Teruhisa Sonoyama

Publications (73)73.02 Total impact

• Source

  Available from: Yoshinori Doi

  Dataset: 080815

  Kazuma Okamoto, Chouhei Sakakura, Takeshi Kubota, Daisuke Ichikawa, Hisashi Ikoma, Tokunari Okayama, Yoshinori Doi, Sachiko Tsukita, Teruhisa Sonoyama, Shojiro Kikuchi, Hitoshi Fujiwara, Yukihito Kokuba, D Montgomery Bissell, Toshiya Ochiai, Eigo Otsuji
• Article: Evaluation of lymph node metastasis in patients with gastric cancer: a comparison of the directionality of lymph node metastasis and the total number of metastatic lymph nodes.

  Maki Kitagawa, Daisuke Ichikawa, Shuhei Komatsu, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Yasutoshi Murayama, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: PURPOSE: The clinical impact of the directionality of lymph node (LN) metastasis was assessed in comparison with the staging by the Japanese Classification of Gastric Carcinoma (JCGC), a numerical LN staging system. METHODS: Two hundred forty-one gastric cancer patients who were diagnosed pathologically to have LN metastasis, and 54 patients who underwent preoperative multidetector-row computed tomography (MDCT) with an image thickness of 1 mm were classified into three groups (unidirectional [Uni-], bidirectional [Bi-], and tridirectional [Tri-] groups) depending on the directionality of their LN metastasis. RESULTS: The prognosis of the Uni-group was better than that of the Bi- or the Tri-group when assessed on the basis of the pathological findings of metastatic LN and also the preoperative MDCT findings. The exact preoperative evaluation was 70.2 % for the directionality system and 61.7 % for the JCGC system, respectively. The stages were less frequently underestimated by the directionality system than the JCGC system (P < 0.02, 19.1 vs. 34.0 %), and the staging could be more precisely performed by both systems in combination. CONCLUSIONS: More precise preoperative evaluation of disease stage could be obtained by the directionality system and the JCGC system in combination.
  Surgery Today 12/2012; · 1.22 Impact Factor
• Article: A case involving long-term survival after esophageal cancer with liver and lung metastases treated by multidisciplinary therapy: report of a case.

  Daisuke Iitaka, Atsushi Shiozaki, Hitoshi Fujiwara, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: A 57-year-old male with lower esophageal cancer underwent subtotal esophagectomy with lymphadenectomy. The histopathological diagnosis was poorly differentiated squamous cell carcinoma, pT2N1M0 pStageIIB. After one course of postoperative adjuvant chemotherapy involving low-dose CDDP/5FU, a PET-CT scan obtained 12 months after surgery revealed a solitary liver metastasis in the S2 area. The patient then underwent five courses of docetaxel chemotherapy (80 mg/body, tri-weekly), and a partial response was observed. We also performed radiofrequency ablation (RFA), after which a complete response was observed. Twenty months after surgery, we detected local liver recurrence in the same position and performed additional RFA. Twenty-four months after surgery, a solitary lung metastasis was detected in the left S2 area and the patient was administered five additional courses of docetaxel therapy. Subsequently, PET-CT revealed growth of lung and liver tumors without recurrence in other areas. Twenty-nine months after surgery, we partially excised metastatic liver and lung tumors, and no subsequent recurrence has since been detected. The prognoses of patients who suffer from esophageal cancer organ recurrence are known to be extremely poor, and optimal therapeutic strategies for treating these patients have not been established. This long-term survival case suggests that multidisciplinary therapy for the treatment of liver and lung recurrence after esophagectomy is effective.
  Surgery Today 07/2012; · 1.22 Impact Factor
• Article: A case of a superficial carcinoma of the esophagus with isolated lymph node metastasis around the abdominal aorta.

