.6 and those with PNI ≥41.6. CONCLUSION An NLR ≥2.8 is a predictor of poorer prognosis in patients receiving systemic treatment with trastuzumab and chemotherapy for unresectable advanced or recurrent gastric cancer.
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Affiliation(s)
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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33
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Yokota K, Serada S, Tsujii S, Toya K, Takahashi T, Matsunaga T, Fujimoto M, Uemura S, Namikawa T, Murakami I, Kobayashi S, Eguchi H, Doki Y, Hanazaki K, Naka T. Anti-Glypican-1 Antibody-drug Conjugate as Potential Therapy Against Tumor Cells and Tumor Vasculature for Glypican-1-Positive Cholangiocarcinoma. Mol Cancer Ther 2021; 20:1713-1722. [PMID: 34224365 DOI: 10.1158/1535-7163.mct-21-0015] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 02/27/2021] [Accepted: 05/27/2021] [Indexed: 02/05/2023]
Abstract
Cholangiocarcinoma is a highly malignant cancer. Many patients need systemic chemotherapy to prevent tumor development and recurrence; however, their prognosis is poor due to the lack of effective therapy. Therefore, a new treatment option is urgently required. We recently identified glypican-1 (GPC1) as a novel cancer antigen of esophageal squamous cell carcinoma. We also demonstrated the efficacy and safety of GPC1-targeted ADC (GPC1-ADC) conjugating anti-GPC1 mAb possessing high internalization activity with monomethyl auristatin F (MMAF), which is a potent tubulin polymerizing inhibitor. In this study, we confirmed that GPC1 was highly expressed in cholangiocarcinoma cells and tissues. IHC analysis of 49 extrahepatic cholangiocarcinoma patient tumor specimens revealed high expression of GPC1 in 47% of patients. These patients demonstrated significantly poorer prognosis compared with the low-expression group in terms of disease-free survival and overall survival (P < 0.05). GPC1 was also expressed in tumor vessels of cholangiocarcinoma, but not on the vessels of nontumor tissues. MMAF-conjugated GPC1-ADC showed potent tumor growth inhibition against GPC1-positive cholangiocarcinoma cells in vitro and in vivo In a GPC1 knockout xenograft model, GPC1-ADC partially inhibited tumor growth. Vascular endothelial cells in tumor tissues of GPC1-negative xenograft mice expressed GPC1 and were arrested in the G2-M phase of cell cycle by GPC1-ADC. GPC1-ADC exhibits direct as well as indirect antitumor effects via inhibition of tumor angiogenesis. Our preclinical data highlight GPC1-ADC as a promising therapy for GPC1-positive cholangiocarcinoma.
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Affiliation(s)
- Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.,Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Satoshi Serada
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Japan.
| | - Shigehiro Tsujii
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan.,Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Keisuke Toya
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Tsuyoshi Takahashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Takashi Matsunaga
- Department of Medical course, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Minoru Fujimoto
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Ichiro Murakami
- Department of Pathology, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, Suita, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kochi University, Nankoku, Japan
| | - Tetsuji Naka
- Department of Clinical Immunology, Kochi Medical School, Kochi University, Nankoku, Japan.
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Namikawa T, Yokota K, Yamaguchi S, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Mibu K, Kobayashi M, Hanazaki K. Spontaneous intra-abdominal hemorrhage of a well-differentiated, grade 3 gastric neuroendocrine tumor during drug-based treatment. Clin J Gastroenterol 2021; 14:1244-1249. [PMID: 33977396 DOI: 10.1007/s12328-021-01433-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 05/02/2021] [Indexed: 02/08/2023]
Abstract
Grade 3, well-differentiated, gastric neuroendocrine tumors (NET G3) are extremely rare. Herein, we report the case of a 64-year-old man with a grade 3 neuroendocrine tumor of the stomach who experienced intra-abdominal bleeding during the course of drug treatment. The patient was referred to our hospital for examination of a gastric tumor that was initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy revealed an elevated lesion with a central ulcer in the upper body of the stomach, and biopsy specimens confirmed the pathological diagnosis of NET G3. Abdominal contrast-enhanced computed tomography (CT) showed a 25-cm, well-defined mass lesion showing heterogeneous enhancement in the liver. A clinical diagnosis of NET G3 with multiple liver metastases was given, after which everolimus was administered in combination with a somatostatin analogue. However, the patient developed sudden-onset epigastric abdominal pain and general fatigue 2 months later, and emergency abdominal contrast-enhanced CT confirmed the presence of intra-abdominal hemorrhage. Following blood transfusion, the patient's symptoms and general condition improved. Although the patient was treated with streptozocin, abdominal CT indicated progression of the liver metastases. Unfortunately, despite receiving best supportive care, the patient died 8 months after the initial of the treatment. To the best of our knowledge, this is the first case of a patient who developed spontaneous hemoperitoneum during drug treatment for a NET G3 to be reported in the English literature. It is essential that additional data be obtained to determine the optimal treatment for this disease.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sachi Yamaguchi
