Kiyohiko Shuto

Chiba University, Chiba-shi, Chiba-ken, Japan

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Publications (83)104.92 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Although percutaneous endoscopic gastrostomy (PEG) is the preferred method to provide enteral nutrition for a longer time period, in obstructive esophageal cancer, we cannot safely perform endoscopic access to the stomach even with the ultrathin endoscope. We experienced 1 fatal case due to esophageal perforation caused by balloon dilation, and hence, we developed a safer method. We treated 4 patients with obstructive esophageal cancer using a 3-step gradual dilation method with nasogastric tubes (from 8 to 16 Fr). After about 2 weeks of initial dilation, we could safely perform endoscopic access to the stomach with the ultrathin endoscope and PEG placement using the introducer technique. The 3-step gradual dilation method is a safe and easy procedure for endoscopic access to the stomach. It can be used to provide enteral access as a palliative treatment for patients with obstructive esophageal cancer that is not suitable for conventional PEG placement.
    Surgical laparoscopy, endoscopy & percutaneous techniques. 08/2014; 24(4):e140-e142.
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    ABSTRACT: Gastrointestinal stromal tumors (GISTs) rarely arise in the esophagus, where carcinoma is the most common malignant neoplasm and leiomyoma is the most common benign tumor. Because of their rarity, the clinical course and treatment of esophageal GISTs are poorly understood. These lesions are generally thought to carry a poor prognosis, making the differential diagnosis of other common mesenchymal neoplasms essential, for both prognostic and therapeutic reasons. We report a case of successfully resected giant esophageal GIST, thought to be the largest resected GIST reported in Japan. The patient was a 65-year-old woman, in whom upper gastrointestinal endoscopy found a 180-mm submucosal tumor in the lower thoracic esophagus, extending just below the aortic arch. We diagnosed esophageal GIST, and the patient underwent middle and lower esophagectomy via left thoracotomy, followed by gastric tube reconstruction. The tumor was resected completely. Histopathological and immunohistochemical staining confirmed that the tumor was a high-risk lesion, and treatment with imatinib was initiated. Computed tomography showed liver metastasis 5 months later, but the patient is doing well 24 months after surgery.
    Surgery Today 06/2014; · 0.96 Impact Factor
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    ABSTRACT: Reports suggest that hepatic blood flow may have an association with cancer progression. The aim of the present study was to evaluate whether the hepatic blood flow measured by CT perfusion (CTP) may identify patients at high‑risk for postoperative recurrence of esophageal squamous cell carcinoma (ESCC). Prior to surgery, hepatic CTP images were obtained using a 320-row area detector CT. The data were analyzed by a commercially available software based on the dual input maximum slope method, and arterial blood flow (AF, ml/min/100 ml tissue), portal blood flow (PF, ml/min/100 ml tissue) and perfusion index [PI (%) = AF/AF + PF x 100] were measured. These parameters were compared with the pathological stage and outcome of the ESCC patients. Forty-five patients with ESCC were eligible for this study. The median follow-up period was 17 months, and recurrences were observed in 9 patients (20%). The preoperative PI values of the 9 patients with recurrence were significantly higher than those of the 36 patients without recurrence (23.9 vs. 15.9, P=0.0022). Patients were categorized into the following two groups; high PI (>20) and low PI (<20). The recurrence-free survival of the low PI group was significantly better than that of the high PI group (P<0.0001). A multivariate analysis showed that a high PI was an independent risk factor for recurrence (odds ratio, 19.1; P=0.0369).Therefore, the preoperative PI of the liver may be a useful imaging biomarker for predicting the recurrence of patients with esophageal cancer.
