Kazuhiro Mikagi

Publications (10)3.77 Total impact

• Article: [Endoscopic retrograde biliary drainage for the liver metastases from colorectal cancer and obstructive jaundice].

  Yuhei Kitasato, Yusuke Ishida, Yoshinobu Okabe, Osamu Tsuruta, Munehiro Yoshitomi, Gen Akasu, Kazuhiro Mikagi, Yousuke Oka, Yuichirou Maruyama, Ryuichi Kawahara, Hisamune Sakai, Hiroto Ishikawa, Toru Hisaka, Masafumi Yasunaga, Hiroyuki Horiuchi, Yoshito Akagi, Koji Okuda, Hisafumi Kinoshita, Kazuo Shirouzu, Hiroyuki Tanaka
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  ABSTRACT: The success of biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice influences its prognosis greatly. In this study, we report a retrospective evaluation of endoscopic retrograde biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice. Materials and methods: From April 2004 to December 2011, 9 patients with liver metastases from colorectal cancer and obstructive jaundice who underwent endoscopic biliary drainage were evaluated retrospectively. Results: The mean serum levels of total bilirubin, aspartate aminotransferase, alanine aminotransferase, and alkaline phosphatase improved significantly after biliary drainage. The median survival time after biliary drainage was 133 days. Only 4 cases were able to resume chemotherapy after biliary drainage, and their prognosis was significantly better than patients who were not able to resume chemotherapy(p=0.014). Discussion: Endoscopic biliary drainage in patients with liver metastases from colorectal cancer and obstructive jaundice was effective, led to the resumption of chemotherapy, and improved prognosis. However, sufficient consideration of the patient's prognosis and performance status is required in order to perform biliary drainage.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1860-2.
• Article: Metastatic pulmonary adenocarcinoma 13 years after curative resection for pancreatic cancer: report of a case and review of Japanese literature.

  Yuhei Kitasato, Masamichi Nakayama, Gen Akasu, Munehiro Yoshitomi, Kazuhiro Mikagi, Yuichiro Maruyama, Ryuichi Kawahara, Hiroto Ishikawa, Toru Hisaka, Masafumi Yasunaga, Hiroyuki Horiuchi, Naoyuki Saito, Shinzo Takamori, Yoshinobu Okabe, Masayoshi Kage, Hisafumi Kinoshita, Hiroyuki Tanaka
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  ABSTRACT: For the majority of patients, ductal adenocarcinoma of the pancreas remains a lethal disease. Currently, surgical extirpation for localized disease offers the only chance for long-term survival. We report a patient who underwent successful resection of isolated lung metastasis occurring 13 years after pancreatic cancer resection. A 59-year-old woman underwent distal pancreatectomy for pancreatic cancer 13 years previously, followed by adjuvant chemotherapy, and was followed-up at the outpatient clinic of a local hospital. From around June 2010, she noticed bloody sputum, so she visited a local hospital. Since her chest X-ray and CT revealed a 1.5 cm mass shadow in the segment 10 of her right lung and she was referred to the Respiratory Disease Center of our hospital. As a result of through examinations, she was strongly suspected of having lung metastasis of pancreatic cancer, and underwent partial pneumonectomy. Postoperative histopathological examination of the resected specimen was consistent with lung metastasis of pancreatic cancer. She is still alive and currently receives third line of chemotherapy. Patients who have achieved long-term survival after pancreatic cancer resection and can tolerate surgery may benefit from resection of a lung metastasis of pancreatic cancer in terms of survival, if it controls the metastasis.
  JOP: Journal of the pancreas 01/2012; 13(3):296-300.
• Article: [A pilot study of intraperitoneal gemcitabine for reduction of peritoneal dissemination in advanced pancreatic cancer].