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kiyo Mibu
- Nursing Department, Kochi Medical School Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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35
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Maeda H, Endo H, Ichihara N, Miyata H, Hasegawa H, Kamiya K, Kakeji Y, Yoshida K, Seto Y, Yamaue H, Yamamoto M, Kitagawa Y, Uemura S, Hanazaki K. Association of day of the week with mortality after elective right hemicolectomy for colon cancer: Case analysis from the National Clinical Database. Ann Gastroenterol Surg 2021; 5:331-337. [PMID: 34095723 PMCID: PMC8164462 DOI: 10.1002/ags3.12420] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/07/2020] [Accepted: 12/08/2020] [Indexed: 12/18/2022] Open
Abstract
AIM We aimed to investigate whether later weekdays are related to worse short-term outcomes after elective right hemicolectomy for colon cancer. METHODS We retrospectively analyzed adult patients who underwent elective right hemicolectomy for colon cancer between 2012 and 2017. Records lacking details about surgical mortality were excluded, and multiple imputation was performed for other missing data (variables). The primary endpoint was surgical mortality, defined as the sum of 30-day mortality and in-hospital deaths within 90 days postoperatively. Using 22 clinical variables, hierarchal logistic regression modeling with clustering of patients from the same institutes was performed. RESULTS Of the 112 658 patients undergoing elective right hemicolectomy for colon cancer, the 30-day mortality and surgical mortality were 0.6% and 1.1%, respectively. Surgery on Friday was less frequent, accounting for 17.1% of all cases. The occurrence of severe postoperative complications, anastomotic leakage, or unadjusted odds ratio for surgical mortality did not show significant differences between weekdays. A hierarchal logistic regression model identified 19 independent factors for surgical mortality. Adjusted odds ratios for surgical mortality were 1.01 (95% confidence interval: 0.83-1.22, P = .915), 0.86 (95% confidence interval: 0.71-1.05, P = .144), 0.86 (95% confidence interval: 0.71-1.05, P = .408), and 0.83 (95% confidence interval: 0.68-1.03, P = .176) for Tuesday, Wednesday, Thursday, and Friday, respectively, showing no significant differences. CONCLUSION This study did not identify an evident difference in surgical mortality between weekdays; a safe elective right hemicolectomy for colon cancer is being offered throughout the week in Japan.
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Affiliation(s)
| | - Hideki Endo
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Nao Ichihara
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroaki Miyata
- Department of Healthcare Quality AssessmentGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroshi Hasegawa
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Kinji Kamiya
- Project Management SubcommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Yoshihiro Kakeji
- Database CommitteeThe Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Kazuhiro Yoshida
- Department of Surgical OncologyGraduate School of MedicineGifu UniversityGifuJapan
| | - Yasuyuki Seto
- Department of Gastrointestinal SurgeryGraduate School of MedicineThe University of TokyoBunkyo‐kuJapan
| | - Hiroki Yamaue
- Second Department of SurgerySchool of MedicineWakayama Medical UniversityWakayamaJapan
| | - Masakazu Yamamoto
- Department of SurgeryInstitute of GastroenterologyTokyo Women's Medical UniversityShinjuku‐kuJapan
| | - Yuko Kitagawa
- The Japanese Society of Gastroenterological SurgeryTokyoJapan
| | - Sunao Uemura
- Department of SurgeryKochi Medical SchoolNankokuJapan
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36
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Cystic lymphangioma of the greater omentum treated by laparoscopic resection. Clin J Gastroenterol 2021; 14:1004-1007. [PMID: 33782862 DOI: 10.1007/s12328-021-01404-8] [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: 01/15/2021] [Accepted: 03/23/2021] [Indexed: 02/05/2023]
Abstract