    Oncology Reports 01/2014; · 2.30 Impact Factor
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    ABSTRACT: The purpose of this study is to evaluate whether computed tomography perfusion (CTP) can evaluate the biological change during chemoradiation therapy (CRT) and the survival of patients with esophageal cancer after CRT.Thirty-two consecutive patients (31 men, 1 woman; mean age 65.9 years) with esophageal squamous cell carcinoma underwent CTP before and 2–3 weeks after CRT. The perfusion data were analyzed using software based on the deconvolution method. We investigated the relationship between the changes of CTP parameters during CRT, the response to CRT and outcome.This study included 22 clinical responders and 10 non-responders. Post-CRT blood flow (BF) was significantly lower than pre-CRT (P = 0.0003). BF in responders decreased significantly greater than in non-responders (P P = 0.03).Substantial BF change may help to evaluate the response to CRT and survival in patients with advanced esophageal squamous cell carcinoma.
    Esophagus 01/2014; 11(1). · 0.83 Impact Factor
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    ABSTRACT: Serotonin (5-hydroxytryptamine [5-HT])3 receptor antagonists are effective for the treatment of diarrhea-predominant irritable bowel syndrome (IBS-D), in which exaggerated intestinal/colonic hypermotility is often observed. Recent studies have suggested that the motility disorder, especially spastic hypermotility, seen in the neorectum following sphincter-preserving operations for rectal cancer may be the basis of the postoperative defecatory malfunction seen in these patients. We investigated the efficacy of 5-HT3 receptor antagonists in patients suffering from severe low anterior resection syndrome. A total of 25 male patients with complaints of uncontrollable urgency or fecal incontinence following sphincter-preserving operations were enrolled in this study. Defecatory status, assessed on the basis of incontinence score (0-20), urgency grade (0-3), and number of toilet visits per day, was evaluated using a questionnaire before and 1 month after the administration of the 5-HT3 antagonist ramosetron. All the parameters assessed improved significantly after taking ramosetron for 1 month. The effect was more prominent in cases whose anastomotic line was lower, ie, inside the anal canal. Defecatory function was better in patients who commenced ramosetron therapy within 6 months postoperatively, as compared to those who were not prescribed ramosetron for more than 7 months postoperatively. These results suggest that 5-HT3 antagonists are effective for the treatment of low anterior resection syndrome, as in diarrhea-predominant irritable bowel syndrome. The improvement in symptoms is not merely time dependent, but it is related to treatment with 5-HT3 antagonists.
    Clinical and Experimental Gastroenterology 01/2014; 7:47-52.
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    ABSTRACT: We have encountered many cases wherein the metastatic nest of esophageal squamous cell carcinoma occupied only a small space in the lymph nodes because of which computed tomography( CT) and fludeoxy glucose( FDG)-positron emission tomography( PET) could not detect the lymph node metastasis satisfactorily. The false-negative lymph nodes that were not detected by FDG-PET before surgery were smaller in diameter, rate of occupation, and area of occupation than the true-positive lymph nodes. The smallest area of the cancer nest in the true-positive group was 7.5 mm2, and therefore, it was reasonable to consider a 5-mm diameter area as the criteria for correct diagnosis by FDG-PET. Most of the false-negative lymph nodes with a large area of carcinoma were attached to the primary tumor; therefore, they could not be precisely identified. The detection of false-negative lymph nodes by FDG-PET was not precise because of increases in the quantity of stroma-like cells in poorly differentiated carcinomas and in fibrosis caused by neoadjuvant therapy in the lymph nodes.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2155-7.
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    ABSTRACT: The aim of this study is to assess the tumor heterogeneity of esophageal squamous cell cancer by dynamic FDG-PET (dPET). Thirty patients were enrolled in this study. Images were obtained after intravenous injection of 370 MBq of 18F-FDG for 1 h. The time-density curve of the standardized uptake value( SUV) was evaluated quantitatively by fractal analysis. Tumor fractal dimension (FD) maps were acquired, and the FD of the tumor was measured. There was a significant correlation between FD and the clinical response to adjuvant therapy. The FD reduction rates of adjuvant therapy were 23.23% in the responder group and 5.83% in the nonresponder group. FD may be a valid imaging biomarker for assessing the response to neoadjuvant therapy.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2152-4.
