[Show abstract][Hide abstract] ABSTRACT: Because obesity is a risk factor during surgery, the effects of a preoperative exercise program to reduce the incidence of peri- and postoperative complications in patients with a high body mass index (>25 kg/m(2)) and metabolic syndrome were investigated. An assessment of the effects of prospectively planned preoperative exercise was performed in a prospective matching study comparing an exercise testing group and a usual preoperative preparation group who underwent gastrectomy for gastric cancer in Japan.
Stage I gastric cancer patients with metabolic syndrome diagnosed according to the criteria of the Japanese Ministry of Health, Labor, and Welfare underwent surgery after preoperative exercise. The control group was selected from a database using an individual matching approach for surgery, sex, weight, body mass index, volume of visceral fat, and institution. The primary end point was the frequency of postoperative complications such as cardiovascular events, pneumonia, and surgery-related abdominal complications.
Data from a total of 72 patients (54 in the surgery-alone group, 18 in the preoperative exercise group) were analyzed. The median operative time and amount of bleeding were 208 min and 130 ml in the surgery-alone group and 248 min and 105 ml in the exercise group, respectively. Postoperative complications occurred in one case (5.5 %) in the exercise group and 22 (40.7 %) cases in the surgery-alone group.
Preoperative exercise is safe, and its benefits in reducing postoperative complications are promising and therefore warrant further investigation.
[Show abstract][Hide abstract] ABSTRACT: We conducted a phase II trial to evaluate the efficacy and safety of preoperative chemotherapy with docetaxel (DTX) plus S-1 for resectable advanced gastric cancer.
A total of 47 patients from 14 centers were centrally registered. Patients received DTX (35 mg/m(2)) on days 1 and 15, and daily oral administration of S-1 (80 mg/m(2)/day) for days 1-14 every 4 weeks for two courses, followed by gastrectomy with D2 lymphadenectomy. The primary endpoint was pathological response rate (pRR). This study was registered in the UMIN clinical trial registry (UMIN000000875).
The primary endpoint pRR was 47 % (90 % confidence interval (CI), 34-60 %; p < 0.0001). The response rate to preoperative chemotherapy using Response Evaluation Criteria in Solid Tumors (RECIST) was 34 %. Forty-six patients (98 %) underwent surgery, and curative resection was performed in 44 patients. Thirty-seven patients completed the protocol treatment. The most common toxicities of neoadjuvant chemotherapy were grade 3/4 neutropenia (42 %), febrile neutropenia (4 %), grade 2 anorexia (21 %), and fatigue (15 %). Treatment-related death and operative mortality was not observed in this study.
The combination of docetaxel and S-1 was well tolerated. This is promising as a preoperative chemotherapy regimen for patients with potentially resectable advanced gastric cancer.
[Show abstract][Hide abstract] ABSTRACT: We describe here a thoracic esophageal cancer with an unusual type of duplicated inferior vena cava. A 58-year-old man was referred to our hospital because a tumor in his lower esophagus had been identified by endoscopy and radiology. Computed tomography scans showed an unusual type of duplicated inferior vena cava characterized by both common iliac veins flowing back into the left-sided inferior vena cava, which drained into the azygos vein, whereas the right-sided one had no drainage. Esophagectomy was performed 3 weeks later after preoperative chemotherapy. Because the patient could have developed thrombosis of the left-sided inferior vena cava and severe hypotension caused by decreased venous return to the heart if the azygos vein had been severed, the azygos vein was preserved. Thus, when performing surgery for thoracic esophageal cancer, the surgeon should check for a duplicated inferior vena cava and preserve the azygos vein if necessary.