We report a rare case of cystic lymphangioma of the greater omentum, which was treated by laparoscopic resection. A 61-year-old man was referred to our hospital for the treatment of a perigastric cystic lesion. Esophagogastroduodenoscopy revealed neither a mucosal lesion nor a submucosal tumor in the stomach. Abdominal contrast-enhanced computed tomography imaging showed a cystic lesion in the ventral side of the lower part of the stomach and no mass lesions in the liver. The patient underwent laparoscopic resection of the cystic lesion. The intraoperative observation confirmed that a well-defined cystic lesion was present wrapped in the greater omentum and located predominantly in the right side. Although the cystic lesion was located directly beside the right gastroepiploic artery and vein, excision of the cystic lesion along with the cuff of the omentum was performed without sacrificing the vessels. Macroscopic examination of the resected specimen showed an ovoid, cystic mass measuring 7.5 × 4.3 cm within the omentum. The pathological diagnosis was "cystic lymphangioma without malignant signs." Following surgery, the patient remained symptom-free without evidence of recurrence for 6 months. The laparoscopic approach, being minimally invasive, can be considered the most feasible approach for the resection of an abdominal cystic lymphangioma.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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37
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Namikawa T, Shimizu S, Yokota K, Tanioka N, Fukudome I, Munekage M, Uemura S, Maeda H, Kitagawa H, Hanazaki K. Isolated adrenocorticotropic hormone deficiency induced by nivolumab treatment for advanced gastric cancer. Clin J Gastroenterol 2021; 14:988-993. [PMID: 33715100 DOI: 10.1007/s12328-021-01384-9] [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: 01/04/2021] [Accepted: 03/08/2021] [Indexed: 02/05/2023]
Abstract
Isolated adrenocorticotropic hormone (ACTH) deficiency is a rare immune-related adverse event associated with immunotherapy using immune checkpoint inhibitors for malignant tumors. A 68-year-old man had previously undergone a complete gastrectomy with regional lymph-node dissection for remnant gastric cancer, with a final diagnosis of T4aN2M1, Stage IV. Because he developed lymph-node metastases during postoperative chemotherapy using S-1 plus oxaliplatin, he was treated with ramucirumab plus nab-paclitaxel. Eight months after the operation, the patient developed multiple liver metastases and was treated with nivolumab (3 mg/kg, every 2 weeks). After four cycles of nivolumab treatment, the cortisol level decreased, and the patient reported general fatigue and appetite loss. Pituitary stimulation testing using a combination of corticotropin-releasing hormone, luteinizing hormone-releasing hormone, and thyrotropin-releasing hormone revealed markedly low ACTH and cortisol responses. Magnetic resonance imaging revealed no enlargement of the pituitary gland or thickening of the stalk. After steroid replacement therapy using hydrocortisone, the patient's symptoms of general fatigue improved. After discharge, nivolumab and steroid replacement were continued. During the subsequent 6 months, the clinical course of the patient was mostly uneventful. Abdominal computed tomography revealed a marked shrinkage of liver and lymph-node metastases, which indicated a partial response with a 95.0% decrease in target lesions compared with baseline. To the best of our knowledge, this is the first case reported in the English literature of a patient who developed isolated ACTH deficiency during nivolumab treatment for a metastatic advanced gastric cancer.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Shigeto Shimizu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Keiichro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Ian Fukudome
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Namikawa T, Yamaguchi S, Fujisawa K, Ogawa M, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Matsuda K, Hanazaki K. Real-time bowel sound analysis using newly developed device in patients undergoing gastric surgery for gastric tumor. JGH Open 2021; 5:454-458. [PMID: 33860095 PMCID: PMC8035471 DOI: 10.1002/jgh3.12515] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 01/15/2021] [Accepted: 02/13/2021] [Indexed: 02/05/2023]
Abstract
Background and Aim Objective measurements are not available for determining bowel sounds. The present study sought to evaluate the efficacy of a novel bowel sound monitoring system for perioperative use in patients undergoing gastric surgery. Methods The study enrolled 14 patients who underwent surgery for gastric cancer at Kochi Medical School from 2017 to 2018. Preoperative and postoperative bowel sounds were recorded using a newly developed real‐time analysis system in the operating theater and recovery room. Clinical information and bowel sound count data were obtained to compare preoperative and postoperative measures. Results The median preoperative and postoperative bowel sound counts across all patients were 1.4 and 2.5 counts per minute (cpm), respectively. In patients who underwent laparoscopic gastrectomy, the postoperative bowel sound count was significantly higher than that recorded preoperatively (2.3 vs. 1.6 cpm, P = 0.005). The findings also revealed a significant negative correlation between postoperative bowel sound count and operation time (r = −0.714, P = 0.003). Conclusions The real‐time bowel sound analysis system tested herein presents a promising diagnostic tool to quantitatively evaluate bowel movements associated with surgery. Our results suggested a need for shorter operation times for gastric procedures with respect to peristalsis recovery and supported the use of minimally invasive surgery.