  Tomoya Hatakeyama, Atsushi Shiozaki, Hitoshi Fujiwara, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Superficial carcinoma of the esophagus with isolated para-aortic lymph node metastasis is quite rare. A 56-year-old female demonstrated a type 0-IIa+IIb lesion in the middle thoracic esophagus on endoscopic examination. Enhanced computed tomography and positron emission tomography demonstrated two swollen lymph nodes on the right side of the inferior vena cava, but did not demonstrate either a primary lesion or regional lymph node metastasis. A retroperitoneal videoscopic lymph node biopsy was thus performed, and the histopathological diagnosis was metastasis of squamous cell carcinoma. Induction chemotherapy was administered with cisplatin/5-FU, and followed by definitive chemoradiotherapy with cisplatin/5-FU plus 60 Gy radiation. The patient showed satisfactory responses in both the primary and metastatic lesions. This is the first case report describing superficial carcinoma of the esophagus with isolated lymph node metastasis around the abdominal aorta. A precise histological diagnosis of the lymph node is quite important in such cases, and an adequate curative effect can be expected.
  Surgery Today 02/2012; 42(7):676-80. · 1.22 Impact Factor
• Article: Video-assisted surgery for gastric carcinoma arising in a gastric tube reconstructed retrosternally.

  Atsushi Shiozaki, Hitoshi Fujiwara, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Advances in diagnostic and surgical techniques have improved the prognosis of esophageal cancer, but there is growing concern about gastric tube cancer after esophagectomy. Gastric carcinoma arising in tubes that were reconstructed retrosternally is usually resected through a median sternotomy; however, this is invasive and carries a risk of osteomyelitis after suture-line failure. We performed video-assisted gastric tube resection, eliminating the need for sternotomy by using a sternal lifting method, on a 71-year-old man who had previously undergone esophagectomy and reconstruction retrosternally. The tumor was a Borrmann type 1 advanced cancer located near the esophagogastric anastomosis. Neck collar and upper abdominal incisions were made, and the sternum was lifted using a Kent retractor to extend the retrosternal space. Under videoscope assistance, we stripped the adhesions around the gastric tube carefully and performed total gastric tube resection. For the reconstruction, the ileocolon was lifted through the retrosternal space, and an ileoesophagostomy and Roux-en-Y reconstruction were performed. Despite leakage from an esophago-ileoanastomosis on postoperative day 6, the patient recovered well without mediastinitis or osteomyelitis of the sternum. Thus, our surgical procedure provides a good surgical view, decreases surgical stress, and reduces the risk of fatal postoperative complications.
  Surgery Today 11/2011; 42(2):209-13. · 1.22 Impact Factor
• Article: Clinicopathologic features and risk factors for extrahepatic recurrences of hepatocellular carcinoma after curative resection.

  Toshiya Ochiai, Hisashi Ikoma, Kazuma Okamoto, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: The aim of this study was to clarify the clinicopathologic features of hepatocellular carcinoma (HCC) patients with extrahepatic metastasis after the removal of primary HCC, and the risk factors of extrahepatic recurrence. Clinicopathologic data were available for 264 HCC patients who underwent an R0 resection for HCC. Twenty-six patients who developed extrahepatic recurrence during the follow-up period (EXT group) were compared with patients who remained free from recurrence for at least 5 years after resection (n = 46) (No R group) or had only intrahepatic recurrences (n = 193) (INT group). We also estimated the risk factors of extrahepatic recurrence and survival in these 26 patients. There were significant differences in primary tumor size, patient's age, findings in the noncancerous portion, macroscopic type, ductal invasion, intrahepatic metastasis, hepatic involvement and curability of primary tumor, treatment for recurrent tumor, and prognosis between the EXT group and the other groups. Extrahepatic recurrence was significantly associated with six factors by univariate analyses: age, indocyanine green (ICG) 15-min retention rate, tumor size, hepatic involvement of primary tumor, type of hepatectomy, and TNM stage, of which tumor size was an independent risk factor. Resection of recurrent tumor was the only independent favorable factor for survival of patients with extrahepatic recurrence. HCC patients with extrahepatic recurrence had advanced primary tumors and poor prognosis. HCC patients with primary tumors larger than 60 mm were predicted to develop extrahepatic recurrence. Resection of recurrent tumor can improve the prognosis of HCC patients with extrahepatic recurrence.
  World Journal of Surgery 11/2011; 36(1):136-43. · 2.36 Impact Factor
• Article: [A case with juvenile hepatocellular carcinoma without hepatitis underwent right hepatic Trisegmentectomy].