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    ABSTRACT: Several essential oils possess pharmacological effects. Among the various constituents of essential oils, 1, 8-cineole has been shown to possess pharmacological effects such as anti-bacterial and anti-inflammatory effects. The effect of 1, 8-cineole on human colorectal cancer cells, however, has not reported previously. In this study, we have investigated the anti-proliferative effect of 1, 8-cineole on human colon cancer cell lines HCT116 and RKO by WST-8 and BrdU assays. The cytotoxicity of 1, 8-cineole was investigated by LDH activity and TUNEL staining. The mechanism of apoptosis by 1, 8-cineole was determined by western blot analyses. In in vivo study, RKO cells were injected into the SCID mice and the effect of 1, 8-cineole was investigated. Specific induction of apoptosis, not necrosis, was observed in human colon cancer cell lines HCT116 and RKO by 1, 8-cineole. The treatment with 1, 8-cineole was associated with inactivation of survivin and Akt and activation of p38. These molecules induced cleaved PARP and caspase-3, finally causing apoptosis. In xenotransplanted SCID mice, the 1, 8-cineole group showed significantly inhibited tumor progression compared to the control group. These results indicated 1, 8-cineole suppressed human colorectal cancer proliferation by inducing apoptosis. Based on these studies 1, 8-cineole would be an effective strategy to treat colorectal cancer.
    Oncology Reports 10/2013; · 2.30 Impact Factor
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    ABSTRACT: Hiatal hernias after total gastrectomy for advanced gastric cancer are very rare. We review a case of a 44-year-old male who presented with dyspnea and chest pain 2 days after total gastrectomy, lower esophagectomy, and splenectomy with retrocolic Roux-en-Y reconstruction approached by a left thoracoabdominal incision for gastric cancer at the cardia. Plain and cross-sectional imaging identified a large hiatal hernia protruding into the right thorax containing left-sided transverse colon and small intestine. Our patient underwent a laparotomy, and after hernia reduction the hiatal defect was repaired by direct suturing. He experienced anastomotic leakage and right pyothorax, but recovered. The potential cause is discussed here and the published literature on this rare complication is reviewed briefly.
    Hernia 08/2013; · 1.69 Impact Factor
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    ABSTRACT: Background: The aim of this study was to investigate the utility of the apparent diffusion coefficient (ADC) value in diffusion-weighted magnetic resonance imaging (DWMRI) for prediction and early detection of treatment response in advanced esophageal squamous cell carcinoma. Method: DWMRI was performed in 27 patients with primary cT4 esophageal carcinoma that were undergoing chemoradiotherapy before treatment and after 20 and 40 Gy. We calculated tumor ADCs and association of the treatment effect between responders and nonresponders. Results: The ADC at the time of 20 Gy was significantly higher in responders compared to nonresponders (1.13 vs. 0.93; p = 0.005). The ADC cut-off value was set at 1.00 × 10(-3) mm(2)/s and the ADC predicted the responders with a sensitivity, positive predictive value and accuracy of 79, 73 and 74%, respectively. The increased rate of the ADC at the time of 20 Gy (ΔADC20) was also significantly higher in responders compared to nonresponders (35.4 vs. 1.5%; p = 0.0007). An ADC cut-off value for ΔADC20 of 15% predicted the responders with a sensitivity, positive predictive value and accuracy of 71, 100 and 85%, respectively. Conclusion: The ADC values predicted the prognosis of patients with advanced esophageal squamous cell carcinoma as well as the treatment response. © 2013 S. Karger AG, Basel.
    Digestive surgery 07/2013; 30(3):247-255. · 1.37 Impact Factor
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    ABSTRACT: A 67-year-old male was referred to our hospital after being diagnosed with esophageal squamous cell carcinoma of the middle thoracic esophagus. The clinical stage was T1b(sm)N4M1 cStage IVb, so he was admitted to our hospital for systemic chemotherapy. He had sustained fever and a dry cough. Chest computed tomography showed the presence of irregular shadows, and unidentified respiratory insufficiency had progressed. A transbronchial lung biopsy revealed a pulmonary artery tumor embolus of esophageal squamous cell carcinoma. He developed DIC and died of respiratory failure on the 19th hospital day. The postmortem autopsy detected pulmonary tumor thrombotic microangiopathy accompanied by esophageal squamous cell carcinoma.
