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Chikara Kunisaki,
Masazumi Takahashi, Hidetaka A Ono,
Shinichi Hasegawa,
Kazuhito Tsuchida,
Takashi Oshima,
Mitsuyoshi Ota,
Tadao Fukushima,
Motohiko Tokuhisa,
Yusuke Izumisawa,
Ryo Takagawa,
Jun Kimura,
Takashi Kosaka,
Hirochika Makino,
Hirotoshi Akiyama,
Itaru Endo
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ABSTRACT: Background/Aim: This study assessed the toxicity and activity of biweekly docetaxel and S-1 combination therapy in elderly patients with advanced gastric cancer.
One-hundred and thirteen patients were enrolled: 35 were 75 years old or more. The objective response rate, toxicity, progression-free survival (PFS), and overall survival (OS) were compared.
Dose reduction was significantly frequent in the elderly group (24/35 versus 25/78, p<0.001). The overall response rate was 54.9%. Out of these, 18 (15.9%) underwent gastrectomy (13 R0 gastrectomy). The median OS was 17.3 months and the median PFS was 8.0 months. Neutropenia was the most frequently observed hematological toxicity at grade 3 and 4 (34.5%), followed by leukopenia (24.8%). Most non-hematological toxicities were of grade 1 or 2. There were no significant differences in overall response rate, median OS, median PFS, or toxicities between the two groups.
This combination offers favourable survival benefits with controllable tolerance for therapy of AGC in the elderly.
Anticancer research 02/2013; 33(2):697-704. · 1.73 Impact Factor
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ABSTRACT: Background/Aims: Single-port and reduced-port laparoscopic surgeries are performed as a less invasive form of surgery than conventional laparoscopy. In this study, short-term patient outcomes were compared between reduced-port laparoscopic distal gastrectomy (RPLDG) and conventional laparoscopy-assisted distal gastrectomy (LADG) to evaluate the feasibility of RPLDG for gastric cancer. Methods: Between August 2010 and July 2011, 38 patients underwent LADGs that were performed by a single surgeon. Of these, 20 patients underwent RPLDG, and 18 patients underwent conventional LADG. Short-term outcomes were compared between the two groups. Results: Surgical procedures, total operation time (278.8 versus 228.7 min, p = 0.0002) and time for lymph node dissection (181.3 versus 136.3 min, p = 0.0001) were significantly longer in the RPLDG group compared with the LADG group, while the volume of blood loss during reconstruction was reduced (17.5 versus 49.6 ml, p = 0.0019). Cosmetic satisfaction in the RPLDG group showed significant superiority over that in the conventional LADG group (p = 0.0252). Conclusion: RPLDG was shown to be an acceptable and satisfactory procedure for the treatment of gastric cancer. To confirm the feasibility of this surgical procedure, it is necessary to conduct a well-designed randomized controlled study comparing RPLDG and conventional LADG in many patients.
Digestive surgery 08/2012; 29(3):261-8. · 1.37 Impact Factor
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ABSTRACT: Objectives: This study was conducted to determine the prognostic value of the Glasgow Prognostic Score (GPS), an inflammation-based prognostic score composed of C-reactive protein and albumin, for patients with advanced cancer. Methods: A total of 83 advanced gastric cancer patients receiving biweekly docetaxel/S-1 treatment (DS) were included in the study. To identify the value of GPS as prognostic factor for disease-specific survival (DSS) and progression-free survival (PFS), univariate and multivariate analyses were performed. Results: Unresectable tumors were observed in 78 patients and recurrent tumors were detected in 5 patients. Of these, 12 patients underwent gastrectomy. There were significant correlations between the GPS and the neutrophil/lymphocyte ratio. Univariate analysis revealed that the GPS, Eastern Cooperative Oncology Group performance status and gastrectomy after DS treatment significantly affected prognosis. Multivariate analysis showed that the GPS, age and gastrectomy independently influenced DSS, and that the GPS and gastrectomy also influenced PFS. Multivariate analysis restricted to patients without gastrectomy showed that the GPS and age independently affected DSS, and that the GPS influenced PFS. Conclusion: In the low GPS group, it may be possible to obtain favorable outcomes by chemotherapy in advanced gastric cancer patients. However, a well-designed prospective trial in a large patient cohort is required to corroborate the prognostic value of the GPS.