  Hiroyuki Horiuchi, Hidefumi Nogita, Yusuke Kawashima, Yuhei Kitazato, Masakane Akashi, Gen Akasu, Kazuhiro Mikagi, Ryuichi Kawahara, Hiroto Ishikawa, Tohru Hisaka, Hisafumi Kinoshita, Kazuo Shirouzu, Yoshinobu Okabe
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  ABSTRACT: We schemed intraperitoneal gemcitabine (ipGEM) for reduction of peritoneal dissemination to three patients with unresectable and one patient with recurrent pancreatic cancer, followed by intraperitoneal catheter and subcutaneous port placement. Two locally advanced cases were performed for intra-operative radiotherapy, and one of 2 locally advanced cases was performed for gastrojejunostomy. And another locally advanced case had ileostomy. The recurrent case was resected for metastatic tumor of abdominal wall. In one of locally advanced cases, we couldn't perform ipGEM for progression of disease. In two remaining locally advanced cases, we could keep on doing ipGEM, and the patients did not experience with abdominal discomfort or hematological toxicity.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2087-9.
• Article: [An example case that chemoradiotherapy was succeeded for unresectable pancreas cancer].

  Yusuke Kawashima, Hiroyuki Horiuchi, Masanori Akashi, Hidefumi Nogita, Yuhei Kitasato, Gen Akasu, Kazuhiro Mikagi, Ryuichi Kawahara, Hiroto Ishikawa, Toru Hisaka, Hisafumi Kinoshita, Kazuo Shirouzu
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  ABSTRACT: BACKGROUND: Prognosis of pancreas cancer is extremely poor. For unresectable pancreas cancer, there has not been an effective method of treating. In our institution, the mean survival time was 13 . 6 months for a chemoradiotherapy case that used gemcitabine (GEM), but was 7.3 months for a non-treatment case in locally advanced and metastatic pancreas cancer. This time, we experienced a good case for unresectable pancreas cancer treated with chemoradiotherapy using GEM/S-1 that clearly exhibited a decrease in tumor size by tumor marker.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2155-7.
• Article: [A case of peritoneal recurrence of invasive carcinoma derived from IPMN after distal pancreatectomy].

  Yuhei Kitasato, Masafumi Yasunaga, Masamichi Nakayama, Gen Akasu, Munehiro Yoshitomi, Kazuhiro Mikagi, Ryuichi Kawahara, Hiroto Ishikawa, Toru Hisaka, Hiroyuki Horiuchi, Hisafumi Kinoshita, Yoshinobu Okabe
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  ABSTRACT: The patient was a 62-year-old man who underwent distal pancreatectomy and partial resection of transverse colon with diagnosis of cystic tumor of pancreas tail in July 2006. In histology, the tumor was an invasive carcinoma derived from intraductal tumor. So, Chemotherapy using gemcitabine (GEM) was administered. Eleven months after the operation, abdominal contrast-enhanced CT showed a cystic tumor in the subdiaphragm and CEA increased to 15 .2 ng/mL. Combination chemotherapy using GEM and S-1 was administered under the diagnosis of peritoneal recurrence. CEA decreased to a normal level, but 19 months after the operation, CA19-9 increased to 187 .7 U/mL. Then, radiotherapy (a total of 40 Gy) was performed. Twenty two months after the radiotherapy, though chemotherapy using S-1 was continued, CA19-9 re- increased to 134 .2 U/mL. Abdominal contrast-enhanced CT and PET detected no other recurrent lesion. A tumor resection was performed in January 2010. In immunostaining MUC1(+), MUC2(-), MUC5AC(+), MUC6(+) and mucus expression forms as well as with previous specimen, and was diagnosed as recurrence of the invasive carcinoma derived from intraductal tumor.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2161-4.
• Article: Accuracy of differential diagnosis for pancreatic cancer is improved in the combination of RCAS1 and CEA measurements and cytology in pancreatic juice.

