Akihiko Murata

Hirosaki University, Khirosaki, Aomori Prefecture, Japan

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Publications (15)5.06 Total impact

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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: 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.
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    ABSTRACT: 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.
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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: 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: 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: 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: We retrospectively investigated the safety and efficacy on outpatient chemotherapy including bevacizumab(BV)as secondline therapy for inoperable metastatic colorectal cancer. Analytical subjects were thirty patients treated with chemotherapy including BV as second-line therapy after first disease progression. All patients were treated with BV 5mg/kg. Concurrent therapy was given mFOLFOX6(2 patients)and FOLFIRI(28 patients). The BV treatment frequency and all course treatment frequency including the prior regimens averaged 20 and 37 times, respectively. The overall response rate was 24. 1%(PR, 7 patients; SD, 17 patients; PD, 5 patients), and the median duration of progression-free survival was 8. 0 months. The median duration of survival after addition of BV was 20. 3 months. The adverse events were 84%(>grade 3, 9%), BV-associated adverse events were GI perforation(1 patient), GI hemorrhage(1 patient), grade 3 hypertension(1 patient)and grade 2 epitaxis(2 patient). Although it is necessary to be careful about GI hemorrhage and GI perforation, we could safely continue the treatment with BV on outpatient chemotherapy. We confirmed that the chemotherapy including BV as second-line therapy had high antitumor effect and patient benefit.
    Gan to kagaku ryoho. Cancer & chemotherapy 06/2010; 37(6):1069-73.
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    ABSTRACT: The operation for liver metastases from colorectal cancer is increasing due to a progress of chemotherapy. On the other hand, the live damage induced by chemotherapy affects on post operative course. We studied histopathological liver injury on the patients who received preoperative chemotherapy. Between January 2004 and May 2009, forty seven patients underwent hepatectomy for colorectal liver metastases after systemic chemotherapy, and the remnant liver was histopathologically investigated about sinusoidal dilatation and non-alcoholic steatohepatitis. As a result, chemotherapy including irinotecan or oxaliplatin was significantly associated with sinusoidal dilatation, and female gender or higher body mass index was correlated with non-alcoholic steatohepatitis. These results should be taken into consideration before liver resection in patients who have received preoperative chemotherapy.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2025-7.
  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2008; 69(7):1578-1584.
  • Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 01/2008; 69(7):1725-1732.
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    ABSTRACT: Orthotopic liver transplantation (OLTx) from non-heart beating donor (NHBD) often involves hepatic warm ischemia and reperfusion injury which is triggered by the inflammatory cytokines. This study was carried out to investigate whether a newly synthesized cytokine suppressive anti-inflammatory agent, FR167653, attenuates graft injury in OLTx from NHBD. Porcine OLTx from NHBD was performed. No-heart beating time was scheduled to be 60 minutes. Animals were divided into two groups: no treatment control (CT) group (n=5), and FR167653 treated (FR) group (n=5), in which FR167653 was administered intravenously before the aortic cross clamp in the donor, and before and after the hepatic allograft reperfusion in the recipient continuously. Four out of five pigs died within 24 hours and one on postoperative day 1 from graft liver failure in the CT group, while two pigs died on day 3, and three survived more than 7 days in the FR group (p<0.05). Microcirculatory disturbance was attenuated, liver injury was lessened, and ATP resynthesis was enhanced in the FR group. Additionally, FR167653 inhibited neutrophils infiltration in the liver tissue, and suppressed release of inflammatory cytokines after OLTx from NHBD. The treatments with FR167653 successfully prevented graft injury after OLTx from NHBD by means of improvement of liver microcirculation, and attenuation of neutrophils activation. The inhibitory effect of FR167653 on the release of inflammatory cytokines played an important role in the liver graft protection.
    Hepato-gastroenterology 01/2005; 52(63):885-92. · 0.77 Impact Factor
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    ABSTRACT: Organ ischemia-reperfusion injury is caused by two consecutive steps, microcirculatory disturbance and neutrophil-endothelial cell interactions, which are caused by inflammatory cytokines. We examined the hypothesis that combination therapy with a donor (FK409) of nitric oxide, one of the potent mediators with diverse roles as a vosodilator and a platelet inhibitor, together with the cytokine suppressor agent (FR167653) attenuates warm ischemic injury in canine small bowel. Small bowel ischemia was initiated by clamping the superior mesenteric artery and vein. Animals were divided into two groups: a control group (n = 5) subjected to 2-hour small bowel ischemia only, and a combination therapy group (FK/FR group, n = 5) that received FK409 (300 mcg/kg/h) plus FR167653 (1 mg/kg/h) intravenously before and after the ischemic event. We evaluated animal survival, small bowel tissue blood flow, and enzyme release from the small bowel. All controls died from severe acidosis within 2 days and all the FK/FR animals survived 7 days (P < .05). The FK/FR group recovered more than 70% of blood flow immediately after the revascularization, while the flow was less than 40% among the controls. Serum creatine phosphokinase values in the control group after reperfusion were significantly higher than those in the FK/FR group. In conclusion improvement of the microcirculation by FK409 and inhibition of cytokine release by FR167653 together attenuated warm ischemic small bowel injury.
    Transplantation Proceedings 10/2004; 36(7):1988-90. · 0.95 Impact Factor
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    ABSTRACT: Surgical practices for treatment of rectal cancer in Japan have changed from extended dissection along perivascular or parietal plane to pelvic autonomic nerve-preserving procedures without compromising radicality of surgical resection. Previous surgical results suggested the significant advantages of extended surgery in survival and local recurrence rate of Dukes B and C patients. More than 15 percent of patients with cancer in the lower rectum have extramesorectal spread to lateral pelvic nodes that can be removed by lateral dissection for local control and cure. Initially the total nerve-preserving procedure has been introduced for a complete preservation of para-aortic and intrapelvic nervous system in patients with early-stage cancer not requiring para-aortic and lateral lymph-node dissection. However, the concept of aggressive surgery for advanced rectal cancer has led to various types of pelvic autonomic nerve-preserving procedures, in which extended lymph-node dissection plus nerve-preserving technique with resection of one or more autonomic nervous segments has been performed. During two decades, total pelvic autonomic nerve-preserving procedure with lateral lymph-node dissection has been used increasingly for Dukes C lesion without increased local recurrence. The overall status of pelvic autonomic nerve-preserving procedures according to clinical experiences in Japan is reviewed in the context of cadaveric anatomic findings, Japanese vs. Western techniques and concepts, and our own clinical data.
    Diseases of the Colon & Rectum 11/2003; 46(10 Suppl):S78-87; discussion S87-8. · 3.34 Impact Factor