Oncology 08/2012; 83(4):183-91. · 2.27 Impact Factor
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ABSTRACT: BackgroundIn an aging population, it is important to evaluate the therapeutic management of diseases. Esophagectomy is a reliable treatment
for esophageal cancer, but it remains controversial for elderly patients as it could carry additional postoperative risks.
MethodsBetween April 1994 and March 2004, 418 patients with esophageal cancer were registered at our hospital. Clinicopathological
factors and therapeutic outcomes for 65 patients aged over 75 years (elderly patients) and 353 patients aged under 75 years
(nonelderly patients) were compared retrospectively.
ResultsIn total, 19 patients aged over 75 years and 203 patients aged under 75 years underwent resection. The elderly patients were
characterized by short operation times, surgery by transhiatal approach, organ reconstruction using the jejunum, fewer lymph
nodes removed, and frequent comorbid disease. Curative resections were performed in 16 elderly patients (84.2%) and 173 nonelderly
patients (85.2%). Postoperative morbidity did not differ between the two groups, but hospital death was more frequent in elderly
patients. The overall survival time was significantly higher for nonelderly patients. However, the disease-specific survival
did not differ between the two groups. Nonsurgical treatments were administered to 46 elderly patients and 150 nonelderly
patients; no significant difference in survival was observed between the two groups. The overall survival times were not different
between surgical treatment and nonsurgical treatment in the elderly group.
ConclusionsElderly patients obtained similar therapeutic benefits from esophagectomy as did nonelderly patients through careful management
of comorbid disease and good perioperative care. Also, nonsurgical treatment is a useful treatment option for elderly patients.
A well-designed randomized trial, of surgical versus nonsurgical treatment, should be conducted in the elderly to clarify
this concern.
Esophagus 04/2012; 5(3):133-139. · 0.66 Impact Factor
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Chikara Kunisaki,
Hirochika Makino,
Takashi Kosaka,
Takashi Oshima,
Shoichi Fujii,
Ryo Takagawa,
Jun Kimura, Hidetaka A Ono,
Hirotoshi Akiyama,
Masataka Taguri,
Satoshi Morita,
Itaru Endo
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ABSTRACT: The aim of this study was to clarify the technical feasibility and oncological efficacy of laparoscopy-assisted gastrectomy (LAG) for gastric cancer compared with open gastrectomy (OG).
Between April 2002 and March 2008, a series of 623 patients with gastric cancer underwent R0 gastrectomy (314 LAG patients and 309 OG patients). Age, gender, lymph node dissection, and pathological stage were matched by propensity scoring, and 212 patients (106 LAG and 106 OG) were selected for analysis after the exclusion of 40 patients who had proximal gastrectomy. Intraoperative factors, postoperative morbidity, long-term quality of life (QOL), and survival were evaluated. Moreover, these outcomes were also compared between the laparoscopy-assisted total gastrectomy (LATG) and the open total gastrectomy (OTG).
There was no significant difference in preoperative characteristics between the two patient groups. Regarding intraoperative characteristics, blood loss was significantly lower in the LAG group (143 ml) than in the OG group (288 ml), while operation time was significantly longer in the LAG group (273 min) than the OG group (231 min). The degree of lymph node dissection and number of retrieved lymph nodes did not differ between the two groups. There were no significant differences in postoperative courses or overall and disease-specific survival (89.8% vs. 83.6%, P = 0.0886; 100% vs. 95.2%, P = 0.1073) except time to first flatus and time to use of nonsteroidal anti-inflammatory derivatives between the two groups. Significantly fewer patients felt wound pain in the LAG group 1 year after surgery. Analyses between the LATG and OTG groups showed similar results.
LAG for gastric cancer may be both feasible and safe. However, it will be necessary to conduct a well-designed randomized controlled trial comparing short-term and long-term outcomes between LAG and OG in a larger number of patients.
