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ABSTRACT: BACKGROUND AND AIM: Despite remarkable advances in diagnostic modalities, preoperative assessment of the local tumor extent in esophageal cancer is still very difficult. The aim of this study was to evaluate the predictive value of the computed tomography (CT) attenuation value between the tumor and the aorta for esophageal cancer. METHODS: Consecutive CT values were determined between the center of the tumor and center of the aorta. We determined the distance between the intersection of the average CT attenuation value of the tumor using the lower CT attenuation value of the inclusion tissues (T-A distance). We also determined the minimal CT attenuation value and the overall circumference of contact area (Picus' angle). This study included 101 patients suspected of having a tumor invading the adventitia, and evaluated the capacity of these parameters for predicting the aortic invasion. RESULTS: The T-A distance in patients who were diagnosed without aortic invasion was significantly longer than patients who were pathologically confirmed to have invasion to the aortic wall [pT4(Ao)] (p<0.05). The minimal CT attenuation value in patients without aortic invasion was significantly lower than pT4(Ao) patients (p<0.05), although such a difference was not observed for the Picus' angle. The T-A distance (1.1 mm >) is the most reliable feature for predicting the aortic invasion, according to the results of the area under the receiver operating characteristic curve. CONCLUSIONS: The assessment of the T-A distance is simple and objective, and can help prevent unnecessary surgery in patients with inoperable tumors.
Journal of Gastroenterology and Hepatology 11/2012; · 2.87 Impact Factor
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Hironori Tsujimoto,
Risa Takahata,
Shinsuke Nomura,
Isao Kumano,
Yusuke Matsumoto, Kazumichi Yoshida,
Shuichi Hiraki,
Suefumi Aosasa,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: OBJECTIVE: Pulmonary complications after esophagectomy continue to be a significant cause of morbidity and mortality. Although several factors have been implicated to be associated with pulmonary complications after esophagectomy, the prediction of pulmonary complications remains a challenge. The purpose of this study was to evaluate the predictive value of cytokine levels in sera and pleural drainage fluid for pneumonia and hypo-oxygenations following esophagectomy. METHODS: A total of 66 patients who underwent esophagectomy for esophageal cancer were retrospectively evaluated for preoperative status, surgical procedures, and postoperative systemic response and laboratory data up to postoperative day (POD) 7. Interleukin-6 (IL-6) and IL-8 levels were also examined in patient sera and pleural drainage fluid until POD 5. RESULTS: Eighteen patients (27.3%) had pneumonia following esophagectomy. Patients with pneumonia had significantly more frequent intraoperative blood transfusions, more frequent re-intubation, longer hospital stays, and higher hospital mortality than those without pulmonary complications. Patients with pneumonia had significantly higher levels of serum and pleural IL-6 immediately after surgery and on POD 1 than those without pneumonia. Univariate and multivariate analyses revealed higher pleural IL-6 levels were associated with postoperative minimum PaO(2)/FiO(2) ratio. CONCLUSIONS: The elevation of pleural IL-6 levels immediately after surgery and on POD 1 may predict the incidence of pneumonia and the levels of postoperative impaired oxygenation following esophagectomy.
Journal of Surgical Research 11/2012; · 2.25 Impact Factor
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Hironori Tsujimoto,
Hiroyuki Horiguchi,
Shuichi Hiraki,
Yoshihisa Yaguchi,
Risa Takahata,
Isao Kumano, Kazumichi Yoshida,
Yusuke Matsumoto,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The results of the Japan Clinical Oncology Group trial demonstrated that adjuvant chemotherapy with S-1 for stage II/III gastric cancer is effective and suggested that this therapy should be adopted as the standard treatment following curative D2 gastric dissection. We reviewed treatment outcomes in 58 consecutive patients who received adjuvant therapy with S-1 for stage II/III gastric cancer following curative D2 dissection; the standard dosage used was determined on the basis of the patient body surface area. Twenty-four patients (41.3%) discontinued treatment before 12 months. Patients who completed 12 months of adjuvant therapy with S-1 were younger and more frequently treated by senior doctors (>15 years of experience) than those who did not. However, no differences existed in pathological features and surgical procedures between groups. Overall survival and relapse-free survival were better in patients who completed 12 months of adjuvant therapy with S-1. Fatigue and nausea were associated with discontinuation of S-1 treatment. In conclusion, immediately after surgery, fatigue and gastrointestinal symptoms of ≤ grade 2 may have a major impact on treatment compliance. Prior to the commencement of S-1 administration, both patients and doctors should be made completely aware of the toxicity, compliance and efficacy issues associated with this adjuvant therapy.