  Yoshiki Naito, Yoshinobu Okabe, Masakatsu Nagayama, Takuya Nishinakagawa, Tomoki Taira, Akihiko Kawahara, Satoshi Hattori, Kazuyuki Machida, Yusuke Ishida, Ryohei Kaji, Kazuhiro Mikagi, Hisafumi Kinoshita, Makiko Yasumoto, Jun Akiba, Masayoshi Kage, Manabu Nakashima, Koichi Ohshima, Hirohisa Yano
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  ABSTRACT: Improvement of diagnostic accuracy for pancreatic cancer in pancreatic disease patients was investigated by examining the combination of three diagnostic methods, i.e., measurements of RCAS1 and CEA levels in pancreatic juice and pancreatic juice cytology. Pancreatic juice was collected from 12 pancreatic cancer (PC) and 26 non-PC patients. RCAS1 and CEA levels were measured by using ELISA. RCAS1 expression on surgically resected tissue was immunohistochemically examined for 2 PC patients. By setting the cutoff level of RCAS1 at 10 U/ml and that of CEA at 18.5 μg/ml, sensitivity of RCAS1 was 42% and that of CEA was 50%. On the other hand, sensitivity and specificity increased from 42% and 85% of RCAS1 alone to 75% and 85% in the examination of RCAS1 + CEA + cytology, and the false-negative rate was also reduced to 25% in this combination. Immunohistochemically, a patient with a high RCAS1 level in pancreatic juice had numerous RCAS1-positive tumor cells in the pancreatic juice. We concluded that RCAS1 and CEA measurements together with cytology in pancreatic juice would be a useful combination method for making a differential diagnosis of PC from non-PC.
  Medical Molecular Morphology 06/2011; 44(2):86-92. · 1.39 Impact Factor
• Article: [Liver histology and surgical outcomes after preoperative chemotherapy in colorectal cancer liver metastases].

  Toru Hisaka, Hiroyuki Horiuchi, Shinji Uchida, Hiroto Ishikawa, Yutaka Ogata, Yoshito Akagi, Nobuya Ishibashi, Ryuichi Kawahara, Yuichiro Maruyama, Kazuhiro Mikagi, Yusuke Kawashima, Manami Fujishita, Daimei Eto, Munehiro Yoshidomi, Rin Yamaguchi, Masayoshi Kage, Hirohisa Yano, Hisafumi Kinoshita, Kazuo Shirozu
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  ABSTRACT: We aimed to assess hepatic histopathological responses to preoperative chemotherapy in patients with colorectal liver metastasis. We selected all patients(n=34)with colorectal liver metastases between September 2006 and March 2009. The preoperative chemotherapy group was significantly associated with tumor regression, inflammatory response, sinusoidal dilatation compared with non-chemotherapy group. There was no difference in the rate of postoperative complications and hospital stay. Prolonged preoperative systemic chemotherapy alters liver parenchyma, but it does not increase postoperative complications. This should be taken into consideration before deciding a major liver resection in patients who have received preoperative chemotherapy.
  Gan to kagaku ryoho. Cancer & chemotherapy 04/2011; 38(4):585-9.
• Article: Effect of preoperative immunonutrition in patients undergoing hepatectomy; a randomized controlled trial.

  Kazuhiro Mikagi, Ryuichi Kawahara, Hisafumi Kinoshita, Shigeaki Aoyagi
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  ABSTRACT: No consensus has been reached concerning the effects of preoperative immunonutrition in patients undergoing hepatectomy. We evaluated the effects of immunonutrition before hepatectomy on perioperative management. This study was performed as a randomized controlled trial. Patients expected to undergo segmentectomy or more extensive hepatectomy for liver tumors were randomized to immunonutrition (IM) and control (C) groups each consisting of 13 patients. The IM group was given 750 ml of IMPACT in addition to half-size hospital meals orally from 5 days before to the day before surgery, and the C group was given conventional hospital meals. The blood level of eicosapentaenoic acid was elevated preoperatively in all patients of the IM group. The white blood cell count and interleukin 6 levels, which are indices of postoperative inflammation, were significantly lower in the IM group. As regards liver function, postoperative increases in the aspartate aminotransferase and alanine aminotransaminase levels were slightly suppressed in the IM group. No significant difference was noted in postoperative complications or duration of postoperative hospital stay. In patients undergoing hepatectomy, preoperative immunonutrition reduced inflammation and protected against liver dysfunction.
  The Kurume Medical Journal 01/2011; 58(1):1-8.
• Article: Perioperative challenges associated with a pancreaticoduodenectomy and distal pancreatectomy for pancreatic cancer in patients with situs inversus totalis: report of two cases.

