Akihiko Murata

Hirosaki University, Khirosaki, Aomori Prefecture, Japan

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Publications (35)26.31 Total impact

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    ABSTRACT: Intersphincteric resection (ISR) is performed as an alternative to abdominoperineal resection for super-low rectal cancer. The purpose of this study was to evaluate risk factors for anastomotic leakage (AL) after ISR without a defunctioning stoma for lower rectal cancer. Between 1995 and 2012, 135 consecutive patients with lower rectal cancer underwent curative ISR without a protective defunctioning stoma. Univariate and multivariate analyses were performed to determine the risk factors for AL. The radiological and symptomatic AL rate was 17.0 % (23/135). Univariate analysis demonstrated that male sex (P = 0.030), preoperative chemotherapy (P = 0.016), partial ISR (P < 0.001), lateral lymph-node dissection (P = 0.042), distal tumor distance from the dentate line (P = 0.007), and straight reconstruction (P < 0.001) were significantly associated with AL. Severe AL requiring re-laparotomy developed in 13 (9.6 %) patients. Univariate analysis demonstrated that male sex (P = 0.006), partial ISR (P < 0.001), distal tumor distance from the dentate line (P = 0.002), and straight reconstruction (P < 0.001) were significantly associated with AL requiring relaparotomy. Multivariate analysis demonstrated that partial ISR [odds ratio (OR) 6.701; P = 0.001] and straight reconstruction (OR 5.552; P = 0.002) were independently predictive of AL. Partial ISR and straight reconstruction increased the risk of AL after ISR without a protective defunctioning stoma. A defunctioning stoma might be mandatory in patients with the risk factors identified in this analysis.
    Annals of Surgical Oncology 03/2015; DOI:10.1245/s10434-015-4461-z · 3.93 Impact Factor

