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Hashimoto D, Mizuma M, Kumamaru H, Miyata H, Chikamoto A, Igarashi H, Itoi T, Egawa S, Kodama Y, Satoi S, Hamada S, Mizumoto K, Yamaue H, Yamamoto M, Kakeji Y, Seto Y, Baba H, Unno M, Shimosegawa T, Okazaki K. Risk model for severe postoperative complications after total pancreatectomy based on a nationwide clinical database. Br J Surg 2020; 107:734-742. [PMID: 32003458 DOI: 10.1002/bjs.11437] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Revised: 07/18/2019] [Accepted: 10/28/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Total pancreatectomy is required to completely clear tumours that are locally advanced or located in the centre of the pancreas. However, reports describing clinical outcomes after total pancreatectomy are rare. The aim of this retrospective observational study was to assess clinical outcomes following total pancreatectomy using a nationwide registry and to create a risk model for severe postoperative complications. METHODS Patients who underwent total pancreatectomy from 2013 to 2017, and who were recorded in the Japan Society of Gastroenterological Surgery and Japanese Society of Hepato-Biliary-Pancreatic Surgery database, were included. Severe complications at 30 days were defined as those with a Clavien-Dindo grade III needing reoperation, or grade IV-V. Occurrence of severe complications was modelled using data from patients treated from 2013 to 2016, and the accuracy of the model tested among patients from 2017 using c-statistics and a calibration plot. RESULTS A total of 2167 patients undergoing total pancreatectomy were included. Postoperative 30-day and in-hospital mortality rates were 1·0 per cent (22 of 2167 patients) and 2·7 per cent (58 of 167) respectively, and severe complications developed in 6·0 per cent (131 of 2167). Factors showing a strong positive association with outcome in this risk model were the ASA performance status grade and combined arterial resection. In the test cohort, the c-statistic of the model was 0·70 (95 per cent c.i. 0·59 to 0·81). CONCLUSION The risk model may be used to predict severe complications after total pancreatectomy.
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Affiliation(s)
- D Hashimoto
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan.,Department of Gastroenterological Surgery, Omuta Tenryo Hospital, Fukuoka, Japan
| | - M Mizuma
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - H Kumamaru
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan
| | - H Miyata
- Department of Healthcare Quality Assessment, University of Tokyo, Tokyo, Japan.,Department of Health Policy and Management, Keio University, Tokyo, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - H Igarashi
- Department of Medicine and Bioregulatory Science, Kyushu University, Fukuoka, Japan
| | - T Itoi
- Department of Gastroenterology, Tokyo Medical University, Tokyo, Japan
| | - S Egawa
- Division of International Cooperation for Disaster Medicine, Tohoku University, Miyagi, Japan
| | - Y Kodama
- Division of Gastroenterology, Department of Internal Medicine, Kobe University, Kobe, Japan
| | - S Satoi
- Department of Surgery, Kansai Medical University, Osaka, Japan
| | - S Hamada
- Division of Gastroenterology, Tohoku University, Miyagi, Japan
| | - K Mizumoto
- Cancer Centre, Kyushu University Hospital, Fukuoka, Japan
| | - H Yamaue
- Second Department of Surgery, Wakayama Medical University, Wakayama, Japan
| | - M Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Y Kakeji
- Division of Gastrointestinal Surgery, Department of Surgery, Kobe University, Kobe, Japan
| | - Y Seto
- Department of Gastrointestinal Surgery, University of Tokyo, Tokyo, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Kumamoto University, Kumamoto, Japan
| | - M Unno
- Department of Surgery, Tohoku University, Miyagi, Japan
| | - T Shimosegawa
- Department of Gastroenterology, South Miyagi Medical Centre, Miyagi, Japan
| | - K Okazaki
- Department of Gastroenterology and Hepatology, Kansai Medical University, Osaka, Japan
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2
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Shiraishi Y, Imai K, Yamashita YI, Nakao Y, Nakagawa S, Okabe H, Nitta H, Chikamoto A, Baba H. Hepatobiliary and Pancreatic: Segmental arterial mediolysis of pancreaticoduodenal artery accompanied by acute pancreatitis and duodenal obstruction. J Gastroenterol Hepatol 2018; 33:1564-1564. [PMID: 29691909 DOI: 10.1111/jgh.14138] [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] [Indexed: 12/09/2022]
Affiliation(s)
- Y Shiraishi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Y-I Yamashita
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Nakao