    Esophagus 06/2013; · 0.83 Impact Factor
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    ABSTRACT: Fatty acid synthase is highly expressed in many types of human cancers. Cerulenin, a natural inhibitor of fatty acid synthase, induced apoptosis in the human colon cancer cell lines HCT116 and RKO. Oxaliplatin also induced cell death in these cell lines. Cerulenin treatment was associated with reduced levels of phosphorylated Akt, activation of p38 and induced caspase-3 cleavage and finally caused apoptosis. Oxaliplatin induced activation of the p53-p21 pathway and p38. In combination with cerulenin and oxaliplatin, activation of the p53-p21 pathway and p38 occurred in a smaller concentration and finally induced caspase-3 cleavage in a smaller concentration of cerulenin and oxaliplatin. In xenotransplanted SCID mice, the cerulenin + oxaliplatin group significantly inhibited tumor progression compared to the control, cerulenin and oxaliplatin groups. Based on these studies, inhibiting fatty acid synthase would be an effective strategy to treat unresectable colorectal cancer tumors in combination with oxaliplatin. Fatty acid synthase inhibitor would be one of the best counterparts of oxaliplatin, which reduces the dose and side-effects of oxaliplatin and would make it possible to endure the chemotherapy over a longer period.
    International Journal of Oncology 06/2013; · 2.66 Impact Factor
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    ABSTRACT: An epiphrenic diverticulum is a pulsion pseudodiverticulum of the distal esophagus that is frequently associated with esophageal motility disorders. Therefore, a simple diverticulectomy leads to a poor outcome. High-resolution impedance manometry (HRIM), introduced recently, enables easier evaluation of both esophageal pressure and bolus transit dynamics. We report the case of a 40-year-old female diagnosed with an epiphrenic diverticulum with hypertensive lower esophageal sphincter pressure by use of HRIM. She underwent a laparoscopic transhiatal diverticulectomy with a long myotomy and Dor’s fundoplication and was discharged with no complications. Four weeks after the operation, HRIM was performed again, and showed no accumulation of water in the esophagus and improvement of bolus transit. We herein report the usefulness of HRIM for evaluation of esophageal motility disorders for patients with an epiphrenic diverticulum.
    Esophagus 04/2013; · 0.83 Impact Factor
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    ABSTRACT: A 65-year-old man with dysphagia and hoarseness was admitted to our hospital. The upper gastrointestinal examinations revealed a tumor in the lower esophagus while the biopsy specimens revealed squamous cell carcinoma. The clinical diagnosis was esophageal cancer(Lt, type 2, cT3N4M0, cStage IVa). The patient underwent neoadjuvant-chemotherapy(5-fluorouracil/cisplatin). After one course, computed tomography(CT)showed rapid growth of the tumor and lymph nodes, resulting in a progressive disease. It was considered unresectable because of the direct invasion of the No. 1 lymph node to the liver. Then, three courses of docetaxel were administered as second-line chemotherapy, and CT revealed the markedly reduced size of the tumor and lymph nodes, resulting in a partial response. The tumor was now thought to be resectable. Subtotal esophagectomy could be performed and the postoperative course was uneventful. Histopathological findings showed no evidence of malignancy at the primary tumor(grade 3), although there were residual atypical keratinocytes in some lymph nodes. The patient is doing well without any signs of recurrence 21 months after the surgery.
    Gan to kagaku ryoho. Cancer & chemotherapy 02/2013; 40(2):233-5.