  Kao Fukui, Hiroki Taniguchi, Hisashi Ikoma, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: A CASE REPORT: A 20-year-old man with juvenile hepatocellular carcinoma (HCC) without HBV, nor HCV infections. A complaint of pain in the right abdomen, wherein a bulky hepatic tumor occupying a large area of the right lobe as well as tumors that were 20 mm and 10 mm in size in liver regions S2 and S3, respectively, were observed via an abdominal CT scan. A biopsy resulted in a diagnosis of well-differentiated hepatocarcinoma. The main voluminous tumor mass in the right lobe was resected, but the tumor still remained in the lateral segment after the surgery. On day 21 after the surgery, we initiated a therapy for the remaining tumor. He is still alive 36 months after surgery.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2475-7.
• Article: [A case report of cholangiectasis with cholangiocarcinoma].

  Tomoyuki Nagata, Hisashi Ikoma, Sousuke Komiyama, Minoru Nishio, Yasutoshi Murayama, Shuuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Chouhei Sakakura, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: This is a case report of cholangiectasis with cholangiocarcinoma in a 37-year-old female. Both computed tomography (CT) and endoscopic retrograde cholangio-pancreatography (ERCP) demonstrated gallstone, and intrahepatic bile duct dilatation with the stone. The diagnosis was intrahepatic cholangiectasis without common bile duct-dilatation. Hepatectomy of segment 3 with resection of the extrahepatic bile duct and reconstruction of the biliary tract was performed. Upon pathological examination, an early stage of cholangiocarcinoma was pointed out within the small range of common bile duct without dilatation or stone. Cholangiocarcinoma with cholangiectasis has been reported to be induced by counter flow of pancreas and intestinal juice because of the pancreaticobiliary maljunction. So we usually choose a diversion operation as our tactics to get rid of the counter flow of those digestive juices. Despite the above-mentioned tendency, this is a very rare case of carcinogenesis in common bile duct without dilatation.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2429-32.
• Article: Lymphadenectomy via a cervical approach for upper mediastinal lymph node recurrence of esophageal cancer: report of a case.

  Hiroyuki Tada, Atsushi Shiozaki, Hitoshi Fujiwara, Daisuke Ichikawa, Kazuma Okamoto, Shuhei Komatsu, Yasutoshi Murayama, Hisashi Ikoma, Yoshiaki Kuriu, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Although there have been several reports about salvage esophagectomy after definitive chemoradiotherapy (CRT), the effectiveness of lymphadenectomy for lymph node recurrence after CRT has not been fully evaluated. Radiation-induced tissue injury and fibrosis make lymphadenectomy after CRT difficult, therefore the choice of surgical approach should be considered carefully. We performed lymphadenectomy via a cervical approach in a 76-year-old man with upper mediastinal lymph node recurrence. He had previously undergone subtotal esophagectomy for squamous cell carcinoma of the upper thoracic esophagus. At 33 months after the operation, left upper mediastinal lymph node recurrence occurred. After localized CRT with docetaxel plus 60 Gy radiation, the tumor disappeared. However, at 1 year after CRT a lymph node recurrence, measuring 10 mm in size, was found in the same position on a computed tomography (CT) scan and (18)F-fluorodeoxyglucose positron emission tomography (FDG-PET) without other recurrences. Lymphadenectomy was performed via a left cervical approach using a Kent retractor to extend the surgical view of the cervicothoracic region. The patient was discharged without complications, and a postoperative CT scan and FDG-PET revealed complete resection of the tumor. In conclusion, our surgical procedure provides a good surgical view, and decreases surgical stress and the incidence of postoperative complications.
  Surgery Today 11/2011; 41(11):1562-6. · 1.22 Impact Factor
• Article: Long-term survival of a patient with common bile duct cancer after Virchow's node recurrence: Report of a case.