Surgical Endoscopy 03/2012; 26(3):804-10. · 4.01 Impact Factor
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Chikara Kunisaki, Hidetaka A Ono,
Shinichi Hasegawa,
Takashi Oshima,
Shoichi Fujii,
Motohiko Tokuhisa,
Yusuke Izumisawa,
Ryo Takagawa,
Jun Kimura,
Takashi Kosaka,
Hirochika Makino,
Hirotoshi Akiyama,
Itaru Endo
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ABSTRACT: To establish a safe, long-term regimen of docetaxel (DOC) and cisplatin (CDDP) in an outpatient setting for gastric cancer refractory to S-1 adjuvant chemotherapy, a dose-escalating phase I study was conducted. Cohorts of patients were treated with escalating doses of DOC (starting at 20 mg/m(2) per week with 5 mg/m(2) increments) and a fixed dose of CDDP (25 mg/m(2)). Drugs were administered on days 1, 8, and 15. A cycle of this treatment was 28 days. In total, 52 courses were performed, and the mean number of courses was 5·3. Two of the four patients at dose level 3 showed dose-limiting toxicities (grade 4 neutropenia, and grade 3 anorexia and dehydration). The recommended dose (RD) of DOC was therefore defined as 25 mg/m(2). There is a need for a phase II clinical trial using this regimen in patients with S-1-refractory stage II/III gastric cancer.
Journal of chemotherapy (Florence, Italy) 01/2012; 24(6):364-8. · 1.08 Impact Factor
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Chikara Kunisaki,
Takashi Kosaka, Hidetaka A Ono,
Takashi Oshima,
Shoichi Fujii,
Ryo Takagawa,
Jun Kimura,
Motohiko Tokuhisa,
Yusuke Izumisawa,
Hirochika Makino,
Hirotoshi Akiyama,
Itaru Endo
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ABSTRACT: This retrospective study evaluated the surgical learning curve and outcomes of thoracolaparoscopic esophagectomy.
The study group comprised a series of 92 patients with preoperatively diagnosed resectable thoracic esophageal cancer. Additionally, the surgical outcomes in 79 esophageal cancer patients receiving open esophagectomies were compared. All patients underwent thoracolaparoscopic esophagectomy in the lateral decubitus position. The short- and long-term outcomes were evaluated, and the surgical learning curve was assessed.
The total operation time was 477.8 ± 102.2 min, the thoracoscopic time was 157.9 ± 61.3 min, the total blood loss was 554.4 ± 280.5 ml, and the number of retrieved lymph nodes was 34.3 ± 14.3. Postoperative morbidity was observed in 23 patients. After the surgeon's first 40 cases, the surgical technique and short-term outcomes were stable. The 5-year disease-specific survival was 66.6% and the 5-year overall survival was 64.6% in patients receiving R0 thoracolaparoscopic esophagectomy. Comparison of 5-year disease-specific survival rate according to tumor-node-metastasis stage between patients receiving R0 thoracolaparoscopic esophagectomy and conventional open esophagectomy showed that there were no significant differences in survival in any stage between the two groups. Loco-regional recurrence was observed in 6 patients, distant recurrence in seven, and combined recurrence in nine after R0 thoracolaparoscopic esophagectomy. There was no significant difference in the pattern of recurrence between the two groups.
Thoracolaparoscopic esophagectomy for esophageal cancer was technically feasible and oncologically satisfactory, according to the surgical learning curve.
Journal of Gastrointestinal Surgery 09/2011; 15(11):1939-51. · 2.83 Impact Factor
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Chikara Kunisaki,
Masazumi Takahashi,
Hirochika Makino,
Takashi Oshima,
Shoichi Fujii,
Ryo Takagawa,
Jun Kimura,
Takashi Kosaka, Hidetaka A Ono,
Hirotoshi Akiyama,
Kunio Kameda,
Fumihiko Kito,
Satoshi Morita,
Itaru Endo
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ABSTRACT: We evaluated the efficacy and toxicity of biweekly S-1 and docetaxel combination therapy in patients with advanced gastric cancer.
Patients with histologically proven, unresectable advanced or recurrent gastric cancer, a performance status (PS) of 0-2 and no prior chemotherapy history were eligible for inclusion (n = 45). Patients received a total of 215 treatment courses (median, 4; range, 2-12) of S-1 oral administration twice daily for 1 week followed by a drug-free interval of 1 week. Docetaxel (40 mg/m(2)) was administered intravenously on days 1 and 15.