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2015; 76(2):308-312. DOI:10.3919/jjsa.76.308
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    ABSTRACT: This study was conducted to assess the usefulness of peritoneal lavage cytology as a prognostic factor in colorectal cancer patients. The subjects were 687 colorectal cancer patients who underwent resections for colorectal cancer and peritoneal lavage cytology from January 2005 to April 2014. Cases were considered ‘positive’ when diagnosed as class III-V. The association between positive peritoneal lavage cytology and clinicopathological features or prognostic factors was investigated. Multivariate analysis showed that depth of invasion (T4), lymphatic invasion (ly2-3), and peritoneal dissemination were independent risk factors for positive peritoneal cytology. In the patients who underwent curative resection, overall survival and disease-free survival two years after operation were significantly shorter in the positive cytology group. Positive peritoneal lavage cytology is a risk factor and a significant prognostic factor in colorectal cancer.
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2015; 76(3):466-471. DOI:10.3919/jjsa.76.466
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    ABSTRACT: The aim ofthis study was to clarify the status ofmultimodality therapy for locally recurrent rectal cancer. Between 2000 and 2012, 27 patients with locally recurrent rectal cancer underwent surgical resection. We examined 18 patients treated with preoperative chemo-radiotherapy(CRT group)and 9 patients treated with surgery alone(surgical group). The rate ofR0 - resection was 89% in the CRT group and 78% in the surgical group. The mean operative durations for the CRT and surgical groups were 323 min and 289 min, respectively. The mean amount of bleeding was 1,462 g for the CRT group and 2,846 g for the surgical group. There was no significant difference in the rate of postoperative complications between both groups(CRT group: 78%, surgical group: 78%). Regarding local recurrences, the recurrence rate ofthe CRT group was 28%, whereas that ofthe surgical group was 67%. The 3-year and 5-year overall survival rates ofthe CRT group were 71%and 44%, respectively, whereas those ofthe surgical group were 58% and 22%, respectively. These results showed that CRT treatment was associated with an improvement in prognosis. Preoperative CRT and surgical resection should be the standard treatment for patients with local recurrence.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):1459-61.
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    ABSTRACT: We retrospectively analyzed the efficacy of stereotactic radiotherapy(SRT)for lung metastasis of colon cancer, with particular emphasis on local tumor control. Seven patients with 8 lesions underwent SRT for lung metastasis of colon cancer in our institution between February 2012 and February 2014. We judged the curative effect of SRT on the basis of tumor shrinkage observed on computed tomography(CT)scans. All lung metastases decreased in size, and local recurrence was not observed. SRT is a technique involving three-dimensionalradiation, which decreases radiation exposure to neighboring normaltissues. The 2-year local tumor control rate for lung metastasis of colon cancer with SRT is 77.9%, and the 2-year survival rate is 53.7%. Our results, in which all patients achieved local control, suggest that SRT is a minimally aggressive treatment option for lung metastasis of colon cancer in cases where a pneumonectomy is difficult to perform. In the future, results from long-term studies are needed to validate our findings.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):1462-4.
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    ABSTRACT: The patient was a man in his seventies who was diagnosed as having an abdominal aortic aneurysm and underwent endovascular aneurysm repair (EVAR). The patient developed abdominal pain and anal bleeding 4 days after EVAR. As intestinal necrosis and perforation were not evident on imaging findings, conservative treatment was employed. On the 6th day after EVAR the abdominal pain was abruptly aggravated and free air was identified in the abdominal cavity. Emergency laparotomy was thus performed. Intraoperative findings included discontinuous necrosis in the intestinal wall from the jejunum to the ileum and a perforated part. Extensive resection of the small intestine by about 300 cm in length was performed. Histopathological study showed no thrombi and occlusion at the mesenteric artery, and non-occlusive mesenteric ischemia (NOMI) was the most likely diagnosis. After the operation the patient developed pneumonia and an infectious aortic aneurysm and died of multiple organ failure on the 57th postoperative day.EVAR is less invasive than the conventional operations, however, owing to its less invasiveness, it is apt to be used even for high risk cases. In treating abdominal pain occurring abruptly after EVAR, it is important to consider a possible onset of NOMI and to make fast determination of therapeutic guideline.
    Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2014; 75(1):45-49. DOI:10.3919/jjsa.75.45
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    ABSTRACT: The purpose of this study was to evaluate S-1 plus oxaliplatin( SOX) as neoadjuvant chemotherapy for the treatment of patients with locally advanced rectal cancer. The clinical features and management of 10 patients with this disease seen at the Hirosaki University Hospital between 2011 and 2013 were examined. Of these patients, 30% were treated with bevacizumab, and the mean number of courses was 3.3. There were no adverse events of severity greater than Grade 3, and no patient required treatment interruption because of toxicity. SOX administered every 3 weeks was associated with a partial response rate of 40% and a tumor control rate of 100%; progressive disease was not observed. Curative resection was performed in all patients except in 1 with liver metastasis. With regard to the pathological findings, 2 cases were of Grade 0; 4 cases, of Grade 1a; and 2 cases, of Grade 2. Postoperative complications such as anastomotic leakage were observed in 80% of the patients. Thus, SOX administration without a central venous drug injection port was very useful because most patients could receive SOX treatment on an outpatient basis. However, the frequency of postoperative complications associated with this treatment is increasing, and therefore, it is important to accumulate more evidence.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):1971-3.
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    ABSTRACT: We evaluated the surgical outcomes and prognostic factors of primary colorectal cancer with peritoneal dissemination. Between 1990 and 2012, a total of 81 cases of operated primary colorectal cancer with peritoneal dissemination were reviewed. According to the classification by the degree of peritoneal dissemination, the 3-year overall survival rate of patients with P1, P2, and P3 were 22%, 14%, and 16%, respectively. A significant difference was not observed between these 3 groups. According to the degree of surgical curability, the 1-year and 3-year overall survival rates of the patients with curability B were 75% and 30%, respectively. The overall survival rate of patients with curability B was higher than those of curability C (p< 0.01). Multivariate analysis showed that the curability of operation (p=0.03) and the existence of hepatic metastases (p=0.01) were significant prognostic factors affecting overall survival. The median relapse-free survival time of patients with curability B was 7.8 months. Nevertheless, long-term survivor cases existed in this group. These findings suggest that complete resection of the primary tumor and metastatic lesions is important to prolong survival term.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2044-6.
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    ABSTRACT: Unlabelled: The aim of this study was to clarify the risk factors associated with recurrence in patients with stage II colorectal cancer. Method: We performed a retrospective analysis of 316 patients with stage II colorectal cancer who underwent gross radical colectomy between 1994 and 2003. Results: The overall recurrence rate was 10.8%. Univariate analysis identified 5 risk factors associated with recurrence: depth of tumor invasion (tumor penetration of the serosa[SE]-tumor invasion of adjacent structure[s SI]), lymphatic invasion( ly2-3), venous invasion( v2-3), budding( grade 2-3), and perineural invasion (PN1). Multivariate analysis identified 3 risk factors associated with recurrence: budding (grade 2-3; p=0.008), depth of tumor invasion( SE-SI; p=0.008), and venous invasion( v2-3; p=0.034). Conclusion: The results of this study suggest that active postoperative adjuvant chemotherapy should be considered for the treatment of patients with stage II colorectal cancer with budding( grade 2-3), venous invasion( v2-3), or tumor depth of SE or SI.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):1650-2. DOI:10.3862/jcoloproctology.68.68
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    ABSTRACT: Conversion therapy, a treatment strategy that facilitates the conversion of unresectable colorectal liver metastases (CRLM) to resectable CLRM after chemotherapy, has been reported to be effective. We assessed the applicability of treatment strategies for conversion therapy in 93 patients with synchronous CRLM encountered at our department. Of the 93 patients, 12 underwent conversion therapy and there was no significant difference in the clinicopathological factors of CRLM. The first-line regimen for 67% of the 12 patients who underwent conversion therapy was multidrug therapy with oxaliplatin and the number of courses administered ranged from 3 to 24. The 5-year survival rate of patients who underwent conversion therapy was 46%,and there was no significant difference when compared with the 5-year survival rate of patients who underwent hepatectomy for resectable CRLM. In order to improve the survival rate of patients with synchronous CRLM, it is important that more patients undergo conversion therapy with effective chemotherapy. Moreover, we believe that it is necessary to assess the appropriate balance in treatment between chemotherapy and hepatectomy in the future.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):1665-7.