General Thoracic and Cardiovascular Surgery 01/2014; 62(5). DOI:10.1007/s11748-014-0372-3
[Show abstract][Hide abstract] ABSTRACT: A questionnaire survey on postoperative adjuvant chemotherapy for gastric cancer was conducted for 76 hospitals affiliated with the Hiroshima Oncology Group of Gastric Cancer in Hiroshima prefecture in January 2011. Responses were obtained from 29 hospitals, including 12 core cancer treatment hospitals, and the following results were obtained. The percentage of patients completing 1 year of oral S-1 was >70%, affecting approximately 75% of the entire hospital cohort. Dose reduction was conducted in approximately 30% of patients because of age, poor PS, and renal insufficiency. The standard S-1 regimen (4 weeks of S-1 treatment followed by 2 weeks of rest)was adopted in almost half of the patients, whereas the rest of the patients received another treatment schedule such as 2 weeks of treatment followed by 1 week of rest. Dose reduction and withdrawal of S-1 due to adverse events were conducted more frequently in hospitals with low completion rates of 1-year S- 1 treatment than those with a high completion rate. S-1 was most commonly discontinued because of subjective adverse events and patient request, although the discontinuation rate according to objective adverse events such as bone marrow depression was not very high. The fact that some hospitals had high completion rates suggested the importance of supplementary tools for patient IC.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2013; 40(13):2555-2559.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the safety and efficiency of using the mesh plug method (MP) to repair inguinal hernias in patients with a history of radical retropubic prostatectomy (RRP). We also investigated how RRP influences the development of inguinal hernias and impacts their repair.
Among 488 adult male patients who underwent inguinal hernia repair during a recent 5-year period, 37 had a history of RRP. We compared the characteristics and surgical outcomes of the patients who had undergone RRP (post-RRP group) with those who had not (non-RRP group).
All post-RRP hernias were treated by MP. The 37 post-RRP patients had a collective 41 hernias, 40 of which were of the indirect type. The side affected by the hernia did not differ significantly between the groups. We compared the short-term surgical outcomes of the indirect post-RRP hernias vs. the indirect non-RPP hernias without recurrence and incarceration. The operation times, postoperative hospital stay, and mobility rates did not differ significantly between the two groups. The blood loss was almost equal in both groups.
Inguinal hernia repair after RRP may be difficult because of inflammatory changes in the preperitoneal cavity, but the surgical outcomes of MP were equivalent in patients with or without a history of RPP in this study. MP is a safe and effective method for post-RPP hernia repair.
Surgery Today 11/2013; 44(5). DOI:10.1007/s00595-013-0784-1 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prognosis for stage 3 gastric cancer is not satisfactory, even with S-1 adjuvant chemotherapy. A randomized phase II trial was conducted to compare two and four courses of neoadjuvant S-1/cisplatin (SC) and paclitaxel/cisplatin (PC) using a two-by-two factorial design for locally advanced gastric cancer. The primary endpoint was overall survival. We clarified the impact of these regimens on the secondary endpoints, including the clinical and pathological responses, chemotherapy-related toxicities, and surgical results.
Patients received S-1 (80 mg/m(2) for 21 days with 1 week's rest)/cisplatin (60 mg/m(2) at day 8) or paclitaxel/cisplatin (80 and 25 mg/m(2), respectively, on days 1, 8, and 15 with 1 week's rest) as neoadjuvant chemotherapy.
Eighty-three patients were assigned to arm A (two courses of SC, n = 21), arm B (four courses of SC, n = 20), arm C (two courses of PC, n = 21), and arm D (four courses of PC, n = 21). Pathological response rate was 43 % in arm A, 40 % in arm B, 29 % in arm C, and 38 % in arm D. Pathological complete response was only observed in arms B (10 %) and D (10 %). Most bone marrow toxicities, nausea, vomiting, alopecia, and fatigue were slightly higher but acceptable in arms B and D. Grade 3/4 surgical morbidities were not commonly observed in all four arms.
Pathological complete response could be induced by four courses of neoadjuvant chemotherapy without a marked increase of toxicities, regardless of a SC or PC regimen.
Annals of Surgical Oncology 07/2013; DOI:10.1245/s10434-013-3055-x · 3.93 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report a case of synchronous bilateral solid papillary carcinoma of the breast. A 73-year-old female had a mass that was detected in the right breast on mammography. An ultrasound examination revealed one intracystic tumor in the right breast and two tumors in the left breast. A fine-needle aspiration biopsy of these three tumors was performed, which revealed a diagnosis of malignancy. A magnetic resonance imaging examination of the breasts showed diffuse small nodules surrounding these tumors bilaterally. Bilateral partial mastectomy and a sentinel lymph node biopsy were performed. Lymph node metastasis was detected in the right axilla, and additional lymph node dissection was performed. The pathological diagnosis was synchronous bilateral breast cancer, invasive ductal carcinoma NOS of the right breast, mucinous carcinomas of the left breast, and bilateral SPCs. A wide range of surgical margins were positive for SPCs, and additional bilateral total mastectomy was then performed. To the best of our knowledge, little is known about synchronous bilateral SPCs. Our case indicates that some SPCs can be widely scattered and make up a variety of invasive carcinomas. It is difficult to make a correct preoperative evaluation in such cases.