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Miyata T, Yamashita Y, Yamao T, Umezaki N, Tsukamoto M, Kitano Y, Yamamura K, Arima K, Kaida T, Nakagawa S, Imai K, Hashimoto D, Chikamoto A, Ishiko T, Asato T, Mikami Y, Aishima S, Baba H. Hepatobiliary and Pancreatic: Hepatocellular carcinoma developed with angiomyolipoma. J Gastroenterol Hepatol 2017; 32:547. [PMID: 28320064 DOI: 10.1111/jgh.13655] [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: 09/24/2016] [Accepted: 11/12/2016] [Indexed: 12/09/2022]
Affiliation(s)
- T Miyata
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Yamashita
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Yamao
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - N Umezaki
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - M Tsukamoto
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - Y Kitano
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Yamamura
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Arima
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Kaida
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Imai
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Ishiko
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Asato
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - Y Mikami
- Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan
| | - S Aishima
- Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of life Sciences, Kumamoto University, Kumamoto, Japan
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4
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Arima K, Ishimoto T, Ohmuraya M, Okabe H, Kitano Y, Yamamura K, Kaida T, Nakagawa S, Imai K, Hashimoto D, Chikamoto A, Yamashita YI, Baba H. 20P Verification of mechanism that CSC markers are implicated in poor prognosis for pancreatic ductal adenocarcinoma. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw573.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Arima K, Ishimoto T, Ohmuraya M, Okabe H, Kitano Y, Yamamura K, Kaida T, Nakagawa S, Imai K, Hashimoto D, Chikamoto A, Yamashita YI, Baba H. 20P Verification of mechanism that CSC markers are implicated in poor prognosis for pancreatic ductal adenocarcinoma. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00182-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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6
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Daitoku N, Okabe H, Hashimoto D, Chikamoto A, Hayashi H, Nitta H, Taki K, Higashi T, Kaida T, Arima K, Ishiko T, Beppu T, Baba H. Education and Imaging. Hepatobiliary and Pancreatic: Replaced common hepatic artery on left gastric artery: a rare anomaly and implication for pancreaticoduodenectomy. J Gastroenterol Hepatol 2015; 30:1695. [PMID: 26768946 DOI: 10.1111/jgh.12968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- N Daitoku
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Taki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Higashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Kaida
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Arima
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Ishiko
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Beppu
- Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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Okabe H, Hashimoto D, Chikamoto A, Hayashi H, Nitta H, Taki K, Higashi T, Arima K, Ishiko T, Beppu T, Baba H. Hepatobiliary and Pancreatic: Skin metastases from cholangiocarcinoma mimicking herpes zoster. J Gastroenterol Hepatol 2015. [PMID: 26211694 DOI: 10.1111/jgh.12964] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- H Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Taki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Higashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - K Arima
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Ishiko
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - T Beppu
- Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
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8
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Arima K, Chikamoto A, Hashimoto D, Kaida T, Higashi T, Taki K, Takeyama H, Okabe H, Nitta H, Hayashi H, Beppu T, Baba H. Education and Imaging. Hepatology: Hepatocellular carcinoma with duodenal metastasis. J Gastroenterol Hepatol 2015; 30:1115. [PMID: 26094663 DOI: 10.1111/jgh.12868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- K Arima
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Kaida
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Higashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Taki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Takeyama
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Okabe