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    ABSTRACT: PURPOSE Assessing the response to chemoradiation therapy (CRT) by contrast-enhanced CT would be valuable for managing esophageal squamous cell carcinoma. The purpose of this study was to evaluate the usefulness of Perfusion CT in assessing the response to CRT of patients with esophageal squamous cell carcinoma. METHOD AND MATERIALS Thirty-one consecutive patients (30 men, 1 women; mean age 65.8 years) with esophageal squamous cell carcinoma underwent perfusion CT before and after CRT. The perfusion data were transferred to an image processing workstation (Advantage Workstation 4.1; GE Medical Systems) and then analyzed using software (CT Perfusion 3.0; GE Medical Systems), based on the deconvolution method. We retrospectively investigated the correlations between the change of Perfusion parameters during CRT, the response to CRT and survival. RESULTS There were 22 clinical responders and 10 non-responders. Post-CRT blood flow was significantly lower than Pre-CRT (P = 0.0009). Blood flow of responders decreased significantly more than non-responders. (P < 0.0001). To further investigate whether the change of blood flow can distinguish between responders and non-responders, we used ROC analysis. The area under the ROC curve was 97 percent (SD 2 percent), which suggests that the change of blood flow is a favorable parameter for detecting responders. The tumor contraction rate during CRT showed a significant correlation with the change of blood flow (r = -0.54, P = 0.0016). Patients with tumors whose post-CRT blood flow decrease more survived significantly longer than those who with tumors whose post-CRT blood flow decrease less (P = 0.03). CONCLUSION Perfusion CT may help to evaluate the response to CRT and survival in patients with advanced esophageal squamous cell carcinoma. We hope that our results will provide an important insight into selecting the optimal therapeutic strategy for the treatment of esophageal squamous cell carcinoma. CLINICAL RELEVANCE/APPLICATION The change of blood flow had a relationship with survival after CRT in patients with advanced esophageal cancer, and I recommend perfusion CT as a promissing modality to evaluate the response to CRT.
    Radiological Society of North America 2012 Scientific Assembly and Annual Meeting; 11/2012
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    ABSTRACT: To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of strangulation ileus in order to make an early diagnosis. A comparative examination was carried out with respect to the CT value of the intestinal tract wall in each scanning phase, the CT value of the content in the intestinal tract, and the CT value of ascites fluid in the portal vein phase for a group in which ischemia was observed (Group I) and a group in which ischemia was not observed (Group N) based on the pathological findings or intra-surgical findings. Moreover, a comparative examination was carried out in Group I subjects for each scanning phase with respect to average differences in the CT values of the intestinal tract wall where ischemia was suspected and in the intestinal tract wall in non-ischemic areas. There were 15 subjects in Group I and 30 subjects in Group N. The CT value of the intestinal tract wall was 41.8 ± 11.2 Hounsfield Unit (HU) in Group I and 69.6 ± 18.4 HU in Group N in the arterial phase, with the CT value of the ischemic bowel wall being significantly lower in Group I. In the portal vein phase, the CT value of the ischemic bowel wall was 60.6 ± 14.6 HU in Group I and 80.7 ± 17.7 HU in Group N, with the CT value of the ischemic bowel wall being significantly lower in Group I; however, no significant differences were observed in the equilibrium phase. The CT value of the solution in the intestine was 18.6 ± 9.5 HU in Group I and 10.4 ± 5.1 HU in Group N, being significantly higher in Group I. No significant differences were observed in the CT value of the accumulation of ascites fluid. The average difference in the CT values between the ischemic bowel wall and the non-ischemic bowel wall for each subject in Group I was 33.7 ± 20.1 HU in the arterial phase, being significantly larger compared to the other two phases. This is a retrospective study using a small number of subjects; however, it suggests that there is a possibility that CT scanning in the arterial phase is useful for the early diagnosis of strangulation ileus.
    World journal of radiology. 11/2012; 4(11):450-4.
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    ABSTRACT: We report a rare case of diffusely infiltrative squamous cell carcinoma of the esophagus. The patient, a 68-year-old man, was admitted to our hospital for investigation of dysphagia. Esophagography and upper gastrointestinal endoscopy revealed esophageal stenosis and gastric cancer. As a biopsy from the esophagus revealed no sign of malignancy, he underwent only distal gastrectomy. After 3 months, the stenosis became worse. Again, biopsy from a gastrointestinal endoscopy showed no malignancy, but endobronchial ultrasound-guided transbronchial needle aspiration revealed squamous cell carcinoma of the esophagus. Despite various treatments, the patient died of disease progression 20 months after its onset. Autopsy revealed diffusely infiltrative squamous cell carcinoma of the esophagus, which is a rare malignancy with few case reports documented.