[Show abstract][Hide abstract] ABSTRACT: Purpose:
Paclitaxel-cisplatin (TC) combination is effective and well tolerated in patients with unresectable gastric cancer. We investigated the efficacy and safety of TC for locally advanced gastric cancers in a neoadjuvant setting.
Patients received 2-4 courses of paclitaxel (80 mg/m(2)) and cisplatin (25 mg/m(2)) on days 1, 8, and 15 in a 4-weekly schedule, followed by radical gastrectomy. Primary endpoint was the pathological response rate: percentage of tumors in which one-third or more parts were affected.
All 52 patients enrolled were eligible. Thirty-six (69.7 %) patients completed two or more courses of chemotherapy. Forty-three patients (82.7 %) underwent surgery, 33 (63.5 %) had R0 resection, and there was no treatment-related death. The pathological response was 34.6 % (95 % CI 22.0-49.1) for all registered patients; the null hypothesis of tumor response ≤10 % was rejected (p < 0.0001). The 3-year overall survival was 41.5 % (95 % CI 27.4-55.0).
The neoadjuvant chemotherapy with TC was safe and effective for patients with locally advanced gastric cancer, and further study is needed to confirm the effectiveness of this regimen.
Cancer Chemotherapy and Pharmacology 03/2013; 71(5). DOI:10.1007/s00280-013-2130-0 · 2.77 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: We herein report the case of a patient with an acute cervicomediastinal hematoma secondary to the spontaneous rupture of a parathyroid adenoma. A 47-year-old female presented with swelling and pain in the neck. She had no history of trauma or of having undergone any medical or odontological procedures. An ultrasound examination revealed the presence of an obscure mass located behind the right lobe of the thyroid gland. A computed tomography scan showed the presence of a low-density lesion extending from the retropharynx to the mediastinum, a high-density lesion located behind the right lobe of the thyroid gland and a right pleural effusion. Because the patient's neck swelling and anemia gradually worsened, she underwent emergency surgery. The neck was found to be swollen due to a hematoma; however, no abscesses were detected in the operative field.Thoracoscopy of the right chest showed no active bleeding. The fragmented mass was histopathologically diagnosed as a parathyroid adenoma with acute hemorrhage, which is quite rare. Our experience suggests that, in patients with severe cervicomediastinal hematomas without any trauma or trigger, a diagnosis of spontaneous rupture of a parathyroid gland lesion should be considered.
[Show abstract][Hide abstract] ABSTRACT: Congenital cystic adenomatoid malformation (CCAM) in adolescents or adults is extremely rare. In this case study, a 17-year-old boy was admitted to our clinic for the treatment of a giant bulla in the lower lobe of the right lung. Preoperative imaging studies led to the diagnosis of cystic lung disease. The patient underwent wedge resection of the right lower lobe with VATS, and histological examination confirmed the presentation of type 1 CCAM. A thoracoscopic lobectomy was performed after the second surgery because of postoperative air leakage.Herein, we report a case of CCAM in an adolescent. VATS was a suitable procedure for the operation. Between the parenchyma-saving resection and lobectomy for CCAM, we believe that the lobectomy is the better treatment option when the extent of the disease cannot be determined clearly or it is extremely large. Therefore, strategies for deciding between parenchyma-saving resection and lobectomy for the treatment of CCAM should be developed.
Asian Journal of Endoscopic Surgery 02/2013; 6(1):44-7. DOI:10.1111/j.1758-5910.2012.00160.x
[Show abstract][Hide abstract] ABSTRACT: Purpose
The education of surgical trainees should be based on an accurate evaluation of their surgical skill levels. In our hospital, the Objective Structured Assessment of Technical Skills (OSATS) is used for this purpose. We conducted this study to demonstrate the validity and accuracy of the OSATS for assessing surgical skills in the operating room (OR) setting.