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Beppu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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9
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Kuroki H, Hayashi H, Nakagawa S, Sakamoto K, Higashi T, Nitta H, Hashimoto D, Chikamoto A, Beppu T, Baba H. Effect of LSKL peptide on thrombospondin 1-mediated transforming growth factor β signal activation and liver regeneration after hepatectomy in an experimental model. Br J Surg 2015; 102:813-25. [PMID: 25866938 PMCID: PMC4654236 DOI: 10.1002/bjs.9765] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [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: 04/26/2014] [Revised: 07/24/2014] [Accepted: 12/04/2014] [Indexed: 12/16/2022]
Abstract
Background A strategy for accelerating liver regeneration after hepatectomy would offer great benefits in preventing postoperative liver failure and improving surgical outcomes. Transforming growth factor (TGF) β is a potent inhibitor of hepatocyte proliferation. Recently, thrombospondin (TSP) 1 has been identified as a negative regulator of liver regeneration by activation of local TGF-β signals. This study aimed to clarify whether the LSKL (leucine–serine–lysine–leucine) peptide, which inhibits TSP-1-mediated TGF-β activation, promotes liver regeneration after hepatectomy in mice. Methods Mice were operated on with a 70 per cent hepatectomy or sham procedure. Operated mice received either LSKL peptide or normal saline intraperitoneally at abdominal closure and 6 h after hepatectomy. Perioperative plasma TSP-1 levels were measured by enzyme-linked immunosorbent assay in patients undergoing hepatectomy. Results Administration of LSKL peptide attenuated Smad2 phosphorylation at 6 h. S-phase entry of hepatocytes was accelerated at 24 and 48 h by LSKL peptide, which resulted in faster recovery of the residual liver and bodyweight. Haematoxylin and eosin tissue staining and blood biochemical examinations revealed no significant adverse effects following the two LSKL peptide administrations. In the clinical setting, plasma TSP-1 levels were lowest on the first day after hepatectomy. However, plasma TSP-1 levels at this stage were significantly higher in patients with subsequent liver dysfunction compared with levels in those without liver dysfunction following hepatectomy. Conclusion Only two doses of LSKL peptide during the early period after hepatectomy can promote liver regeneration. The transient inhibition of TSP-1/TGF-β signal activation using LSKL peptide soon after hepatectomy may be a promising strategy to promote subsequent liver regeneration.
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Affiliation(s)
- H Kuroki
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - K Sakamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - T Higashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - T Beppu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860–8556, Japan
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Itoyama R, Hashimoto D, Chikamoto A, Hayashi H, Beppu T, Baba H. Hepatobiliary and pancreatic: sigmoidal mesenterial lymph node metastasis from pancreatic cancer. J Gastroenterol Hepatol 2014; 29:1953. [PMID: 25404108 DOI: 10.1111/jgh.12807] [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] [Indexed: 12/09/2022]
Affiliation(s)
- R Itoyama
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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11
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Mima K, Beppu T, Ishiko T, Chikamoto A, Nakagawa S, Hayashi H, Watanabe M, Sakamaki K, Baba H. Preoperative serum hyaluronic acid level as a prognostic factor in patients undergoing hepatic resection for hepatocellular carcinoma. Br J Surg 2014; 101:269-76. [DOI: 10.1002/bjs.9343] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2013] [Indexed: 11/09/2022]
Abstract
Abstract
Background
Hyaluronic acid (HA) probably plays a critical role in tumorigenesis. The clinical significance of serum HA concentration in patients with hepatocellular carcinoma (HCC) remains to be elucidated. This study analysed the relationship between preoperative serum HA levels and prognosis after hepatic resection in patients with HCC.
Methods
Consecutive patients who underwent hepatic resection for HCC between September 1999 and March 2012 were included in this retrospective study. Serum HA levels were measured within 4 weeks before surgery by an immunoturbidimetric automated latex assay. The cut-off level for preoperative serum HA was validated using a time-dependent receiver operating characteristic (ROC) curve analysis. The prognostic impact of preoperative serum HA levels was analysed using Cox proportional hazards models.