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2013; 74(12):3420-3424. DOI:10.3919/jjsa.74.3420
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    ABSTRACT: Treatment of recurrent GIST is often difficult. Here, we report a case of recurrent intestinal GIST with long-term survival. A 67-year-old woman underwent surgical resection of a GIST of the jejunum. Recurrence was observed 2 years after the operation: a tumor was found in the abdominal wall and imatinib therapy was started at a daily dose of 400 mg. However, a new metastatic nodule was noted 2 months later. Because a duplication mutation in KIT exon 9 was found in the primary tumor, we decided to increase the dose of imatinib to 800 mg/day. The tumors presented with PR-SD thereafter. About 3 years after the first surgery, a new lesion was found. We assessed the tumor as resectable and performed resection. About 10 months after the second surgery, however, a new lesion was detected. Imanitib therapy was re-started at a dose of 800 mg/day, and the tumor has remained PR-SD to date. She continues to be an outpatient 7 years and 5 months after the first operation. The multimodality therapy of high-dose imatinib and surgery is beneficial for the control of recurrent intestinal GIST.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1975-7.
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    ABSTRACT: A 48-year-old man, who had presented with anal pain and cloudy urine, was referred to our hospital. Colonoscopy showed a type 2 circular tumor at the higher rectum, and a diagnosis of well-differentiated adenocarcinoma was made by biopsy. CT demonstrated increased thickness of the rectum wall, an equivocal boundary between the rectum and the bladder, and abnormal gas production in the bladder. Following diagnosis of T4 rectal cancer, preoperative chemotherapy was initiated with the aim of downstaging the tumor and avoiding total pelvic exenteration. After 5 courses of mFOLFOX+bevacizumab, the tumor showed a partial response on CT, which enabled the tumor to be resected without sacrificing the bladder. The whole tumor was resected by performing low anterior resection (D3) and partial resection of the bladder. Subsequent pathological examination of the resected specimen indicated complete response to chemotherapy due to the absence of malignant cells. Because higher response rate is reported for modern chemotherapy, including targeted therapy, preoperative intensive chemotherapy is an option for the local treatment of advanced rectal cancer. Downstaging chemotherapy is expected to enhance the role of function-preserving surgery for T4 rectal cancer.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1954-6.
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    ABSTRACT: We report a case of cancer in the rectal remnant 8 years following a near total proctocolectomy for ulcerative colitis. A 71-year-old man had undergone a subtotal colectomy in November 1998, following an additional proctocolectomy and reconstruction by ileo-anal canal anastomosis in August 2000. The resected specimen of the primary procedure showed a diffuse severe inflammation throughout the rectosigmoid and sigmoid colon but revealed no dysplastic lesions in the rectum. It also included adenomas in the sigmoid colon. Eight years later, he developed a macroscopically type 3 cancer in the remnant rectum just caudal to the ilio-anal canal anastomosis. Pathology revealed a node-negative stage I rectal cancer of moderately-differentiated tubular adenocarcinoma invading the muscularis propriae. Although such cases are rare, the possibility of the late development of cancer arising from the remnant rectal mucosa after near-total proctocolectomy and ileo-anal canal anastomosis.
    Nippon Shokaki Geka Gakkai zasshi 01/2012; 45(11):1129-1136. DOI:10.5833/jjgs.45.1129