Oncology letters 11/2012; 4(5):1135-1139. · 0.11 Impact Factor
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Hironori Tsujimoto,
Yoshihisa Yaguchi,
Isao Kumano,
Risa Takahata,
Yusuke Matsumoto, Kazumichi Yoshida,
Hiroyuki Horiguchi,
Suefumi Aosasa,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: Endoscopic submucosal dissection (ESD) utilizes electrical coagulation, which can cause burns, fibrosis and adhesion of the stomach and surrounding tissue; these complications might increase the surgical difficulties for subsequent laparoscopy-assisted gastrectomy (LAG) and the risk of complications. However, scarce data are available on the influence of previous ESD on LAG. The purpose of this study was to evaluate the feasibility and safety of LAG following incomplete ESD in patients with early gastric cancer. Ninety-seven patients who underwent LAG were analyzed retrospectively; 17 patients had undergone ESD previously and the remaining 80 patients had no history of ESD. Clinicopathological data and surgical outcomes were compared between the two groups. No differences were observed in surgical outcomes of LAG after ESD in terms of operation time, intraoperative blood loss, total number of harvested lymph nodes, time until start of flatus, and postoperative hospital stay. These results were not influenced by tumor location and operative procedures. In conclusion, in terms of surgical outcomes, LAG is a safe and feasible procedure for the treatment of early gastric cancer regardless of previous endoscopic treatment. LAG may be the first-choice radical treatment after incomplete ESD for early gastric cancer.
Oncology Reports 09/2012; 28(6):2205-10. · 1.84 Impact Factor
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Hironori Tsujimoto,
Shuichi Hiraki,
Naoko Sakamoto,
Yoshihisa Yaguchi,
Isao Kumano, Kazumichi Yoshida,
Yusuke Matsumoto,
Takayoshi Akase,
Hiroyuki Horiguchi,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The median arcuate ligament syndrome is an unusual disease associated with postprandial epigastric pain, and the optimal treatment of this syndrome remains to be established. A 52-year-old woman manifested in our hospital postprandial epigastric pain, and extrinsic compression of the celiac trunk revealed by an abdominal computed tomography. After the induction of general anesthesia, the celiac artery origin was completely skeletonized using a laparoscopic dissector and vessel sealing system. Intraoperative Doppler ultrasound demonstrated that, after surgery, the stenosis of the celiac artery, and poststenotic dilatation observed before the release of the median arcuate ligament, had completely disappeared. In conclusion, the laparoscopic release of the median arcuate ligament is a minimally invasive treatment for median arcuate ligament syndrome. The intraoperative Doppler ultrasound is useful for confirming the decompression of the celiac artery, although long-term follow-up is mandatory.
Surgical laparoscopy, endoscopy & percutaneous techniques 04/2012; 22(2):e71-5. · 1.23 Impact Factor
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Hironori Tsujimoto,
Ichiro Uyama,
Yoshihisa Yaguchi,
Isao Kumano,
Risa Takahata,
Yusuke Matsumoto, Kazumichi Yoshida,
Hiroyuki Horiguchi,
Suefumi Aosasa,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: Recently, novel intracorporeal esophagojejunostomy using a linear stapler after laparoscopic total gastrectomy (LTG) was reported and termed as the overlap method. In this study, we evaluated the feasibility and safety of the overlap method for esophagojejunostomy or esophagogastrostomy after LTG or laparoscopic proximal gastrectomy (LPG), respectively.