Results
A total of 506 patients of median age 66 years (405 men, 80·0 per cent) were analysed. The median length of follow-up was 32 months. High serum HA levels (100 ng/ml or above) were associated with shorter recurrence-free survival (P < 0·001) (hazard ratio (HR) 1·50, 95 per cent confidence interval 1·17 to 1·93; P = 0·002) and overall survival (P = 0·001) (HR 1·46, 1·03 to 2·07; P = 0·033). In patients with HCC without severe liver fibrosis, serum HA level was correlated with multiple tumours (P = 0·039), early recurrence (P = 0·033), and poor recurrence-free (P < 0·001) and overall (P = 0·024) survival.
Conclusion
High preoperative serum HA levels predict poor prognosis in patients with HCC after hepatic resection, and may serve as a future biomarker.
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Affiliation(s)
- K Mima
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - T Beppu
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
- Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto, Japan
| | - T Ishiko
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - K Sakamaki
- Department of Biostatistics and Epidemiology, Graduate School of Medicine, Yokohama City University, Yokohama, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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12
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Okabe H, Ishimoto T, Mima K, Nakagawa S, Hayashi H, Kuroki H, Imai K, Nitta H, Saito S, Hashimoto D, Chikamoto A, Ishiko T, Watanabe M, Nagano O, Beppu T, Saya H, Baba H. CD44s signals the acquisition of the mesenchymal phenotype required for anchorage-independent cell survival in hepatocellular carcinoma. Br J Cancer 2013; 110:958-66. [PMID: 24300972 PMCID: PMC3929866 DOI: 10.1038/bjc.2013.759] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [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: 08/10/2013] [Revised: 09/24/2013] [Accepted: 11/11/2013] [Indexed: 12/11/2022] Open
Abstract
Background: Circulating tumour cells (CTCs) have an important role in metastatic processes, but details of their basic characteristics remain elusive. We hypothesised that CD44-expressing CTCs show a mesenchymal phenotype and high potential for survival in hepatocellular carcinoma (HCC). Methods: Circulating CD44+CD90+ cells, previously shown to be tumour-initiating cells, were sorted from human blood and their genetic characteristics were compared with those of tumour cells from primary tissues. The mechanism underlying the high survival potential of CD44-expressing cells in the circulatory system was investigated in vitro. Results: CD44+CD90+ cells in the blood acquired epithelial–mesenchymal transition, and CD44 expression remarkably increased from the tissue to the blood. In Li7 and HLE cells, the CD44high population showed higher anoikis resistance and sphere-forming ability than did the CD44low population. This difference was found to be attributed to the upregulation of Twist1 and Akt signal in the CD44high population. Twist1 knockdown showed remarkable reduction in anoikis resistance, sphere formation, and Akt signal in HLE cells. In addition, mesenchymal markers and CD44s expression were downregulated in the Twist1 knockdown. Conclusions: CD44s symbolises the acquisition of a mesenchymal phenotype regulating anchorage-independent capacity. CD44s-expressing tumour cells in peripheral blood are clinically important therapeutic targets in HCC.