Between January, 2007 and December, 2010, the OSATS global rating scale was used to assess several operations in which surgical trainees participated. We assessed ten surgical trainees who participated as the main surgeon or first assistant, and studied the correlation between their postgraduate year and their OSATS score.
The median score of the global rating scale for each trainee improved with each year of experience. The median scores of all trainees in postgraduate years 3, 4, and 5 were significantly different (p < 0.001 for both the main surgeon and first assistant roles; Kruskal–Wallis test).
Using the OSATS global rating scale to assess the surgical skills of trainees in the OR was feasible and effective.
Surgery Today 09/2012; 43(3). DOI:10.1007/s00595-012-0313-7 · 1.53 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Background TH-302 is a hypoxia targeted prodrug with a hypoxia-triggered 2-nitroimidazole component designed to release the DNA alkylator,
bromo-isophosphoramide mustard (Br-IPM), when reduced in severe hypoxia. A randomized Phase 2B study (NCT01144455) was conducted to assess the benefit of G + T to standard dose G as first-line therapy of PAC.
[Show abstract][Hide abstract] ABSTRACT: Gastrointestinal stromal tumors (GISTs) of the esophagus are a rare entity. Diagnosis of GIST is currently based on immunohistochemical staining of c-KIT or CD34. However, some tumors have clinicopathologic features of GIST but do not express c-KIT or CD34. A few GISTs contain mutations within a receptor tyrosine kinase protein, platelet-derived growth factor receptor alpha (PDGFRA). We herein report a case of esophageal GIST that was KIT negative and had a PDGFRA mutation. A 75-year-old male who had a giant submucosal tumor in the lower part of the thoracic esophagus underwent surgical resection. Immunohistochemical staining of the tumor revealed that it was uniformly negative for KIT, but partially positive for CD34, and negative for S-100 protein and smooth muscle actin (SMA), which led to the final diagnosis of GIST. PDGFRA genetic testing revealed a mutation in exon 12. The mitotic index was over 5/50 high-power fields, and necrotic changes were noted. Adjuvant chemotherapy using imatinib mesylate was administered. The patient has been disease free for 2 years. To the best of our knowledge, this is the only reported case of esophageal GIST that was KIT negative and had a PDGFRA mutation. In cases of digestive submucosal tumor that are difficult to diagnose because of c-KIT or CD34 negativity despite being suspicious for GIST, PDGFRA genetic testing may help for diagnosis of this minority type of GIST.
[Show abstract][Hide abstract] ABSTRACT: We established reference values for hand grip strength, muscle mass, walking time, and one-leg standing time as indices reflecting components of locomotive syndrome and associated disability using a large-scale population-based sample from the second survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) cohort.
We measured the above-mentioned indices in 2,468 individuals ≥ 40 years old (826 men, 1,642 women; mean age 71.8 years) during the second visit of the ROAD study. Disability was defined as certified disability according to the long-term care insurance system through public health centres of each municipality.
Mean values for hand grip strength (weaker side), muscle mass of the thighs, walking time for 6 m at the usual pace, and the fastest pace for men were 32.7 kg, 7.0 kg, 5.6 s, and 3.7 s, respectively, and those for women were 20.8 kg, 5.2 kg, 5.9 s, and 4.1 s, respectively. The median values for one-leg standing time (weaker side) were 14 s for men and 12 s for women. The prevalence of disability in men aged 65-69, 70-74, 75-79, and ≥ 80 was 0.0, 1.0, 6.3, and 8.8%, respectively, and in women was 3.4, 3.5, 9.2, and 14.7%, respectively. There were significant associations between the presence of disability and walking time for 6 m at the usual pace and at the fastest pace, and between the presence of disability and walking speed.
We established reference values for indices reflecting components of locomotive syndrome, and identified significant associations between walking ability and disability.
[Show abstract][Hide abstract] ABSTRACT: It is unclear whether S-1 plus cisplatin is effective for patients with recurrent gastric cancer after adjuvant S-1 chemotherapy.
We retrospectively evaluated the efficacy of S-1 plus cisplatin in patients whose gastric cancer recurred after adjuvant S-1 chemotherapy.