Twenty-five patients underwent anastomosis using a linear stapler during esophagojejunostomy and esophagogastrostomy after LTG and LPG, respectively. Clinicopathological data and surgical outcomes were evaluated.
The average surgical duration for LTG was 236.8 min compared with 224.1 min for LPG. Postoperative complications were observed in four patients (16.0%); these included a wound infection, an intestinal obstruction, an afferent loop syndrome, and a reflux symptom. The average postoperative hospital stay of the patients was 12.5 days. There was no case of conversion to open surgery, anastomotic leakage or stenosis, or mortality.
The overlap method for esophagojejunostomy or esophagogastrostomy after LTG or LPG is safe and feasible and does not require an additional minilaparotomy, which may result in less pain and favorable cosmetic outcomes.
Langenbeck s Archives of Surgery 03/2012; 397(5):833-40. · 1.81 Impact Factor
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Hironori Tsujimoto,
Takashi Ichikura,
Satoshi Aiko,
Yoshihisa Yaguchi,
Isao Kumano,
Risa Takahata,
Yusuke Matsumoto, Kazumichi Yoshida,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The objective of this study was to evaluate the multidetector computed tomography (MDCT) attenuation value between the tumor and aorta in response to the induction therapy for esophageal cancer. In advanced esophageal cancer, the main reason for unresectability is the local invasion of the tumor into the aorta or trachea. Despite remarkable advances in diagnostic modalities, pre-operative assessment of pathological response and local tumor extent in esophageal cancer remains difficult. MDCT attenuation values between the tumor and aorta, and the contact angle of the tumor to the aorta (Picus' angle) were retrospectively evaluated in patients with esophageal cancer who underwent induction therapy in terms of predicting the pathological response, aortic invasion and prognosis of esophageal cancer. The induction therapy may increase the tumor-to-aorta distance and decrease the maximum tumor size and Picus' angle. When the tumor-to-aorta cut-off value was set at <1.3 mm, the accuracy of this distance for aortic invasion was 94.6%. In terms of this distance, 14 out of 19 patients with a tumor-to-aorta distance of <1.3 mm prior to the induction therapy had a distance of >1.3 mm following therapy and underwent curative resection. The assessment of the MDCT attenuation value between the esophageal tumor and the aorta is simple and objectively assesses the response to the induction therapy and aortic invasion in esophageal cancer. This method should be applied to predict the response to the induction therapy and to prevent unnecessary surgery in patients with tumors involving the aorta.
Experimental and therapeutic medicine 02/2012; 3(2):243-248.
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Hironori Tsujimoto,
Risa Takahata,
Shinsuke Nomura,
Yoshihisa Yaguchi,
Isao Kumano,
Yusuke Matsumoto, Kazumichi Yoshida,
Hiroyuki Horiguchi,
Shuichi Hiraki,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: Less invasive operations such as laparoscopic surgery have been developed for treating gastrointestinal malignancies. However, the advantages of video-assisted thoracoscopic surgery for esophageal cancer (VATS-e) with regard to postoperative morbidity and mortality remains controversial.
We investigated the postoperative clinical course of patients who underwent esophagectomy for esophageal cancer in terms of systemic inflammatory response syndrome (SIRS) induced by VATS-e (VATS-e group) or conventional open surgery (OS group) combined with laparoscopic gastric tube reconstruction.
Compared with the OS group (n = 27), the VATS-e group (n = 22) had a greater thoracic operation time (VATS-e versus OS, 181 ± 56 vs 143 ± 45 minutes, respectively), and lesser duration of stay in the intensive care unit (17 ± 2 vs 32 ± 21 hours, respectively). The VATS-e group also had a lesser SIRS duration (1.5 vs 4.3 days), a lesser incidence of SIRS, a lesser number of positive SIRS criteria, and lesser serum interleukin-6 levels immediately after operation and on postoperative day (POD) 1. The heart rate in the VATS-e group was less than that in the OS group on POD 3. The respiratory rate in the VATS-e group was significantly less than that in the OS group on PODs 3, 5, and 7. Although no difference was observed in the frequencies of postoperative complications between the 2 groups, the VATS-e group had less postoperative pneumonia.