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Affiliation(s)
- H Okabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - T Ishimoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - K Mima
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - S Nakagawa
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - H Hayashi
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - H Kuroki
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - K Imai
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - H Nitta
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - S Saito
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - D Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - A Chikamoto
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - T Ishiko
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - M Watanabe
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - O Nagano
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, Minato, Japan
| | - T Beppu
- 1] Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan [2] Department of Multidisciplinary Treatment for Gastroenterological Cancer, Kumamoto University Hospital, Kumamoto 860-8556, Japan
| | - H Saya
- Division of Gene Regulation, Institute for Advanced Medical Research, School of Medicine, Keio University, Minato, Japan
| | - H Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, 1-1-1 Honjo, Kumamoto 860-8556, Japan
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13
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Hashimoto D, Chikamoto A, Hirota M, Beppu T, Baba H. Education and Imaging. Hepatobiliary and pancreatic: huge bile duct stones after hepaticojejunostomy. J Gastroenterol Hepatol 2013; 28:764. [PMID: 23614344 DOI: 10.1111/jgh.12174] [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] [Indexed: 12/09/2022]
Affiliation(s)
- D Hashimoto
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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14
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Matsuura K, Hashimoto D, Ikuta Y, Chikamoto A, Beppu T, Baba H. Education and imaging. Hepatobiliary and pancreatic: cystic bile duct remnant after surgery for a choledochal cyst. J Gastroenterol Hepatol 2013; 28:754. [PMID: 23527761 DOI: 10.1111/jgh.12126] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Affiliation(s)
- K Matsuura
- Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, Kumamoto, Japan
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15
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Hirota M, Hashimoto D, Ishiko T, Satoh N, Takamori H, Chikamoto A, Tanaka H, Sugita H, Sand J, Nordback I, Baba H. Distal pancreatectomy using a no-touch isolation technique. Scand J Surg 2013; 101:156-9. [PMID: 22968237 DOI: 10.1177/145749691210100303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Distal pancreatectomy is the only effective treatment for cancers of the pancreatic body and tail. The recurrence rate after DP has remained high. In an effort to over-come this problem, we developed a no-touch surgical technique for DP. This is a pilot study to see if distal pancreatectomy can be technically done using a no-touch surgical technique with-out deteriorating the post-operative prognosis. PATIENTS AND METHODS From November 2000 through May 2011, 16 pancreatic ductal adeno-carcinoma patients have been operated on using a no-touch technique by a single operator. We described the surgical technique, and we reported our preliminary experience. During the procedure, the pancreatic body and tail is neither grasped nor squeezed by the surgeon. And all drainage vessels from the pancreatic body and tail are ligated and divided during the early phase of the operation. Furthermore, for improved dissection of the retroperitoneal tissue (rightward and posterior margins), we use a hanging and clamping maneuver and dissection behind Gerota's fascia. RESULTS In the current series, the posterior and rightward resection margins were free in all patients, although seven were positive for anterior serosal invasion. The post-operative prognosis was not deteriorated with this technique. CONCLUSION No-touch distal pancreatectomy technique may have some theoretical advantages, which merit future investigation in randomized controlled trials.
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Affiliation(s)
- M Hirota
- Department of Surgery, Kumamoto Regional Medical Center, Kumamoto-city, Kumamoto, Japan.
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16
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Otao R, Beppu T, Isiko T, Mima K, Okabe H, Hayashi H, Masuda T, Chikamoto A, Takamori H, Baba H. External biliary drainage and liver regeneration after major hepatectomy. Br J Surg 2012; 99:1569-74. [PMID: 23027074 DOI: 10.1002/bjs.8906] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bile acid signalling and farnesoid X receptor activation are assumed to be essential for liver regeneration. This study was designed to investigate the association between serum bile acid levels and extent of liver regeneration after major hepatectomy. METHODS Patients who underwent left- or right-sided hemihepatectomy between 2006 and 2009 at the authors' institution were eligible for inclusion. Patients were divided into two groups: those undergoing hemihepatectomy with external bile drainage by cystic duct tube (group 1) and those having hemihepatectomy without drainage (group 2). Serum bile acid levels were measured before and after hepatectomy. Computed tomography was used to calculate liver volume before hepatectomy and remnant liver volume on day 7 after surgery. RESULTS A total of 46 patients were enrolled. Mean(s.d.) serum bile acid levels on day 3 after hemihepatectomy were significantly higher in group 2 than in group 1 (11·6(13·5) versus 2·7(2·1) µmol/l; P = 0·003). Regenerated liver volumes on day 7 after hepatectomy were significantly greater in group 2 138·1(135·9) ml versus 40·0(158·8) ml in group 1; P = 0·038). Liver regeneration volumes and rates on day 7 after hemihepatectomy were positively associated with serum bile acid levels on day 3 after hemihepatectomy (P = 0·006 and P < 0·001 respectively). The incidence of bile leakage was similar in the two groups. CONCLUSION Initial liver regeneration after major hepatectomy was less after biliary drainage and was associated with serum bile acid levels. External biliary drainage should be used judiciously after liver resection.