  Toshiya Ochiai, Hisashi Ikoma, Koji Inoue, Shuhei Komatsu, Yasutoshi Murayama, Atsushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: A 62-year-old male patient with common bile duct (CBD) cancer underwent pancreaticoduodenectomy with lymphadenectomy in 2002. Histological examinations revealed moderately differentiated tubular adenocarcinoma with lymph node metastasis around the pancreas head and hepatoduodenal ligament. No adjuvant chemotherapy was performed, due to the risk of side effects. Two years after the first operation, new lesions developed at the left supraclavicular area. These lesions were considered to be Virchow's node metastasis of the original CBD cancer. However, we could not detect any other metastatic lesions in the intraabdominal lymph nodes around the aorta. We resected the lesion. Histological examinations showed a similar histological appearance of this lesion to that of the CBD cancer resected in 2002. At present, the patient has survived for more than 80 months after receiving the second surgery. In selected cases, surgery might be considered even for a Virchow's node metastasis of CBD cancers if there are no other recurrent lesions.
  Surgery Today 10/2011; 41(10):1432-5. · 1.22 Impact Factor
• Article: Use of multidetector-row computed tomography to evaluate branch duct type intraductal papillary mucinous neoplasms of the pancreas: influence on surgical decision-making.

  Hiromichi Ishii, Hiroki Taniguchi, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba, Chohei Sakakura, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: The purpose of this study was to evaluate factors predictive of the malignant grade associated with branch duct type intraductal papillary mucinous neoplasm (BD-IPMN) using multidetectorrow computed tomography (MDCT). We reviewed the morphological features of 26 BDIPMNs using MDCT. Tumor size, caliber of the main pancreatic duct, number of mural nodules, diameter of the largest mural nodule and volume of the largest mural nodule were assessed and correlated with the pathological findings. By multiple- and single-regression analyses and Mann-Whitney U test, significant differences in the caliber of the main pancreatic duct and number of mural nodules were observed between adenoma and non-invasive carcinoma and in the number of mural nodules between adenoma and invasive carcinoma. No significant differences were observed between non-invasive carcinoma and invasive carcinoma. Based on the differential diagnostic criterion of 1 or more mural nodules for distinguishing adenoma from non-invasive carcinoma and invasive carcinoma, the sensitivities were 60% and 100%, respectively, and the specificity was 93% for both. Although it was impossible to distinguish non-invasive carcinoma from invasive carcinoma, MDCT was reliable for distinguishing adenoma from non-invasive carcinoma and invasive carcinoma.
  Hepato-gastroenterology 09/2011; 59(115):884-8. · 0.66 Impact Factor
• Article: Intraoperative real-time cholangiography and C-tube drainage in donor hepatectomy reduce biliary tract complications.

  Toshiya Ochiai, Hisashi Ikoma, Koji Inoue, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: In living-donor liver transplantation, biliary tract complications are a serious problem for recipients and donors. We applied intraoperative real-time cholangiography using a C-arm and/or C-tube drainage to reduce biliary tract complications in donor hepatectomy. From 2003 to 2010, intraoperative real-time cholangiography and C-tube drainage was applied to 39 and 19 donor cases, respectively. Fifteen donor cases had both procedures. We confirmed the division line of the hepatic duct by visualizing a stricture on the monitor of the C-arm by pulling a thread and dissecting the proper site of the bile duct. The number of hepatic ducts of the graft to be anastomosed was 1 in 11 cases and 2 or 3 in 8 of the 19 cases without intraoperative real-time cholangiography, and it was 1 in 32 cases and 2 in 7 of the 39 cases with intraoperative real-time cholangiography. Bile leakage from the resection occurred in seven donors without, and in none of those with, C-tube drainage. In living-donor liver transplantation, intraoperative real-time cholangiography enables effective determination of the precise division line of the hepatic duct. Moreover, C-tube drainage is effective for reducing bile leakage from the resected surface of the liver of donors.
  Journal of Gastrointestinal Surgery 09/2011; 15(12):2159-64. · 2.83 Impact Factor
• Article: Expression of cancer stem cell markers CD133 and CD44 in locoregional recurrence of rectal cancer.