We observed 25 partial responses (55.6%) and one complete response (2.2%), resulting in an overall response rate of 57.8%. Twenty-four patients (53.3%) received second-line chemotherapy. Five patients (11.1%) underwent R0 gastrectomy during the course of the study. The median overall survival time was 15.3 months, the median time to progression was 6.9 months, and the median duration of response in 26 patients was 8.0 months. Neutropenia was the most frequently observed (40.4%) haematological toxicity at grades 3 and 4 and leucopenia was the second most common (29.8%). There were no treatment-related deaths.
S-1 plus docetaxel combination therapy in an outpatient setting provided promising activity with acceptable adverse toxicities.
Cancer Chemotherapy and Pharmacology 06/2011; 67(6):1363-8. · 2.83 Impact Factor
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ABSTRACT: The incidence of proximal gastric cancer is increasing, so proximal gastrectomies are often performed to preserve gastric function, but the optimal reconstruction method after surgery remains controversial. We therefore conducted a prospective pilot study comparing reconstructions using jejunal pouch interposition or jejunal interposition.
Thirty-eight patients with early proximal gastric cancer were included in this study. Equal numbers of patients were randomly assigned for reconstruction using jejunal interposition (the IP group) or jejunal pouch interposition (the PO group). Postoperative morbidity and patient symptoms were compared between the 2 groups.
Postoperative morbidity was significantly more frequent in the IP than the PO group (p = 0.036). Moreover, the incidence of gastrointestinal complaints was more frequent in the IP group until 6 months after surgery. By contrast, the caloric intake was more favorable in the PO group until 1 year post-surgery.
Short-term and mid-term outcomes were more favorable following jejunal pouch interposition compared with jejunal interposition after proximal gastrectomy.
Digestive surgery 11/2010; 27(6):502-8. · 1.37 Impact Factor
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Hirochika Makino,
Chikara Kunisaki,
Yusuke Izumisawa,
Motohiko Tokuhisa,
Takashi Oshima,
Yasuhiko Nagano,
Shoichi Fujii,
Jun Kimura,
Ryo Takagawa,
Takashi Kosaka, Hidetaka A Ono,
Hirotoshi Akiyama,
Itaru Endo
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ABSTRACT: This study compared surgical outcomes between patients undergoing laparoscopy-assisted distal gastrectomy (LADG) and those undergoing open distal gastrectomy (ODG) from the viewpoint of obesity.
Between June 2002 and May 2008, 146 patients with preoperatively diagnosed early gastric cancer who underwent LADG (n = 90) or ODG (n = 56) were enrolled in this study and compared in terms of clinicopathological findings and operative outcome. The visceral fat area (VFA) and subcutaneous fat area (SFA) were assessed as identifiers of obesity using FatScan software. The relationship between obesity and operative outcomes after LADG and ODG was evaluated.
There were no significant correlations between intraoperative blood loss (IBL) and any obesity-related factors, or between operation time (OT) and any obesity-related factors in the LADG group. There was a significant correlation between IBL and BMI (r = 0.486, P = 0.0001), IBL and VFA (r = 0.456, P = 0.0003), IBL and SFA (r = 0.311, P = 0.0193), OT and BMI (r = 0.406, P = 0.0017), OT and VFA (r = 0.314, P = 0.0178), and between OT and SFA (r = 0.382, P = 0.0034) in the ODG group.
LADG may be a useful operative manipulation that is not influenced by obesity, whereas ODG may be influenced by obesity even after reaching the surgical plateau.
Journal of Surgical Oncology 08/2010; 102(2):141-7. · 2.10 Impact Factor
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ABSTRACT: The prognosis for patients with N0 oesophageal cancer is favourable, but relevant prognostic factors and appropriate surveillance protocols have not been identified for these patients.
A total of 210 oesophageal cancer patients were included in this study. Of these, 92 (43.8%) had no lymph node metastasis. Predictive factors for lymph node metastasis were evaluated in N0 oesophageal cancer. Survival, prognostic factors, causes of death and pattern of recurrence were assessed between patients with and without lymph node metastasis.