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Affiliation(s)
- R Otao
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
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17
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Baba H, Watanabe M, Okabe H, Miyamoto Y, Sakamoto Y, Baba Y, Iwatsuki M, Chikamoto A, Beppu T. Upregulation of ERCC1 and DPD expressions after oxaliplatin-based first-line chemotherapy for metastatic colorectal cancer. Br J Cancer 2012; 107:1950-5. [PMID: 23169295 PMCID: PMC3516688 DOI: 10.1038/bjc.2012.502] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The updated randomised phase 2/3 FIRIS study demonstrated the noninferiority of IRIS (irinotecan and S-1) to FOLFIRI (irinotecan, folinic acid, and 5-FU) for metastatic colorectal cancer. Meanwhile, in the subset analysis including patients who previously have undergone oxaliplatin-containing chemotherapy, the IRIS group showed longer survival than the FOLFIRI group. However, the molecular mechanism underlying this result is still unknown. METHODS The National Cancer Institute 60 (NCI60) cell line panel data were utilised to build the hypothesis. A total of 45 irinotecan-naive metastatic colorectal cancer patients who had undergone hepatic resection were included for the validation study. The mRNA expressions of excision repair cross-complementing group 1 (ERCC1), dihydropyrimidine dehydrogenase (DPD), and topoisomerase-1 (TOP1) were evaluated by quantitative RT-PCR. The expressions of ERCC1 and DPD were also evaluated by immunohistochemistry. RESULTS Sensitivity to oxaliplatin in 60 cell lines was significantly correlated with that of 5-FU. Resistant cells to oxaliplatin showed significantly higher ERCC1 and DPD expression than sensitive cells. In validation study, ERCC1 and DPD but not TOP1 expressions in cancer cells were significantly higher in FOLFOX (oxaliplatin, folinic acid, and 5-FU)-treated patients (N=24) than nontreated patients (N=21). The ERCC1 and DPD protein expressions were also significantly higher in FOLFOX-treated patients. CONCLUSION The ERCC1 and DPD expression levels at both mRNA and protein levels were significantly higher in patients with oxaliplatin as a first-line chemotherapy than those without oxaliplatin. The IRIS regimens with the DPD inhibitory fluoropyrimidine may show superior activity against DPD-high tumours (e.g., tumours treated with oxaliplatin) compared with FOLFIRI.
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Affiliation(s)
- H Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Science, Kumamoto University, 1-1-1, Honjo, Kumamoto, 860-8556, Japan.
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Hayashi N, Satoh N, Chikamoto A, Ikeda O, Horino K, Watanabe M, Ishiko T, Takamori H, Beppu T, Baba H. Cost-effectiveness analysis of hepatic resection after chemotherapy in the management of patients with initially unresectable colorectal liver metastases. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e16554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Takamori H, Kanemitsu K, Chikamoto A, Ishiko T, Beppu T, Hirota M, Baba H. A novel multimodality treatment for resectable pancreatic cancer (PC). J Clin Oncol 2007. [DOI: 10.1200/jco.2007.25.18_suppl.4630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4630 Background: Patients with PC often suffer from tumor recurrence despite curative resection, thus indicating that systemic therapy added to local control might be required to further improve the survival. The aim of this phase II trial was to assess the feasibility and tolerance as well as overall survival of a novel multimodality therapy composed of pancreatic resection and intraoperative radiation therapy (IORT) combined with neoadjuvant (NAC) and adjuvant (AC) combination chemotherapy for patients with PC. Methods: Eligibility