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Affiliation(s)
| | - Sachi Yamaguchi
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Kazune Fujisawa
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Maho Ogawa
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Jun Iwabu
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Masaya Munekage
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Sunao Uemura
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | - Hiromichi Maeda
- Department of Surgery Kochi Medical School Nankoku Kochi Japan
| | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences Kochi Medical School Nankoku Kochi Japan
| | - Kenichi Matsuda
- Department of Emergency and Critical Care Medicine, Faculty of Medicine University of Yamanashi Chuo Yamanashi Japan
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Namikawa T, Maeda M, Yokota K, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Enteral Vitamin B12 Supplementation Is Effective for Improving Anemia in Patients Who Underwent Total Gastrectomy. Oncology 2021; 99:225-233. [PMID: 33601391 DOI: 10.1159/000513888] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 12/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND This study aimed to investigate the efficacy of enteral supplementation of vitamin B12 for vitamin B12 deficiency in patients who underwent total gastrectomy for gastric cancer. METHODS The study enrolled 133 patients who underwent total gastrectomy for gastric cancer at Kochi Medical School. Clinical data were obtained to investigate associations between vitamin B12 supplementation and vitamin B12 levels. Vitamin B12 deficiency was defined as serum vitamin B12 less than 200 pg/mL. Baseline characteristics and changes in hematological variables, including vitamin B12 levels, were examined. RESULTS Vitamin B12 deficiency was present in 71.4% of the 133 patients. Vitamin B12 levels at 3, 6, and 12 months after enteral supplementation were 306 pg/mL, 294 pg/mL, and 367 pg/mL, respectively, which were all significantly higher than those before supplementation (p < 0.001 for all comparisons). The median red blood cell count at 3, 6, and 12 months after enteral supplementation were 380 × 104/mm3, 394 × 104/mm3, and 395 × 104/mm3, respectively, which were all significantly higher than those before supplementation (p = 0.020, p = 0.001, and p = 0.003, respectively). Vitamin B12 levels at 3, 6, and 12 months after supplementation were significantly higher in patients supplemented enterally than those supplemented parenterally (p < 0.001 for all comparisons). CONCLUSIONS Vitamin B12 deficiency was found in 71.4% of postoperative patients who underwent total gastrectomy for gastric cancer, and enteral vitamin B12 supplements might be effective to improve anemia in these patients.
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Affiliation(s)
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | | | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Japan
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Uemura S, Maeda H, Obatake M, Namikawa T, Kitagawa H, Fujieda Y, Nishimoto Y, Morishita Y, Fujieda M, Hanazaki K. Laparoscopic cholecystectomy for gallbladder torsion in a 3‐year‐old child. Acute Med Surg 2021; 8:e722. [PMID: 34987833 PMCID: PMC8693826 DOI: 10.1002/ams2.722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/22/2021] [Accepted: 12/02/2021] [Indexed: 11/07/2022] Open
Abstract
Background Case presentation Conclusion
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Affiliation(s)
- Sunao Uemura
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | - Hiromichi Maeda
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | - Masayuki Obatake
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | - Tsutomu Namikawa
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | | | - Yuki Fujieda
- Department of Surgery Kochi Medical School Hospital Nankoku Japan
| | - Yuka Nishimoto
- Department of Pediatrics, Kochi Medical School Kochi University Nankoku Japan
| | - Yusuke Morishita
- Department of Pediatrics, Kochi Medical School Kochi University Nankoku Japan
| | - Mikiya Fujieda
- Department of Pediatrics, Kochi Medical School Kochi University Nankoku Japan
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Araki M, Yonetsu T, Kurihara O, Nakajima A, Lee H, Soeda T, Minami Y, Uemura S, Kakuta T, Jang I. Predictors of rapid plaque progression: an optical coherence tomography study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2459] [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: 11/14/2022] Open
Abstract
Abstract
Background
Two patterns of plaque progression have been described: slow linear progression and rapid step-wise progression. The former will cause stable angina when the narrowing reaches a critical threshold, while the latter may lead to acute coronary syndromes or sudden cardiac death.
Purpose
The aim of the study was to identify morphologic predictors for rapid plaque progression.
Methods
Patients who had OCT imaging during the index procedure and follow-up angiography with a minimum of 6-month interval were selected. Non-culprit lesion was defined as a plaque with a diameter stenosis ≥30% on index angiogram. Lesion progression was defined as the decrease of angiographic minimum lumen diameter ≥0.4 mm at follow-up (mean, 7.1 months). Baseline morphological characteristics of the plaques with rapid progression were evaluated by OCT. In a subgroup with follow-up OCT imaging for plaques with progression, morphological changes from baseline to follow-up were assessed.
Results
Among 517 lesions, 50 lesions showed progression. These lesions had a significantly higher prevalence of lipid-rich plaque (76.0% vs. 50.5%), thin-cap fibroatheroma (TCFA) (20.0% vs. 5.8%), layered plaque (60.0% vs. 34.0%), macrophage accumulation (62.0% vs. 42.4%), microvessel (46.0% vs. 29.1%), plaque rupture (12.0% vs. 4.7%), and thrombus (6.0% vs. 1.1%), compared to those without progression. The multivariable analysis identified lipid-rich plaque [odds ratio (OR) 2.17, 95% confidence interval (CI) 1.02–4.62, p=0.045], TCFA (OR 5.85, 95% CI 2.01–17.03, p=0.001), and layered plaque (OR 2.19, 95% CI 1.03–4.17, p=0.040) as predictors of subsequent lesion progression. In a subgroup with follow-up OCT, a new layer was detected in 14/41 (34.1%) plaques.