Logistic regression analysis revealed that depth of tumour invasion (T1) was an independent predictive factor for N0. The Cox proportional hazard regression model showed that venous invasion was an independent prognostic factor for disease-specific survival in N0 oesophageal cancer patients (hazard ratio=3.977, p=0.042). Locoregional recurrence was less frequent in patients with N0 oesophageal cancer (p=0.0319).
Meticulous and long-term follow-up is necessary even for patients with N0 oesophageal cancer, particularly for those with adverse prognostic factors.
Anticancer research 07/2010; 30(7):3063-9. · 1.73 Impact Factor
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Hirochika Makino,
Chikara Kunisaki,
Yusuke Izumisawa,
Motohiko Tokuhisa,
Takashi Oshima,
Yasuhiko Nagano,
Shoichi Fujii,
Jun Kimura,
Ryo Takagawa,
Takashi Kosaka, Hidetaka A Ono,
Hirotoshi Akiyama,
Kuniya Tanaka,
Itaru Endo
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ABSTRACT: The significance of hepatic resection for liver metastasis after gastric cancer is not well established. This study aimed to evaluate the effect of hepatic resection in such patients.
A retrospective analysis was performed on the outcome of 63 patients with liver metastases without other non-curative factors of gastric cancer who underwent gastrectomy with or without hepatic resection.
Overall 1-, 3-, and 5-year survival rates were 61.9%, 17.2%, and 10.3%, respectively, with a median survival time of 16 months. This increased to 82.3%, 46.4%, and 37.1%, respectively, with a median survival time of 31.2 months in patients who underwent hepatic resection. Multivariate analysis showed that hepatic resection was an independent prognostic factor. Moreover, unilobar liver metastases significantly influenced favorable prognosis in patients receiving hepatic resection by univariate analysis.
In patients with liver metastases, hepatic resection may be a therapeutic option in the presence of unilobar liver metastases.
Anticancer research 06/2010; 30(6):2367-76. · 1.73 Impact Factor
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ABSTRACT: We retrospectively compared surgical outcomes between patients with intra-thoracic and extra-thoracic (cervical and abdominal) lymph-node metastasis.
The study population comprised 96 patients with lymph-node metastasis who had undergone curative esophagectomy for thoracic esophageal cancer. The patients were grouped according to whether the site of lymph-node metastasis was intra-thoracic, extra-thoracic, or both intra-thoracic and extra-thoracic. The patient characteristics, survival time, and prognostic factors were compared.
The most significant difference in disease-specific survival was detected at a threshold value of four metastatic lymph nodes. Lymph-node metastasis was observed at intra-thoracic sites in 41 patients, at extra-thoracic sites in 20 patients, and at both intra-thoracic and extra-thoracic sites in 35 patients. Intra-thoracic lymph-node metastasis was frequently observed in patients with middle and upper thoracic esophageal cancer. There was no difference in the number of metastatic lymph nodes between patients with intra-thoracic and extra-thoracic lymph-node metastasis. Multivariate analysis revealed that the number of metastatic lymph nodes was an independent prognostic factor, whereas the site of metastatic lymph nodes was not.
These findings suggest that the surgical outcomes in patients with thoracic esophageal cancer depend on the number, but not the site, of metastatic lymph nodes after curative esophagectomy.
Journal of Surgical Oncology 11/2009; 101(1):36-42. · 2.10 Impact Factor
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ABSTRACT: Patients with stage I gastric cancer often suffer from tumor recurrence despite a generally favorable operative outcome. It is therefore important to determine the prognostic factors in order to improve such outcomes.
Between April 1985 and March 2000, a total of 1,880 patients with histologically proven stage I gastric cancer were included in this study. Operative outcomes (survival time, prognostic factors, pattern of recurrence) were evaluated in these patients.
Multivariate analysis in patients with all stage I gastric cancer revealed that depth of invasion, lymph node metastasis, and lymphovascular invasion independently influenced prognosis. Moreover, advanced age was selected as an independent prognostic factor in patients with stage IA, and lymphovascular invasion in patients with stage IB gastric cancer by multivariate analyses. The 5-year survival rates in stage T1N1 patients with moderate to severe lymphovascular invasion, T2N0 with moderate to severe lymphovascular invasion, and II were 95.1%, 83.5%, and 76.9%, respectively. There was a significant difference in survival time between stage T1N1 and II (P = .0189) but not between stage T1N1 and T2N0 or stage T2N0 and II.