criteria included: no distant metastases / no tumor extension to the CA or the SMA by imaging, tumor size ≥ 1 cm, ECOG PS ≤ 2, age < 80, and normal organ function. For NAC, 5-FU was administered at a dose of 125 mg/m2 on days 1–5 every week as a continuous pancreatic and hepatic arterial infusion, and gemcitabine was infused intravenously at a dose of 800 mg/m2 for 30 min once weekly for 2 weeks. Pancreatic resection combined with IORT (30 Gy, 12 Mev of electron beam) was performed after a one-week rest following the completion of NAC. AC was performed in the same regimen as NAC after the recovery from surgery. We performed intension to treat analyses. Results: Between 2001 and 2006, 32 pts were enrolled: 32 received NAC, 28 received AC, and 28 received IORT. Of 32 pts given NAC, 13 had grade 3–4 hematological toxicity. All pts underwent surgery, including R0 resection in 26 pts, without delay by NAC- related toxicity. Of 28 pts given AC, 18 had grade 3–4 hematological, and 6 had non-hematological toxicity, although no chemotherapy-related death was observed. The median follow-up period was 20 months (rang 3.9 to 67.4). Overall survivals at 1, 3, and 5 years were 77.0 %, 60.2 %, and 48.1 %, respectively. Median survival was 38.5 months. Conclusions: This new multimodality treatment is feasible and tolerable, and may contribute to the survival benefit of patients with PC. No significant financial relationships to disclose.
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Affiliation(s)
| | | | | | - T. Ishiko
- Kumamoto University, Kumamoto, Japan
| | - T. Beppu
- Kumamoto University, Kumamoto, Japan
| | - M. Hirota
- Kumamoto University, Kumamoto, Japan
| | - H. Baba
- Kumamoto University, Kumamoto, Japan
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Tsuji T, Kanemitsu K, Hiraoka T, Takamori H, Toyama E, Tanaka H, Chikamoto A, Kawasuji M. A new method to establish the rational extent of hepatic resection for advanced gallbladder cancer using dye injection through the cystic artery. HPB (Oxford) 2004; 6:33-66. [PMID: 18333043 PMCID: PMC2020642 DOI: 10.1080/13651820410026086] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatic resection has been indicated to eliminate cancer at the surgical margin in cases of advanced gallbladder carcinoma, but there is considerable controversy about the reasonable extent of liver resection. A new on-table dye injection technique has been introduced to determine the venous drainage of the gallbladder and ascertain the amount of liver to remove. METHODS In four hepatic resections for pT2 gallbladder cancer, indocyanine green solution (25 mg/20 ml) was injected over a period of 30 seconds through the cystic artery. The stained area of the liver surface was completely resected, maintaining a margin of at least 2 cm from the gallbladder. RESULTS The entire serosal surface of the gallbladder takes on a light green stain immediately after dye injection, and then the liver surface around the gallbladder gradually becomes stained with a clear demarcation line. The distance between the demarcation line and the gallbladder ranged from 1.0 to 5.0 cm. The extent of the stained area differed from one individual to another. Histopathological examination of resected liver specimens revealed that one of the four resected livers had micrometastasis in the portal area 27 mm from the gallbladder wall and there were no cancer cells at the surgical margins. No recurrence has been seen in any of our 4 patients at 16-26 months after operation. DISCUSSION The dye injection method is useful in determining the appropriate extent of hepatic resection for advanced gallbladder cancer, as it is possible to determine the necessary and sufficient amount of liver parenchyma that should be removed according to the perfusion area of the cystic veins in each individual patient.