Conclusions
Lipid-rich plaque, TCFA, and layered plaque were predictors of subsequent rapid plaque progression. A new layer, a signature of rapid progression through plaque disruption and healing, was detected in 1/3 of the cases.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- M Araki
- Massachusetts General Hospital, Boston, United States of America
| | - T Yonetsu
- Tokyo Medical and Dental University, Tokyo, Japan
| | - O Kurihara
- Massachusetts General Hospital, Boston, United States of America
| | - A Nakajima
- Massachusetts General Hospital, Boston, United States of America
| | - H Lee
- Massachusetts General Hospital, Boston, United States of America
| | - T Soeda
- Nara Medical University, Nara, Japan
| | - Y Minami
- Kitasato University School of Medicine, Sagamihara, Japan
| | - S Uemura
- Nara Medical University, Nara, Japan
| | - T Kakuta
- Tsuchiura Kyodo General Hospital, Tsuchiura, Japan
| | - I.K Jang
- Massachusetts General Hospital, Boston, United States of America
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42
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Namikawa T, Yokota K, Iwabu J, Munekage M, Uemura S, Tsujii S, Maeda H, Kitagawa H, Karashima T, Kumon M, Inoue K, Kobayashi M, Hanazaki K. Incidence and risk factors of osteoporotic status in outpatients who underwent gastrectomy for gastric cancer. JGH Open 2020; 4:903-908. [PMID: 33102762 PMCID: PMC7578282 DOI: 10.1002/jgh3.12347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/14/2020] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
Background and Aim Disorders in bone metabolism have long been recognized as typical sequelae of gastrectomy; however, the pathogenesis has not been fully elucidated, resulting in a variation of reported incidence. This study aimed to evaluate current bone health by measuring bone mineral density (BMD) in patients treated by gastrectomy for gastric cancer, with a focus on incidence and risk factors of osteoporosis. Methods The study enrolled 81 patients who underwent gastrectomy for gastric cancer at Kochi Medical School. BMD of the lumbar spine was measured by dual‐energy X‐ray mineral absorptiometry, with the results expressed as a percentage of the young adult mean (YAM). Clinical data were also obtained to investigate associations with BMD. Results Of the 81 study patients, 12 (14.8%) were deemed to have osteoporosis, defined by a percentage of YAM <70, with a dominance of females over males (66.7% vs 17.4%; P < 0.001). The median body weight, hemoglobin concentration, and serum alkaline phosphatase (ALP) level of the patients with osteoporosis was significantly lower than in those with a percentage of YAM ≥70 group (39.6 kg vs 53.1 kg, P < 0.001; 10.9 mg/dL vs 12.5 mg/dL, P = 0.010; 210 U/L vs 251 U/L, P = 0.002). Further analyses revealed a significant positive correlation between body weight and percentage of YAM (r = 0.441, P < 0.001). Despite the administration of bisphosphonates in these patients during this study, one acquired a bone fracture. Conclusion Osteoporosis was found in 14.8% of postoperative gastric cancer patients, with female gender, low body weight, and low ALP proposed as risk factors for osteoporosis and thus future bone fracture.
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Affiliation(s)
| | | | - Jun Iwabu
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | - Sunao Uemura
- Department of Surgery Kochi Medical School Nankoku Japan
| | | | | | | | | | | | - Keiji Inoue
- Department of Urology Kochi Medical School Nankoku Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences Kochi Medical School Nankoku Japan
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Namikawa T, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nakayama T, Fukuhara H, Inoue K, Al-Sheikh M, Jaiswal N, Kobayashi M, Hanazaki K. Laparoscopic-endoscopic cooperative surgery for early gastric cancer with gastroesophageal varices. Asian J Endosc Surg 2020; 13:539-543. [PMID: 32066204 DOI: 10.1111/ases.12791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 12/30/2019] [Accepted: 02/02/2020] [Indexed: 02/05/2023]
Abstract
This report describes a patient with early gastric cancer with gastroesophageal varices who underwent laparoscopic-endoscopic cooperative surgery. The patient, a 75-year-old woman, was referred to our hospital for the treatment of gastric cancer. Esophagogastroduodenoscopy revealed a superficial spreading-type tumor on the posterior wall of the upper third of the stomach that was very close to the gastric varices. Biopsy specimens showed a moderately differentiated tubular adenocarcinoma. Abdominal contrast-enhanced CT showed an enhanced submucosal area with noticeably dilated veins around the perigastric region and no masses in the liver. The patient underwent local resection of the stomach using laparoscopic-endoscopic cooperative surgery; this procedure was chosen because of the patient's risk of bleeding from the gastric varices in the area adjacent to the cancer during endoscopic submucosal dissection. Macroscopic examination of the resected specimen showed a superficial spreading lesion measuring 55 × 50 mm. The pathological diagnosis was moderately differentiated tubular adenocarcinoma invading the gastric submucosal layer without lymphovascular invasion.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Nankoku, Japan.,Center for Photodynamic Medicine, Kochi Medical School Hospital, Nankoku, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Nankoku, Japan
| | | | | | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Nankoku, Japan
| | - Hideo Fukuhara
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Nankoku, Japan.,Department of Urology, Kochi Medical School Hospital, Nankoku, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Nankoku, Japan.,Department of Urology, Kochi Medical School Hospital, Nankoku, Japan
| | - Mariam Al-Sheikh
- Medical Department, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Bahrain
| | - Nalin Jaiswal
- Medical Department, Royal College of Surgeons in Ireland - Medical University of Bahrain, Busaiteen, Bahrain
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Nankoku, Japan.,Center for Photodynamic Medicine, Kochi Medical School Hospital, Nankoku, Japan
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Yokota K, Namikawa T, Maeda M, Tanioka N, Iwabu J, Uemura S, Munekage M, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Synchronous duodenal mucosa-associated lymphoid tissue lymphoma and gastric cancer. Clin J Gastroenterol 2020; 14:109-114. [PMID: 32959165 DOI: 10.1007/s12328-020-01241-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/11/2020] [Indexed: 02/05/2023]
Abstract
Duodenal mucosa-associated lymphoid tissue (MALT) lymphoma is an extremely rare tumor. Herein, we report multidisciplinary treatment of a patient with synchronous development of primary MALT lymphoma of the duodenum and gastric cancer. A 70-year-old woman was referred to our hospital for examination of a gastric cancer initially diagnosed by a local medical doctor. Esophagogastroduodenoscopy showed an elevated lesion with a central ulcer in the lower body of the stomach, and a partially whitish aggregated lesion in the descending portion of the duodenum. Histopathological examination of biopsy specimens from the gastric lesion showed moderately differentiated adenocarcinoma, and duodenal specimens showed low-grade MALT lymphoma composed of atypical lymphoid cells with a lymphoepithelial lesion. The patient underwent distal gastrectomy with regional lymph node dissection for the gastric cancer. Histological examination showed muscularis propria invading adenocarcinoma with two lymph node metastases. After operation, four courses of systemic rituximab treatment were administered for the MALT lymphoma, followed by adjuvant S-1 (tegafur/gimeracil/oteracil) chemotherapy for the gastric cancer. In the 4 months after operation, the patient was well with no evidence of recurrence. To the best of our knowledge, this is the second reported case of synchronous gastric adenocarcinoma and duodenal MALT lymphoma in the English literature.
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Affiliation(s)
- Keiichiro Yokota
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan.
| | - Masahiro Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Nobuhisa Tanioka
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Nankoku, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, Kochi, 783-8505, Japan
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Namikawa T, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Nakayama T, Inoue K, Sato T, Kobayashi M, Hanazaki K. Evolution of photodynamic medicine based on fluorescence image-guided diagnosis using indocyanine green and 5-aminolevulinic acid. Surg Today 2020; 50:821-831. [PMID: 31346808 DOI: 10.1007/s00595-019-01851-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/21/2019] [Indexed: 02/05/2023]
Abstract
New diagnostic techniques based on photodynamic medicine, such as near-infrared fluorescence using indocyanine green (NIR-ICG) and 5-aminolevulinic acid-mediated photodynamic diagnosis (ALA-PDD), are aiding navigation tasks across various fields of surgery. Specifically, NIR-ICG is being used for the intraoperative identification of sentinel lymph nodes or blood vessels in organ resection and for blood flow evaluation in surgery. These ICG-fluorescent imaging techniques could provide an additional and potentially valuable way to identify vascular and lymphatic structures in surrounding tissue. 5-Aminolevulinic acid is a precursor of a photosensitizing substance with affinity for tumors; thus, diagnostic laparoscopy using ALA-PDD in combination should improve the accuracy of detecting peritoneal dissemination in patients with advanced gastric cancer. The ability to overlay fluorescent imaging with conventional color images in real time using ALA-PDD and NIR with ICG would be of immense benefit to surgeons, providing good visualization and detection of target lesions not seen with the naked eye. A multi-center clinical study examining the safety and efficacy of ALA-PDD during laparoscopic examination for patients with advanced gastric cancer is currently underway in the form of doctor-initiated trials, and further verification studies will be conducted. Such imaging capability could have broad potential across cancer and vascular surgery.
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Affiliation(s)
- Tsutomu Namikawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan.