T2N0 gastric cancer patients with moderate to severe lymphovascular invasion may be suitable candidates for adjuvant chemotherapy.
Surgery 10/2009; 147(2):204-11. · 3.10 Impact Factor
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ABSTRACT: We retrospectively investigated the efficacy of a chemoradiotherapy regimen using daily low-dose cisplatin and continuous 5-fluorouracil infusion in 71 registered patients with unresectable esophageal cancer. The overall response rate (complete response plus partial response) was 59%. The major toxicities observed were leukopenia and anorexia. The 1- and 3-year overall survival rates were 54.6% and 18.4%, respectively. A low preoperative C-reactive protein level was found to be associated with a good response. The pretreatment performance status and response results were both shown to be prognostic factors for overall survival. These findings confirmed that the chemoradiotherapy regimen had curative potential for unresectable esophageal cancer.
Diseases of the Esophagus 02/2009; 22(6):482-9. · 1.81 Impact Factor
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Chikara Kunisaki,
Hirochika Makino,
Ryo Takagawa,
Takashi Oshima,
Yasuhiko Nagano,
Takashi Kosaka, Hidetaka A Ono,
Yuichi Otsuka,
Hirotoshi Akiyama,
Yasushi Ichikawa,
Hiroshi Shimada
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ABSTRACT: The aim of this study was to evaluate the prognostic value of tumor diameter in gastric cancer.
The study group comprised a series of 1215 patients who underwent curative gastrectomy. The appropriate tumor diameter cutoff value was determined. Prognostic factors were evaluated by univariate and multivariate analyses.
The tumor diameter cutoff value was 100 mm. Multivariate analysis showed that tumor site, macroscopic appearance, tumor diameter, depth of invasion, and presence of lymph node metastasis independently affected prognosis in all patients. Multivariate analysis of patients with larger tumors identified depth of invasion as an independent prognostic factor. A comparison between patients with smaller and larger tumors showed marked differences in the survival of those with stage II, IIIA, and IIIB tumors. A comparison of clinicopathological factors between stage II and III patients revealed that tumors occupying the entire stomach, ill-defined, undifferentiated, and serosa-penetrating tumors, and peritoneal metastases were far more frequent in patients with larger tumors.
Tumor diameter in gastric cancer is a reliable prognostic factor that might be a candidate for use in the staging system. To improve outcomes for patients with tumors >/=100 mm in diameter, it is necessary to establish therapeutic strategies for peritoneal metastasis, particularly in stage II and III tumors.
Annals of Surgical Oncology 07/2008; 15(7):1959-67. · 4.17 Impact Factor
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Chikara Kunisaki,
Hirochika Makino,
Naoto Yamamoto,
Tsutomu Sato,
Takashi Oshima,
Yasuhiko Nagano,
Syoichi Fujii,
Hirotoshi Akiyama,
Yuichi Otsuka, Hidetaka A Ono,
Takashi Kosaka,
Ryo Takagawa,
Hiroshi Shimada
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ABSTRACT: An assessment of the learning curve of laparoscopy-assisted distal gastrectomy (LADG) might encourage its worldwide spread among inexperienced surgeons. One hundred sixty-seven patients with early gastric cancer were enrolled in this study: 67 underwent conventional open distal gastrectomy and 100 underwent LADG after classification into 5 groups of 20 according to the surgeon's level of experience. Patient characteristics and operative findings were compared between groups. Operation time was significantly longer, time to first flatus earlier, and blood loss reduced in the LADG groups compared with the open distal gastrectomy group. Surgeons with experience of 60 cases performed operations of similar times in both groups, and blood loss decreased with experience of 20 cases. There was no operative conversion, the frequency of nonsteroidal anti-inflammatory drugs administered were significantly less, and length of hospital stay were shorter by surgeons with experience of 60 cases. LADG is a technically feasible surgical procedure, depending on the surgeon's technical proficiency. Experience of at least 60 cases of LADG seems to result in satisfactory patient outcomes.