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2012; 73(4):936-941. DOI:10.3919/jjsa.73.936

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2012; 73(1):148-154. DOI:10.3919/jjsa.73.148
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    ABSTRACT: In Japan, surgical therapy is utilized as the main treatment modality for anal squamous cell carcinoma (SCC). Subjects were 6 patients with anal SCC treated at our hospital from 2000-2010, and a study was made on the treatment. In the early 3 cases (Stage IIIA, IIIB, IIIB), chemoradiotherapy (CRT) was used as adjuvant therapy on the premise of surgery. All of them were considered as stable disease, and they all experienced postoperative complications. The average length of the hospital stay was 45 days. Two cases are still surviving without recurrence, but the other one developed a distant metastasis. In contrast, we selected CRT with curative intent in the late 3 cases(Stage II, IIIA, IIIB). Two cases were considered as complete response (CR), and the other one considered as partial response (PR) was performed a salvage operation. Two cases are still surviving without recurrence, but the other case metastasized to the internal iliac lymph nodes. CRT with curative intent for anal SCC demonstrated a good antitumor effect. Salvage operation was safely performed, and showed a good prognosis.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2116-8.
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    ABSTRACT: A 54-year-old female with cecal cancer underwent Rt. hemicolectomy in December 2000. The lesion was mod, ss, p1(+), n1, stage IV. The level of CEA increased around August 2002. Abdominal CT revealed a recurrent tumor in the RLQ in July 2003, peritoneal dissemination was suspected. In December 2003, we performed a partial resection of the ileum and transverse colon including initial anastomosis. Lung metastases were found by chest CT in right S4, S5, S9 and S3, S8 in February 2004. Because of experience of severe side effect of intravenous chemotherapy, UFT/LV was administered from February 2004. Chest CT revealed the disappearance of tumor in September 2004, and no signs of recurrence were observed for 65 months.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2520-2.
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    ABSTRACT: We describe a case of lower colorectal cancer associated with Crohn colitis in which anus-preserving surgery was performed. The patient, a 40-year-old woman, was first given a diagnosis of Crohn disease (CD) in 1978, when a longitudinal ulcer and pseudopolyposis of the large intestine extending from the cecum to the sigmoid colon was discovered, together with stenosis of the ascending colon. She underwent subtotal proctocolectomy in 1988, and thereafter a wait-and-see approach was adopted by internal medicine specialists. However, stenosis developed at the site of anastomosis on several occasions from 2003, and the patient underwent endoscopic dilatation at regular intervals. Because high-grade dysplasia of the remnant rectal mucosa was found in January 2009, she was admitted to our hospital for surgery due to the possibility that cancer might develop. Extirpation of the remnant rectum and ileoanal anastomosis with diverting loop ileostomy was performed. The specimen was diagnosed pathologically as adenocarcinoma (tub1), pSM, N0, pStage I. Because of improvements in medical management, the number of CD patients undergoing long-term treatment has increased. We expect that surveillance will reveal more CD patients with precancerous dysplasia and early stage cancer in the future. Anus-preserving surgery is a realistic option for such patients.
    Nippon Shokaki Geka Gakkai zasshi 01/2011; 44(5):624-631. DOI:10.5833/jjgs.44.624

  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2011; 72(8):2046-2049. DOI:10.3919/jjsa.72.2046