VATS-e attenuates postoperative SIRS, and is therefore a potentially less invasive operative procedure.
Surgery 01/2012; 151(5):667-73. · 3.10 Impact Factor
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Yoshihisa Yaguchi,
Hironori Tsujimoto,
Isao Kumano,
Risa Takahata,
Yusuke Matsumoto, Kazumichi Yoshida,
Hiroyuki Horiguchi,
Satoshi Ono,
Takashi Ichikura,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The purpose of this study was to evaluate the merits of the sentinel node (SN)-navigated reduced gastrectomy (SNRG) procedure. The subjects (sT1N0) were divided into the SNRG group (n=34) and the GL group, that consisted of patients which underwent gastrectomy according to the Japanese Gastric Cancer Association guidelines (n=33). We compared the area of the resected stomach and evaluated their body weight changes, and the results of a questionnaire survey about postoperative symptoms, and nutritional effects by blood tests administered at postoperative months (POM) 3, 6 and 12. The median area of the resected stomach was 104 cm2 in the SNRG group vs. 192 cm2 in the GL group. The body weight loss ratio was -5.9±5.8 vs. -9.3±4.1% at POM 3, and the henoglobin (g/dl) change rate was -1.1±7.9 vs. -6.4±6.5% at POM 12 in the SNRG and GL groups, respectively. There were no significant differences regarding the passage of food, reflux, the incidence of dumping syndrome, digestive and excretory function, or general condition and the satisfaction levels of the patients. In conclusion, SNRG has some advantages over GL in terms of postoperative disorders for at least one year after surgery, and is the recommended choice of a surgical procedure for early gastric cancer.
Oncology Reports 11/2011; 27(3):643-9. · 1.84 Impact Factor
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Hironori Tsujimoto,
Satoshi Ono,
Risa Takahata,
Shuichi Hiraki,
Yoshihisa Yaguchi,
Isao Kumano,
Yusuke Matsumoto, Kazumichi Yoshida,
Satoshi Aiko,
Takashi Ichikura,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: Esophageal anastomotic leakage is still a major cause of morbidity and mortality after esophagectomy. We conducted this study to elucidate how anastomotic leakage affects the systemic inflammatory response syndrome (SIRS) criteria.
The subjects of this retrospective study were 61 patients who underwent esophagectomy. We evaluated their preoperative status, the surgical procedures, and postoperative systemic response, including white blood cell count, heart rate, respiratory rate, body temperature, and laboratory data up to postoperative day (POD) 4.
Anastomotic leakage developed in nine patients (14.8%) and was found on POD 7 on average. These patients had a significantly longer hospital stay than those without leakage. Although no difference was observed in postoperative changes of any of the SIRS criteria, the postoperative incidence of SIRS was significantly higher in the patients with anastomotic leakage on POD 4. The number of positive criteria for SIRS was also significantly higher in patients with anastomotic leakage than in those without leakage on PODs 3 and 4.
The SIRS scoring system is valuable for evaluating the severity of systemic inflammatory response caused by anastomosis leakage, and may serve as an indicator for prompt management.
Surgery Today 11/2011; 42(2):141-6. · 1.22 Impact Factor
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Hironori Tsujimoto,
Yoshihisa Yaguchi,
Shuichi Hiraki,
Naoko Sakamoto,
Isao Kumano,
Yusuke Matsumoto, Kazumichi Yoshida,
Hidekazu Sugasawa,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The aim of this study was to evaluate the peritoneal computed tomography (CT) attenuation values and relate them to the severity of peritonitis in patients with gastrointestinal tract (GI) perforations.