  Tomoyuki Nagata, Chouhei Sakakura, Sousuke Komiyama, Atsushi Miyashita, Minoru Nishio, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Recent findings suggest that cells with surface CD markers include cancer stem cells (CSCs) which can produce a cancer cluster, and that the presence of CSCs may be linked with prognosis. CD133 and CD44 are among the most useful markers for identification of colorectal CSCs. An immunohistological analysis of CD133 and CD44 was performed using tissue from cases shown to be locoregionally recurrent or non-recurrent clinico-pathologically. The CD133-positive rates were 38.7% and 59.23% in non-recurrent and recurrent cases, respectively, and the CD44-positive rates were 35.5% and 44.4%, respectively. Expression of the CD markers had no correlation with other clinicopathological factors. The prognosis of patients who were positive for both markers was significantly worse than that of other patients. These results suggest that detection of CD133 and CD44 can provide useful information for selection of treatment and performance of intensive follow-up of colorectal cancer.
  Anticancer research 02/2011; 31(2):495-500. · 1.73 Impact Factor
• Article: Risk factors and management of postoperative bile leakage after hepatectomy without bilioenteric anastomosis.

  Hiromichi Ishii, Toshiya Ochiai, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Bile leakage frequently causes major complications after hepatic resection. We investigated perioperative risk factors and management of postoperative bile leakage after hepatic resection without extrahepatic biliary resection and reconstruction. We included 247 consecutive patients who underwent elective hepatic resection without bilioenteric anastomosis at our institution between 2002 and 2009. Perioperative risk factors, including patient and surgical variables, were evaluated using univariate and logistic regression analyses. Postoperative bile leakage occurred in 26 patients (10.5%). The surgical drain was retained in 6 patients (23%); 9 (35%) underwent drain salvage and 11 (42%) underwent percutaneous puncture under computed tomography or ultrasound guidance. Eight patients underwent endoscopic nasobiliary drainage (ENBD) for postoperative bile leakage, and bile leakage healed at a median interval of 19.5 days after ENBD. By univariate analysis, postoperative bile leakage was associated with central bisectionectomy, surgical time and intraoperative blood loss. Logistic regression analysis identified central bisectionectomy as an independent risk factor for postoperative bile leakage (p = 0.0003, odds ratio 16.724). Meticulous procedures are necessary during parenchymal hepatic resection, especially during central bisectionectomy. Drain management should be precise in the case of postoperative bile leakage. We believe ENBD may rapidly cure postoperative major bile leakage.
  Digestive surgery 01/2011; 28(3):198-204. · 1.37 Impact Factor
• Article: [A case of esophageal cancer with sigmoid colon tumor treated by laparoscopic surgery].

  Tomohiro Arita, Atsushi Shiozaki, Hitoshi Fujiwara, Yukihito Kokuba, Yoshiaki Kuriu, Takeshi Kubota, Daisuke Ichikawa, Kazuma Okamoto, Hiromichi Ishii, Hisashi Ikoma, Masayoshi Nakanishi, Toshiya Ochiai, Chohei Sakakura, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: We performed a subtotal esophagectomy with gastric tube reconstruction by hand assisted laparoscopic surgery and laparoscopic sigmoidectomy simultaneously for the patient with middle thoracic esophageal cancer and lateral spreading tumor in the sigmoid colon. Upper abdominal and transumbilical incisions were made and Lap Discs (regular, mini) were set respectively. Two 12 mm ports were inserted in the right flank and lower quadrant, and two 5 mm ports were inserted in the left flank and lower quadrant. First, by using video-scope from upper Lap Disc, laparoscopic sigmoidectomy was performed. Anastomosis was performed via lower Lap Disc. For the gastric tube reconstruction, upper Lap Disc was used for hand assistance, and video-scope was inserted from lower Lap Disc. The patient was discharged at 26 days after surgery without complications. In conclusion, our surgical procedure provided a good surgical view and decreased a surgical stress.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2388-90.
• Article: [Usefulness of esophageal stenting by using a covered self-expandable metallic stent for esophagorespiratory fistula associated with esophageal carcinoma].