    Surgery Today 11/2012; · 0.96 Impact Factor
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    ABSTRACT: OBJECTIVES:: T1 esophageal squamous cell carcinoma (ESCC) has a low, but still present, risk of lymph node (LN) metastasis. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is often applied for T1 ESCC. To achieve successful treatment by EMR/ESD, the risk of LN metastases, LN recurrence, and hematological recurrence need to be better understood. The aim of this study was to determine the precise risk for metastasis in T1 ESCC. METHODS:: We divided 295 patients with T1 ESCC who underwent surgery and/or ESD/EMR into 6 categories (m1, m2, m3, sm1, sm2, and sm3). Their risks of LN metastasis, LN recurrence, hematological recurrence, and the outcome were determined. RESULTS:: The rates of LN metastasis and LN recurrence were 0% in m1 and m2, 9% in m3, 16% in sm1, 35% in sm2, and 62% in sm3 cases. The incidence of hematological recurrence was 0% in m1, m2, m3, and sm1 cases; 9% in sm2 cases; and 13% in sm3 cases. The overall risk of metastasis was 9% in m3, 16% in sm1, 38% in sm2, and 64% in sm3 patients. The 5-year disease-specific survival rates were 100% in m1, m2, and m3; 90.9% in sm1; 78.8% in sm2; and 68.6% in sm3 patients. Statistically, both lymphatic and venous invasion were selected as predictive markers for metastasis. In m3 patients, positivity for either of these had an odds ratio for metastasis of 7.333 (P = 0.093). CONCLUSIONS:: Our study provides a precise assessment of the comprehensive risk of metastasis and feasible predictive markers for T1 ESCC.
    Annals of surgery 10/2012; · 7.90 Impact Factor
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    ABSTRACT: Pneumonia, recurrent nerve injury and anastomotic leakage are common complications occurring after esophagectomy. However, there have so far been few reports on tracheal compression by the gastric tube. The patient was a 66-year-old female with a history of ankylosing spondylitis and esophageal superficial squamous carcinoma treated with endoscopic mucosal resection. The new lesion was located just next to the last treated lesion. Therefore, it was difficult to treat this lesion endoscopically because of severe stenosis and scarring due to the previous treatment. Transhiatal esophagectomy was therefore performed. However, severe tracheal obstruction occurred following extubation after the surgery due to compression caused by the gastric tube. This case was successfully treated with a mediastinal pleural incision through a right thoracotomy. The distance between the sternum and the vertebra in this case was narrower than normal, thereby inducing this rare condition.
    Surgery Today 08/2012; · 0.96 Impact Factor
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    ABSTRACT: Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is exceedingly rare. This report presents the case of a 57-year-old male who presented with the chief complaint of dysphagia. Endoscopy and computed tomography revealed a locally advanced tumor of the cervical esophagus and swollen mediastinal lymph nodes. He underwent chemoradiotherapy followed by esophagectomy with three-field lymph node dissection. The resected tumor was a circumferentially scarred lesion located 1.5 cm from the proximal margin. The tumor was identified to be a well-differentiated adenocarcinoma arising from HGM with invasion to the muscularis propria. Postoperative chemoradiotherapy was performed because positive surgical margins were observed in the resected tissue. The patient has remained alive for more than 4 years after surgery, without any evidence of recurrence.
    Surgery Today 06/2012; · 0.96 Impact Factor

Publication Stats

423 Citations
104.92 Total Impact Points

Institutions

  • 2004–2013
    • Chiba University
      • Graduate School of Medicine
      Chiba-shi, Chiba-ken, Japan
    • Seirei Sakura Citizen Hospital
      Сакура, Chiba, Japan
  • 2006
    • Chiba Cancer Center
      Tiba, Chiba, Japan