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan.
| | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Masaya Munekage
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiromichi Maeda
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Hiroyuki Kitagawa
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
| | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
| | - Keiji Inoue
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Urology, Kochi Medical School, Kochi, Japan
| | - Takayuki Sato
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
- Department of Cardiovascular Control, Kochi Medical School, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
| | - Kazuhiro Hanazaki
- Department of Surgery, Kochi Medical School, Kohasu, Oko-cho, Nankoku, 783-8505, Kochi, Japan
- Center for Photodynamic Medicine, Kochi Medical School Hospital, Kochi, Japan
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Namikawa T, Yokota K, Tanioka N, Fukudome I, Iwabu J, Munekage M, Uemura S, Maeda H, Kitagawa H, Kobayashi M, Hanazaki K. Systemic inflammatory response and nutritional biomarkers as predictors of nivolumab efficacy for gastric cancer. Surg Today 2020; 50:1486-1495. [PMID: 32542414 DOI: 10.1007/s00595-020-02048-w] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 05/13/2020] [Indexed: 02/08/2023]
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Uemura S, Namikawa T, Fujisawa K, Hanazaki K. A case of advanced hepatocellular carcinoma with gallbladder invasion. Jpn J Clin Oncol 2020; 50:623-625. [PMID: 32115654 DOI: 10.1093/jjco/hyz184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 11/05/2019] [Accepted: 11/09/2019] [Indexed: 02/05/2023] Open
Affiliation(s)
- Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
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Isozaki A, Nakagawa Y, Loo MH, Shibata Y, Tanaka N, Setyaningrum DL, Park JW, Shirasaki Y, Mikami H, Huang D, Tsoi H, Riche CT, Ota T, Miwa H, Kanda Y, Ito T, Yamada K, Iwata O, Suzuki K, Ohnuki S, Ohya Y, Kato Y, Hasunuma T, Matsusaka S, Yamagishi M, Yazawa M, Uemura S, Nagasawa K, Watarai H, Di Carlo D, Goda K. Sequentially addressable dielectrophoretic array for high-throughput sorting of large-volume biological compartments. Sci Adv 2020; 6:eaba6712. [PMID: 32524002 PMCID: PMC7259936 DOI: 10.1126/sciadv.aba6712] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/25/2020] [Indexed: 05/27/2023]
Abstract
Droplet microfluidics has become a powerful tool in precision medicine, green biotechnology, and cell therapy for single-cell analysis and selection by virtue of its ability to effectively confine cells. However, there remains a fundamental trade-off between droplet volume and sorting throughput, limiting the advantages of droplet microfluidics to small droplets (<10 pl) that are incompatible with long-term maintenance and growth of most cells. We present a sequentially addressable dielectrophoretic array (SADA) sorter to overcome this problem. The SADA sorter uses an on-chip array of electrodes activated and deactivated in a sequence synchronized to the speed and position of a passing target droplet to deliver an accumulated dielectrophoretic force and gently pull it in the direction of sorting in a high-speed flow. We use it to demonstrate large-droplet sorting with ~20-fold higher throughputs than conventional techniques and apply it to long-term single-cell analysis of Saccharomyces cerevisiae based on their growth rate.
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Affiliation(s)
- A. Isozaki
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Kanagawa Institute of Industrial Science and Technology, 3-2-1 Sakado, Takatsu-ku, Kawasaki-shi, Kanagawa 213-0012, Japan
| | - Y. Nakagawa
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - M. H. Loo
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Y. Shibata
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - N. Tanaka
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - D. L. Setyaningrum
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - J.-W. Park
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Y. Shirasaki
- Department of Biological Sciences, Graduate School of Science, University of Tokyo, Faculty of Science Building 1 (East), Room 575, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H. Mikami
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - D. Huang
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H. Tsoi
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - C. T. Riche
- Department of Bioengineering, Samueli School of Engineering, University of California, Los Angeles, 420 Westwood Plaza, 5121E Engineering V, Los Angeles, CA 90095, USA
| | - T. Ota
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - H. Miwa
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Y. Kanda
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - T. Ito
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Japan Science and Technology Agency, 4-1-8, Honcho, Kawaguchi-shi, Saitama 332-0012, Japan
| | - K. Yamada
- R&D Department, euglena Co., Ltd., 75-1, Ono-machi, Tsurumi-ku, Yokohama-shi 230-0046, Japan
| | - O. Iwata
- R&D Department, euglena Co., Ltd., 75-1, Ono-machi, Tsurumi-ku, Yokohama-shi 230-0046, Japan
| | - K. Suzuki
- R&D Department, euglena Co., Ltd., 75-1, Ono-machi, Tsurumi-ku, Yokohama-shi 230-0046, Japan
| | - S. Ohnuki
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8562, Japan
| | - Y. Ohya
- Department of Integrated Biosciences, Graduate School of Frontier Sciences, University of Tokyo, 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8562, Japan