  Seiji Umehara, Hitoshi Fujiwara, Atushi Shiozaki, Shuhei Komatsu, Daisuke Ichikawa, Kazuma Okamoto, Yasutoshi Murayama, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: We report three cases of esophagorespiratory fistula associated with esophageal carcinoma successfully treated with esophageal stenting by using a covered self-expandable metallic stent (SEMS). All three cases had advanced esophageal carcinoma at middle thoracic esophagus with esophagorespiratory fistula at the level of esophageal carcinoma. Case 1 is a 58-year-old man who had lung abscess due to esophagopulmonary fistula caused after induction chemoradiotherapy. He underwent a surgical resection of the affected lung and intraoperative esophageal stenting with dietary intake starting on day 26 after stenting. Case 2 is a 60-year-old man with esophagopulmonary fistula caused after primary chemotherapy. He started to take an oral intake on day 3 after esophageal stenting. Case 3 is a 68-year-old man with esophagobronchial fistula detected at the first medical examination. He started to take an oral diet on day 7 after esophageal stenting. All three cases had a rapid improvement of respiratory symptoms, pneumonia and malnutrition by esophageal stenting leading to marked improvement of impaired general condition. Esophageal stenting is a useful method for palliation of esophageal carcinoma with respiratory fistula.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2391-3.
• Article: [A case report--locally advanced pancreatic adenocarcinoma was resected after chemotherapy].

  Daisuke Iitaka, Hisashi Ikoma, Tsutomu Kawaguchi, Yasutoshi Murayama, Shuhei Komatsu, Atsushi Shiozaki, Yoshiaki Kuriu, Masayoshi Nakanishi, Daisuke Ichikawa, Hitoshi Fujiwara, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Hideyuki Konishi, Toshikazu Yoshikawa, Eigo Otsuji
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  ABSTRACT: The case was a 36-year-old male whose chief complaints were anorexia and weight loss. Upper gastrointestinal endoscopy revealed circumferential stenosis in the fourth portion of the duodenum, while CT revealed a tumor with a diameter of 60 mm continuing as a single mass from the pancreatic body and tail to the fourth portion of the duodenum, and this was accompanied by findings that raised suspicions of circumferential invasion of the superior mesentric artery (SMA). Based on these results and biopsy, the patient was diagnosed with pancreatic and SMA invasion of duodenal cancer that was considered to be unresectable. After performing gastrojejunostomy, we administered DOC (40 mg/m2, day 1), CDDP (60 mg/m2, day 1), and S-1( 80 mg/m2, day 1-14) for 3 courses. The tumor response was PR and the images indicated the SMA invasion was disappeared. We judged that the tumor could be gone by a resection while preserving the SMA. In the surgical findings, the tumor continued as a single mass from the pancreatic body and tail to the third portion of the duodenum, and the surrounding area exhibited marked fibrosis. We performed a pancreatic tail resection along with combined resection of third and fourth portions of the duodenum, transverse colon and splenic flexure, and left adrenal gland. The case was diagnosed to be well-differentiated invasive ductal pancreatic cancer with duodenal invasion. Cancer invasion was not observed in any of the stripped surfaces surrounding the pancreas. The T3, N1, M0, fStage III antitumor effects were mildly effective. In this case, the treatment was initially started by considering the case as one of duodenal cancer, but the final results of a pathological diagnosis revealed that it was pancreatic cancer. However, either way, even though the case was unresectable before the chemotherapy performed for duodenal cancer was significantly effective for the pancreatic cancer. Therefore, a resection became possible, and an R0 resection was also effective.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2358-60.
• Article: [Early prediction of treatment response by serum CRP levels in patients with advanced esophageal cancer who underwent definitive chemoradiotherapy].