In the 52 patients evaluated, the median duration of adjuvant S-1 chemotherapy was 8.1 months, and the median recurrence-free interval (RFI) since the last administration of adjuvant S-1 was 6.4 months. Among the 36 patients with measurable lesions, 7 achieved a complete or partial response, and 13 were evaluated as having stable disease, for an overall response rate of 19.4% and a disease control rate of 55.6%. For all patients, the median progression-free survival (PFS) was 4.8 months, and the median overall survival (OS) was 12.2 months. Compared with patients with an RFI of <6 months (n = 25), patients with an RFI of ≥6 months (n = 27) had a significantly higher response rate (5.0 vs. 37.5%, respectively), longer PFS (2.3 vs. 6.2 months, respectively), and longer overall survival (7.3 vs. 16.6 months, respectively). According to a multivariate Cox model including performance status (PS) and reason for discontinuation of adjuvant S-1, an RFI of 6 months was still significantly associated with PFS and OS.
S-1 plus cisplatin is effective for patients with gastric cancer that recurs after adjuvant S-1 chemotherapy, especially for those with an RFI of ≥6 months.
Gastric Cancer 10/2011; 15(3):245-51. DOI:10.1007/s10120-011-0101-x · 3.72 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Hiroshima Oncology Group of Gastric Cancer(HOG-GC)distributed a multiple-answer questionnaire to investigate the realities of chemotherapy for gastric cancer.
Seventy-six hospitals in Hiroshima were surveyed. The Japanese classification was used for the staging criteria.
Forty-one hospitals, including 10 centers for cancer treatment, completed and returned the questionnaires. For stage II & III cases requiring adjuvant chemotherapy, S-1 was the most commonly used(84%)regimen. A standard starting dose was used in 79% of these cases, and S-1 was administered for one year continuously in 84% of the cases. For stage I B & II (T1), S-1 and UFT were used in 45%and 20%of the cases, respectively. In cases with non-resectable gastric cancer, S-1 plus CDDP and S-1 alone were used as a first-line therapy in 62% and 26% of the patients under 75 years age, respectively, and in 33% and 46% of the patients older than 75 years of age, respectively. In patients with ascites and peritoneal dissemination, S-1 plus CDDP, S-1, S-1 plus DTX, S-1 plus PTX, and PTX were used in 26%, 15%, 21%, 17%, and 17% of cases, respectively. Some of the patients with peritoneal dissemination underwent gastrectomy.
S-1 was widely used for gastric cancer chemotherapy in Hiroshima Prefecture. Taxane-containing regimens or palliative gastrectomy were commonly used in cases with peritoneal dissemination.
Gan to kagaku ryoho. Cancer & chemotherapy 06/2011; 38(6):941-4.
[Show abstract][Hide abstract] ABSTRACT: Esophagus and gastric cancer are one of the most common in Asian countries, but molecular event in the carcinogenesis remains as largely unidentified associated oncogenes. Detailed karyotypic analyses were performed on 4 cell lines derived from malignant cells of a patient with esophagus carcinoma of both diagnosis and metastasis stages and 2 cell lines from 2 independent patients with gastric cancer of metastasis stages. Most of these cells examined were near triploid with modal chromosome number of 59-73. These cells had a complex karyotype with more than 10 rearrangements. The karyotypic pattern was relatively stable; consistent alterations involved long arm of chromosomes 2, 9 and 12 and short arm of chromosomes 3 in both diagnosis and metastasis stages in esophagus cell lines. Those alterations of gastric cancer involved chromosomes 7 and 11. Higher rearrangements associated with translocations and deletions were observed at 2q23 of chromosome2, 3p14 of chromosome 3, 4q11 of chromosome 4 and 11q25 of chromosome 11 in esophagus cancer; while 7p13 of chromosome 7 and 11p15 of chromosome 11 in gastric cancer. The overall chromosome pattern was not similar between these cancers, although these tumors arise from anatomically or biologically related site. Unknown oncogenes localizing on these chromosome breakpoints for translocation or deletion region might be associated with the pathogenesis of esophagus or gastric cancer. These newly established cell lines will be useful tools in the study of the molecular pathogenesis and for testing new therapeutic reagents for these cancers in the future.