- AIST-UTokyo Advanced Operando-Measurement Technology Open Innovation Laboratory (OPERANDO-OIL), National Institute of Advanced Industrial Science and Technology (AIST), 5-1-5 Kashiwanoha, Kashiwa, Chiba 277-8589, Japan
| | - Y. Kato
- Graduate School of Science, Technology Innovation, Kobe University, 1-1 Rokkodai, Nada, Kobe 657-8501, Japan
| | - T. Hasunuma
- Graduate School of Science, Technology Innovation, Kobe University, 1-1 Rokkodai, Nada, Kobe 657-8501, Japan
- Engineering Biology Research Center, Kobe University, 1-1 Rokkodai, Nada, Kobe 657-8501, Japan
| | - S. Matsusaka
- Clinical Research and Regional Innovation, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki 305-8575, Japan
| | - M. Yamagishi
- Department of Biological Sciences, Graduate School of Science, University of Tokyo, Faculty of Science Building 1 (East), Room 575, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - M. Yazawa
- Department of Rehabilitation and Regenerative Medicine, Pharmacology, Columbia University, 650 West 168th Street, BB1108, New York, NY 10032, USA
| | - S. Uemura
- Department of Biological Sciences, Graduate School of Science, University of Tokyo, Faculty of Science Building 1 (East), Room 575, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - K. Nagasawa
- Division of Stem Cell Cellomics, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
| | - H. Watarai
- Division of Stem Cell Cellomics, Institute of Medical Science, University of Tokyo, 4-6-1 Shirokanedai, Minato-ku, Tokyo 108-8639, Japan
- Department of Immunology and Stem Cell Biology, Faculty of Medicine, Institute of Medical, Pharmaceutical and Health Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, Ishikawa 920-8640, Japan
| | - D. Di Carlo
- Department of Bioengineering, Samueli School of Engineering, University of California, Los Angeles, 420 Westwood Plaza, 5121E Engineering V, Los Angeles, CA 90095, USA
| | - K. Goda
- Department of Chemistry, Graduate School of Science, University of Tokyo, East Chemistry Building, Room 213, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
- Department of Bioengineering, Samueli School of Engineering, University of California, Los Angeles, 420 Westwood Plaza, 5121E Engineering V, Los Angeles, CA 90095, USA
- Japan Science and Technology Agency, 4-1-8, Honcho, Kawaguchi-shi, Saitama 332-0012, Japan
- Institute of Technological Sciences, Wuhan University, Hubei 430072, China
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Namikawa T, Yokota K, Yamaguchi S, Iwabu J, Munekage M, Uemura S, Tsujii S, Maeda H, Kitagawa H, Kumon M, Kobayashi M, Hanazaki K. Evaluation of Systemic Inflammatory Response and Nutritional Biomarkers as Predictive Factors in Patients with Recurrent Gastric Cancer. Oncology 2020; 98:452-459. [PMID: 32182616 DOI: 10.1159/000505973] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 01/16/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND The present study sought to evaluate host-related factors as predictors in patients receiving chemotherapy for recurrent advanced gastric cancer. METHODS Sixty-three patients were enrolled in the study and received chemotherapy for recurrent gastric cancer at the Kochi Medical School from 2008 to 2015. Clinicopathological information and systemic inflammatory response data were obtained retrospectively to investigate associations between baseline cancer-related prognostic variables and survival outcomes. RESULTS The median survival time was significantly higher for patients with a Glasgow prognostic score (GPS) of 0 compared to a GPS of 1 or 2 (18.2 vs. 7.1 months; p = 0.006), and for patients in the normal range for carbohydrate antigen-125 (CA125) compared to higher levels (17.9 vs. 4.1 months; p = 0.003). There was no significant influence on overall survival by age, gender, disease status, metastatic site, time to recurrence, carcinoembryonic antigen level, CA19-9 level, prognostic nutrition index, or neutrophil to lymphocyte ratio according to the results of the univariate log-rank tests. Multivariate survival analysis identified a GPS of 1 or 2 (hazard ratio, 3.520; 95% confidence interval, 1.343-9.227; p = 0.010) and a high CA125 level (hazard ratio, 3.135; 95% confidence interval, 1.276-7.697; p = 0.013) as significant independent predictors associated with a poorer prognosis in the studied group of cancer patients. CONCLUSIONS A GPS of 1 or 2 and a high level of CA125 are independent predictors of a poorer prognosis in patients receiving chemotherapy for recurrent gastric cancer.
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Affiliation(s)
| | | | | | - Jun Iwabu
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | - Sunao Uemura
- Department of Surgery, Kochi Medical School, Kochi, Japan
| | | | | | | | - Masamitsu Kumon
- Department of Surgery, Noichi Central Hospital, Kochi, Japan
| | - Michiya Kobayashi
- Department of Human Health and Medical Sciences, Kochi Medical School, Kochi, Japan
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Fukudome I, Dabanaka K, Yokota K, Ishida N, Uemura S, Namikawa T, Iguchi M, Toi M, Hanazaki K. Emphysematous Gastritis Which Coincided with Portal Venous Gas, and Mediastinal Emphysema with Anorexia Nervosa. Jpn J Gastroenterol Surg 2019. [DOI: 10.5833/jjgs.2018.0142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Affiliation(s)
| | | | | | | | | | | | - Mitsuko Iguchi
- Laboratory of Diagnostic Pathology, Kochi Medical School Hospital
| | - Makoto Toi
- Laboratory of Diagnostic Pathology, Kochi Medical School Hospital
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