A total of 56 consecutive patients with GI perforations who underwent CT scan and emergency laparotomy in our hospital were enrolled in this study. The CT attenuation values of the peritoneum were measured on a workstation by 2 independent investigators, and were investigated in relation to the severity of illness and hospital mortality.
Peritoneal CT attenuation values in hospital nonsurvivors were significantly lower than those in survivors. There was significant negative correlation between peritoneal CT attenuation values and sequential organ failure assessment score, acute physiology and chronic health evaluation II score, and the Mannheim peritonitis index.
The evaluation of peritoneal CT attenuation values in patients with peritonitis is simple and can be used for objective assessment of the severity of peritonitis.
American journal of surgery 10/2011; 202(4):455-60. · 2.36 Impact Factor
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Hironori Tsujimoto,
Naoko Sakamoto,
Takashi Ichikura,
Shuichi Hiraki,
Yoshihisa Yaguchi,
Isao Kumano,
Yusuke Matsumoto, Kazumichi Yoshida,
Satoshi Ono,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: In order to improve a patient's quality of life after total gastrectomy, jejunal pouch reconstruction has been employed. However, little information exists regarding the optimal size of the jejunal pouch after total gastrectomy.
The study was designed as a single-center randomized trial in which the results of double-tract reconstruction with pouches of two different sizes were compared, i.e., short and long pouch double tract (SPDT and LPDT, respectively). We conducted a clinical assessment with standard questionnaire after surgery. The amount of residual food in the jejunal pouch was determined by endoscopy.
No demographic differences were noted between the two groups. The eating capacity per meal was higher in the SPDT group than in the LPDT group. The postoperative weight loss 24 months after surgery was lower in SPDT group than that in the LPDT group. Although the incidence of early dumping symptoms was higher in the SPDT group, no difference was noted in the other postprandial abdominal symptoms between the two groups.
We conclude that the optimal pouch should be relatively short, as a short pouch improves the eating capacity per meal and the weight loss ratio to the preoperative value.
Journal of Gastrointestinal Surgery 07/2011; 15(10):1777-82. · 2.83 Impact Factor
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ABSTRACT: Percutaneous endoscopic gastrostomy (PEG) has gained wide acceptance for patients suffering malnutrition. However, the PEG technique is not always feasible in cases in which endoscopic passage is not possible due to an obstruction in the esophagus.
Under general anesthesia, a 2.0 nylon suture with a straight needle was inserted into the peritoneal cavity approximately 1 cm cranial to the planned gastrostomy. After this straight needle was held with the laparoscopic needle holder, the layers of the anterior gastric wall were sutured, and then the needle was put through the abdominal wall. The same procedures were performed at 2 cm on the caudal side of the first suture. A trocar with a peel-away sheath was used to penetrate the gastric wall. The peel-away sheath was removed and a balloon catheter was placed between the two gastropexy sutures.
This surgical procedure was performed in 6 cases. The mean operation time was 46.7 ± 10.0 min, the postoperative courses were uneventful, and feeding was started on postoperative day 1 in all cases.
This laparoscopic gastrostomy procedure should be especially useful in patients in whom endoscopic passage is not possible due to a neck or esophageal stenosis.