Surgical laparoscopy, endoscopy & percutaneous techniques 07/2008; 18(3):236-41. · 1.23 Impact Factor
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Chikara Kunisaki,
Masazumi Takahashi,
Tadao Fukushima,
Yutaka Nagahori,
Hirotoshi Akiyama,
Hirochika Makino,
Yuichi Otsuka, Hidetaka A Ono,
Takashi Kosaka,
Ryo Takagawa,
Hiroshi Shimada
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ABSTRACT: The aim of this study was to determine the influence of stage migration on the outcomes of D2 gastrectomy compared with D3 gastrectomy in advanced gastric cancer.
A series of 580 advanced gastric cancer patients (430 D2 gastrectomy and 150 D3 gastrectomy) were registered. The incidence of stage migration and the surgical results of D2 and D3 gastrectomy were compared.
The incidence of N-stage migration was 22.7% and that of pathological stage was 20.7%. Stage-specific survival times of simulated D2 gastrectomy and real D2 gastrectomy were equal. In patients with pN2 tumors measuring 50 to 100 mm in diameter, there was a significant difference in survival between D2 and D3 gastrectomy. However, no difference was observed between D2 and simulated D2 gastrectomy.
Because there was a high incidence of stage migration in patients after D3 gastrectomy, it may be more feasible to validate comparisons between different levels of lymph node dissection in a randomized controlled trial.
American journal of surgery 06/2008; 196(3):358-63. · 2.36 Impact Factor
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ABSTRACT: The full realization of the therapeutic potential of conditionally replicative adenoviruses (CRAds) in the field of pancreatic cancer has been hindered by limited tumor transduction and suboptimal replication control.
We optimized infectivity enhancements and tumor-specific promoters (tsps) for pancreatic cancer. Infectivity was enhanced both by incorporating an RGD motif and by substituting the knob region with Ad serotype 3 knob (Ad5/Ad3). An optimized CRAd was tested in an orthotopic pancreatic cancer model by systemic administration.
Among a panel of 8 tsps, the 1.5-kb cyclooxygenase-2 (Cox-2L) promoter profile was most advantageous in the pancreatic cancer cell lines, whereas 4 more promoters were also promising. An infectivity-enhanced Ad5/Ad3 CRAd controlled with Cox-2L promoter was found to safely exhibit replication within a tumor in this model and was found to suppress tumor growth after systemic delivery.
The infectivity-enhanced, promoter-controlled CRAd promises useful clinical applications for pancreatic cancer gene therapy.
American journal of surgery 05/2008; 195(4):481-90. · 2.36 Impact Factor
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Chikara Kunisaki,
Hirochika Makino,
Ryo Takagawa,
Naoto Yamamoto,
Yasuhiko Nagano,
Syoichi Fujii,
Takashi Kosaka, Hidetaka A Ono,
Yuichi Otsuka,
Hirotoshi Akiyama,
Yasushi Ichikawa,
Hiroshi Shimada
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ABSTRACT: This study aimed to identify predictive factors and to evaluate appropriate treatments for recurrence of esophageal cancer after curative esophagectomy. About 166 consecutive patients, who underwent curative esophagectomy, were enrolled between April 1994 and March 2003. Recurrence was classified as loco-regional or distant. Logistic regression analysis was used to identify predictive factors for recurrence. Prognostic factors were evaluated by Log-rank test and Cox proportional hazard regression analysis. The disease-specific 5-year survival was 56.8%. Recurrence was observed in 72 patients (43.4%), with 64 of these occurring within 3 years. The number of metastatic lymph nodes and lymphatic invasion independently predicted recurrence. There were significant differences in time to recurrence and survival time between loco-regional, distant recurrence, and combined recurrence. The 5-year survival time in patients with recurrence was 11.9%, and median survival time was 24 months. There was also a significant difference in survival after recurrence between treatment methods (no treatment vs chemo-radiotherapy, p=0.0063; chemotherapy, p=0.0247; and radiotherapy, p<0.0001). Meticulous, long-term follow-up is particularly necessary in patients with four or more metastatic lymph nodes to achieve early detection of recurrence. Randomized controlled trials should be used to develop effective modalities for each recurrence pattern to improve therapeutic outcomes.
Journal of Gastrointestinal Surgery 05/2008; 12(5):802-10. · 2.83 Impact Factor