  Yuichiro Maruyama, Hiroyuki Horiuchi, Yoshinobu Okabe, Ryuichi Kawahara, Shinji Uchida, Takenori Sakai, Toru Hisaka, Hiroto Ishikawa, Kazuhiro Mikagi, Munehiro Yoshitomi, Yusuke Kawashima, Manami Fujishita, Gen Akasu, Mitsuru Katsumoto, Daimei Eto, Mitsutoshi Ureshino, Yuichi Goto, Hiroki Ureshino, Hisafumi Kinoshita
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  ABSTRACT: Situs inversus totalis is a rare anatomic variant of a complete mirror-image transposition of the thoracic and abdominal viscera. The performance of a pancreaticoduodenectomy and distal pancreatectomy in patients with situs inversus totalis is both rare and challenging. We herein present two cases of pancreatic cancer with situs inversus totalis. The abdominal anatomy was preoperatively assessed by multidetectorrow computed tomography, three-dimensional reconstruction, and angiography. We herein report that a pancreaticoduodenectomy and distal pancreatectomy with standard regional lymphadenectomy are feasible in patients with situs inversus totalis. Due to the transposition of the viscera and major blood vessels in such cases, preoperative knowledge of the exact anatomy, mapping of anomalies, and meticulous forward planning are essential for performing these technically difficult and complex hepatobiliary-pancreatic surgeries.
  Surgery Today 01/2010; 40(1):79-82. · 1.22 Impact Factor
• Article: Usefulness of lavage cytology during endoscopic transpapillary catheterization into the gallbladder in the cytological diagnosis of gallbladder disease.

  Yoshiki Naito, Yoshinobu Okabe, Akihiko Kawahara, Tomoki Taira, Yusuke Isida, Ryouhei Kaji, Michio Sata, Hiroki Ureshino, Kazuhiro Mikagi, Hisafumi Kinoshita, Makiko Yasumoto, Hironori Kusano, Masayoshi Kage, Hirohisa Yano
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  ABSTRACT: Many studies have reported methods of cell collection involving percutaneous transhepatic cholangiodrainage (PTCD) and fine-needle aspiration cytology for the diagnosis of gallbladder disease. However, few studies have described the use of a transpapillary approach, i.e., endoscopic transpapillary catheterization into the gallbladder (ETCG). In this study, we analyzed cells collected by ETCG to evaluate its usefulness in the cytological diagnosis of gallbladder disease. The subjects were 19 patients who had undergone ETCG for the diagnosis of gallbladder disease. Of these patients, 11 and 8 had gallbladder cancer and benign gallbladder disease, respectively. We also evaluated the diagnostic accuracy of PTCD cytology performed in 15 patients with gallbladder cancer.Specimens were cytologically diagnosed as normal or benign, indeterminate, suspected malignancy, malignant, and inadequate in 47% (9/19), 11% (2/19), 0% (0/19), 37% (7/19), and 5% (1/19) of patients, respectively. Specimens were diagnosed as malignant, indeterminate, normal or benign, and inadequate in 7, 2, 1, and 1, respectively, of the 11 patients diagnosed with gallbladder cancer. The sensitivity and specificity of ETCG cytology were 78 and 100%, respectively, whereas the diagnostic accuracy of PTCD cytology was 20% (3/15). None of the patients developed complications of ETCG. Despite its technical difficulty, ETCG for bile cytology allows the collection of adequate cell numbers from patients with benign disease or gallbladder cancer and facilitates a cytological diagnosis, making it a useful method for collecting cells.
  Diagnostic Cytopathology 03/2009; 37(6):402-6. · 1.16 Impact Factor