Digestive surgery 01/2011; 28(3):163-6. · 1.37 Impact Factor
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Hironori Tsujimoto,
Yoshihisa Yaguchi,
Naoko Sakamoto,
Isao Kumano,
Risa Takahata,
Yusuke Matsumoto, Kazumichi Yoshida,
Hidekazu Sugasawa,
Satoshi Ono,
Takashi Ichikura,
Junji Yamamoto,
Kazuo Hase
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ABSTRACT: The sentinel node (SN) concept has been found to be feasible in gastric cancer. However, the lymphatic network of gastric cancer may be more complex, and it may be difficult to visualize all the SN distributed in unexpected areas by conventional modalities. In this study, we evaluate the feasibility and efficacy of CT lymphography for the detection of SN in gastric cancer. A total 24 patients with early gastric cancer were enrolled in the study. Three modalities (CT lymphography, dye and radioisotope [RI] methods) were used for the detection of SN. The images of CT lymphography were obtained at 10 min after injection of contrast agents. The SN were successfully identified by CT lymphography in 83.3% of patients; detection rates by the dye and RI methods were 95% and 100%, respectively. Most patients, in whom SN were successfully detected by CT lymphography, had positive results at 5 min after injection of the contrast material. The SN stations detected by CT lymphography were consistent with or included those detected by dye and/or RI methods. In conclusion, CT lymphography for the detection of SN in gastric cancer is feasible and has several advantages. However, based on this initial experience, CT lymphography had a relatively low detection rate compared with conventional methods, and further efforts will be necessary to improve the detection rate and widen the clinical application of CT lymphography for the detection of SN in gastric cancer.
Cancer Science 12/2010; 101(12):2586-90. · 3.33 Impact Factor
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Annals of Surgical Oncology 06/2009; · 4.17 Impact Factor
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ABSTRACT: In sentinel node (SN) detection for cases of early gastric cancer, the submucosal dye injection method appears to be more reasonable than the subserosal injection. To compare the two injection methods, we have focused on the rate of concordance between hot nodes (HNs) obtained from the radioisotope (RI) method and green nodes (GNs) obtained from the dye-guided method in addition to the number and distribution of GNs detected, and the sensitivity of metastatic detection.
The subjects of this study were 63 consecutive patients with gastric cancer (sT1-T2, sN0, tumor diameter <== 4 cm) in whom we attempted SN detection using a combination of RI and dye methods. 99mTc-tin colloid was injected a day before the surgery, and indocyanine green was injected either submucosally (n = 43) with endoscopes or subserosally (n = 20) by direct vision.
An average of hot and green nodes (H&G: 4 +/- 3 vs. 4 +/- 3), hot and non-green nodes (H&NG: 2 +/- 3 vs. 1 +/- 2), cold and green nodes (C&G: 2 +/- 2 vs. 3 +/- 4), and the rate of concordance (H&G/H&G + H&NG + C&G: 45 + 27% vs. 48 +/- 30%) were not significantly different between the submucosal and subserosal injection methods. The spread of GNs to tier 2 stations (24% vs. 30%) and metastatic detection sensitivity (86% vs. 100%) were also not different between the submucosal and subserosal injection methods.
The tracer injection sites do not have to be limited to the submucosa.
Journal of Experimental & Clinical Cancer Research 01/2009; 27:79. · 2.15 Impact Factor
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ABSTRACT: We focused on the impact of postoperative infection on long-term survival after potentially curative resection for gastric cancer. Postoperative surgical and medical complications have been implicated as a negative predictor of long-term outcome in various malignancies. However, there have been no published reports assessing the impact of complications arising from postoperative infection on survival in gastric cancer. We studied a population of 1,332 patients who underwent curative resection for gastric cancer. These patients were divided into two groups based on the occurrence (141 patients, 10.6%) or absence (1,191 patients, 89.4%) of postoperative complications due to infection. We investigated the demographic and clinicopathological features of each patient with and without postoperative complications from infection, and thereby the impact of postoperative infection on long-term survival. Patients with postoperative infection had significantly higher frequency of males, upper side tumor location, and total gastrectomy as a surgical procedure, more advanced stage of gastric cancer, and greater age compared with those without postoperative infection. Patients with complications due to postoperative infection had significantly more unfavorable outcome compared with those patients without postoperative infection. Multivariate analysis demonstrated that age, preoperative comorbidity, blood transfusion, tumor depth, nodal involvement, and postoperative infection correlated with overall survival. We conclude that postoperative complications from infection are a predictor of adverse clinical outcome in patients with gastric cancer. However, further immunological study and prospective trials are necessary to confirm the biological significance of these findings.
Annals of Surgical Oncology 12/2008; 16(2):311-8. · 4.17 Impact Factor