  Masayuki Yoneda, Hitoshi Fujiwara, Shinichi Okamura, Hiroko Okamura, Seiji Umehara, Momoko Todo, Akinobu Furutani, Atsushi Shiozaki, Shuhei Komatsu, Daisuke Ichikawa, Kazuma Okamoto, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Serum CRP has been shown to be associated with the progression of esophageal cancer. The purpose of this study was to examine the relationship between treatment response and serum CRP levels in time course during definitive chemoradiotherapy (CRT) in terms of early prediction of CRT response by serum CRP. The subjects of this study were 36 patients with cT3/cT4 esophageal squamous cell carcinoma who underwent definitive CRT in our hospital. Serum CRP levels during definitive CRT (pretreatment, 1W, 2W and 3W after CRT initiation) were compared between CR and non-CR group. In addition, partition model was constructed to discriminate CR with non-CR and the prediction accuracy was evaluated. The patients were consisted of 28 males and 8 females. At pretreatment diagnosis, tumors were categorized as T3 (n=21) and T4 (n=15). Thirty four patients received FP-based chemotherapy and 2 patients received docetaxel-based chemotherapy. Treatment responses were categorized as CR (n=8), PR (n=14), NC (n=2) and PD (n=12). Serum CRP levels at the time of 2W after CRT initiation (CRT2W) in CR group were low compared to those in non-CR group (p=0.071). The partition model was constructed based on CRP levels at CRT2W. The prediction accuracies to discriminate CR from non-CR by CRP≤0.1 were 50%, 82%, and 75% in sensitivity, specificity and accuracy, respectively. Serum CRP is a useful biomarker for an early prediction of CRT response.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2237-9.
• Article: Elevated serum CRP levels after induction chemoradiotherapy reflect poor treatment response in association with IL‐6 in serum and local tumor site in patients with advanced esophageal cancer

  Hitoshi Fujiwara MD, Kentaro Suchi, Shinichi Okamura, Hiroko Okamura, Seiji Umehara, Momoko Todo, Atsushi Shiozaki, Takeshi Kubota, Daisuke Ichikawa, Kazuma Okamoto, Toshiya Ochiai, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: Background and Objectives Elevated serum CRP levels are associated with tumor progression and poor prognosis of esophageal cancer. The aim of this study was to clarify the clinical significance of CRP in relation to response to chemoradiotherapy in patients with esophageal cancer.Methods The relationship between serum CRP levels and response to chemoradiotherapy and prognosis was analyzed in 34 patients with advanced esophageal squamous cell carcinoma who underwent induction chemoradiotherapy followed by surgery. The relationship between response to chemoradiotherapy and interleukin-6 (IL-6) expression in sera and tumor tissues was also analyzed.ResultsAlthough elevated serum CRP levels were associated with poor response to chemoradiotherapy, significant difference in CRP levels between pathological responders (n = 18) and non-responders (n = 16) was observed after chemoradiotherapy, but not before. Patients with elevated CRP levels had shorter cause-specific survival, but significant difference was observed only after chemoradiotherapy. In addition, serum levels of IL-6 were also associated with poor treatment response following chemoradiotherapy and were correlated with residual tumor volume. IL-6 expression was detected in residual tumor tissues by immunohistochemistry.Conclusions Elevated serum CRP levels after chemoradiotherapy may predict poor response to chemoradiotherapy more accurately than before chemoradiotherapy, and IL-6 may be a possible target associated with chemoradiotherapy resistance. J. Surg. Oncol. 2011;103:62–68. © 2010 Wiley-Liss, Inc.
  Journal of Surgical Oncology 10/2010; 103(1):62 - 68. · 2.10 Impact Factor
• Article: [The role of adjuvant chemotherapy with S-1 for gastric cancer patients].

  Maki Kitagawa, Daisuke Ichikawa, Kazuma Okamoto, Atsushi Shiozaki, Hitoshi Fujiwara, Yoshiaki Kuriu, Hisashi Ikoma, Masayoshi Nakanishi, Toshiya Ochiai, Chohei Sakakura, Yukihito Kokuba, Teruhisa Sonoyama, Eigo Otsuji
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  ABSTRACT: A randomized controlled trial of adjuvant chemotherapy with S-1 for gastric cancer (ACTS-GC) demonstrated that the chemotherapy with S-1 improved the relapse-free survival and overall survival rates of patients with locally advanced gastric cancer. We examined retrospectively 47 patients with locally advanced gastric cancer, who received adjuvant chemotherapy with S-1 after curative gastrectomy. Patients who received more than 50% of the total scheduled dose of S-1 during the first 1 year after starting the chemotherapy showed a tendency to favorable outcome in terms of relapse-free survival compared with patients who received less than 50% of the dose, although no statistical significance was detected. Age did not show a significant correlation with tolerability. The number of elderly people with gastric cancer will increase in the next decade. They should be candidates for adjuvant chemotherapy on the basis of a geriatric assessment.
  Gan to kagaku ryoho. Cancer & chemotherapy 10/2010; 37(10):1917-9.