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Affiliation(s)
- T Tsuji
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - K Kanemitsu
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - T Hiraoka
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - H Takamori
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - E Toyama
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - H Tanaka
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - A Chikamoto
- First Department of Surgery, Kumamoto University School of MedicineJapan
| | - M Kawasuji
- First Department of Surgery, Kumamoto University School of MedicineJapan
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Yoshimura H, Chikamoto A, Honda T, Tashiro K, Nakamoto T, Takano M, Takagi K, Nagasue N, Soma G. Relationship between microvessel quantification and inducibility of endogenous tumor necrosis factor in colorectal adenocarcinoma. Anticancer Res 2000; 20:629-33. [PMID: 10769707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Although we have reported that the inducibility of endogenous tumor necrosis factor (en-TNF) by tumor cells is an independent prognostic factor in Dukes stage C colorectal cancer patients, the mechanism by which the patients having high inducibility of en-TNF show better prognosis is still unclear. We hypothesize that the inducibility of en-TNF by colorectal tumor cells affects the prognosis of patients through the modulation of angiogenesis. Thus, the aim of this study is to clarify the relationship between inducibility of en-TNF and tumor vascularity in colorectal cancer. PATIENTS AND METHODS Histological sections from 62 Dukes stage C colorectal cancer patients who received curative operation were immunostained for CD34 antigen. Microvessels were counted in the photograph of x200 fields (0.298 mm2). The average count of five most vascular areas was determined as a microvessel density of each case. RESULTS Two of 62 cases were excluded from the analysis, because of insufficient staining. A total of 60 patients were dichotomized by a median vessel count of 34 into two groups: 30 patients with lower microvessel density (Low MVD group) and 30 patients with higher microvessel density (High MVD group). There was no significance in the distribution of all clinicopathological factors among these two groups. Regarding en-TNF inducibility, no difference was shown between the two groups. The five year survival rate of Low MVD group and High MVD group were 58.7% and 68.0%, respectively. And, the 5 year relapse-free survival rate of Low MVD group and High MVD group were 59.7% and 52.2%, respectively. No significant difference was demonstrated between Low MVD group and High MVD group. CONCLUSION Intratumoral microvessel density did not influence on the prognosis of colorectal cancer patients in Dukes stage C after curative operation. The inducibility of en-TNF showed no correlation with intratumoral microvessel density in Dukes stage C patients after curative operation.
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Affiliation(s)
- H Yoshimura
- Department of Surgery, Takano Hospital, Kumamoto, Japan
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22
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Takagi K, Tomita K, Fukushima Y, Chikamoto A, Kanou J, Honda T, Yoshimura H, Nozaki R, Tashiro K, Soma G. Endogenous TNF inducibility and prognosis of colorectal cancer. Anticancer Res 1998; 18:4141-6. [PMID: 9891459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND We have demonstrated that the inducibility of endogenous TNF (en-TNF) by colorectal tumor cells is a factor in predicting a patient prognosis. The prognoses of colorectal tumor patients with the K-ras gene mutations in their tumors were poorer to those of patients with the wild type gene. Therefore, we analyzed the possible relationship between the inducibility of en-TNF by colorectal tumor cells during the follow-up of patients with K-ras mutations. MATERIALS AND PATIENTS In 62 of 154 Dukes Stage C patients who received curative operation from June 1988 to June 1997, the prognoses in terms of the tumor-free rate and survival rate were compared with the inducibility of en-TNF by colorectal tumor cells, which were classified into three groups: grade 1: > or = 500 pg/ml, grade 2: 100-500 pg/ml, and grade 3: < 100 pg/ml. Regardless of the Dukes Stage of the patients, the K-ras gene was analyzed in 21 whose colorectal tumor cells were classified as grade 1: 8, grade 2: 4, and grade 3: 9. RESULTS The tumor-free rate of the patients with grade 1 was significantly higher than that of the patients with grade 3, and the survival period of the patients with grades 1 and 2 was significantly longer than that of the patients with grade 3. Possible mutations disorder of K-ras were observed in 37.5% (grade 1), 50.0% (grade 2), and 88.9% (grade 3) of cases, respectively. CONCLUSION The prognostic value of the inducibility of en-TNF by colorectal tumor cells from colorectal cancer patients who received curative operation at Dukes Stage C was confirmed. It is suggested that K-ras mutation may affect patient prognosis through modulation of the quality and/or quantity of cytokines such as TNF produced by tumor cells.
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Affiliation(s)
- K Takagi
- Department of Surgery, Takano Hospital, Kumamoto, Japan
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