Masatoshi Makuuchi

Japanese Red Cross, Edo, Tōkyō, Japan

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Publications (727)3054.52 Total impact

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    ABSTRACT: Background & aims: Anatomic resection (AR) of the tumor-bearing portal territory has been reported to be associated with decreased recurrence of hepatocellular carcinoma (HCC). However, because of the heterogeneity of the study populations, its oncologic advantage remains controversial. The objective of the present study was to determine the clinical advantage of AR for primary HCC, based on the data from a large prospective cohort treated under a constant surgical policy. Methods: In 209 Child-Pugh class A patients with primary, solitary HCC measuring ⩽5.0 cm in diameter, which was resectable either by AR or limited resection (non-AR), overall survival (OS) and disease-free survival (DFS) were compared between patients in whom complete AR was achieved and those who eventually ended up with non-AR after adjustment for the propensity scores to select AR. Advantages of AR in disease-specific survival and local recurrence were also evaluated by competing-risks regression to clarify the true oncologic impact of AR. Results: AR group showed better DFS than non-AR group (HR, 0.67; 95% CI, 0.45-0.99; P=0.046), while no significant difference was observed in OS (hazard ratio [HR], 0.82; 95% CI, 0.46-1.48; P=0.511). Competing-risks regression revealed that AR significantly decreases local recurrence (HR, 0.12; 95% CI, 0.05-0.30; P<0.001) and improves disease-specific survival (HR, 0.50; 95% CI, 0.28-0.90; P=0.020), while the other cause of death was highly influenced by patient age (>65 years) (HR, 7.51; 95% CI, 2.16-26.04; P=0.002) and not associated with AR. Conclusion: Complete removal of tumor-bearing portal territory decreases risk of local recurrence and death from HCC.
    Journal of Hepatology 10/2015; DOI:10.1016/j.jhep.2015.10.015 · 11.34 Impact Factor
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    ABSTRACT: Background: Relapse is common after the resection of colorectal liver metastases (CLM); however, the optimal treatment for such recurrent disease remains uncertain. We investigated whether repeat resections for successive recurrences of CLM provide survival benefit on the postrecurrence survival. Methods: We reviewed patients who underwent upfront, curative resection for CLM at our center during a 15-year period. Of these, 263 patients who had not received any other perioperative treatment for the metastases were eligible for our analysis. The recurrence-free survival (RFS0) after the initial hepatic resection and after the first (n = 108), second (n = 43), and third (n = 15) repeat resections for recurrent disease were assessed (RFS1-3). The overall survival after the initial hepatic resection and the postrecurrence survival (n = 198) also was assessed. Results: The median RFS0 was 0.8 years, and RFS1, RFS2, and RFS3 were 1.3, 1.1, and 2.0 years, respectively. The hazard ratio for RFS for the first, second, and third resections versus the initial hepatic resection was 0.9 (95% confidence interval [95% CI] 0.7-1.1; P = .34), 1.00 (95% CI 0.7-1.4; P = .97), and 0.7 (95% CI 0.4-1.3; P = .29). The 5-year and 10-year OS rates were 54.6% and 42.2%, and the 5-year and 10-year postrecurrence survival was 34.3% and 28.6%, respectively. Conclusion: Repeat resection in patients with recurrent disease after CLM resection is beneficial, offering the potential for cure in a small proportion of patients with recurrent disease.
    Surgery 10/2015; DOI:10.1016/j.surg.2015.09.003 · 3.38 Impact Factor

  • Liver Transplantation 10/2015; DOI:10.1002/lt.24351 · 4.24 Impact Factor
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    ABSTRACT: Background: There is no standard of care for adjuvant therapy for patients with hepatocellular carcinoma. This trial was designed to assess the efficacy and safety of sorafenib versus placebo as adjuvant therapy in patients with hepatocellular carcinoma after surgical resection or local ablation. Methods: We undertook this phase 3, double-blind, placebo-controlled study of patients with hepatocellular carcinoma with a complete radiological response after surgical resection (n=900) or local ablation (n=214) in 202 sites (hospitals and research centres) in 28 countries. Patients were randomly assigned (1:1) to receive 400 mg oral sorafenib or placebo twice a day, for a maximum of 4 years, according to a block randomisation scheme (block size of four) using an interactive voice-response system. Patients were stratified by curative treatment, geography, Child-Pugh status, and recurrence risk. The primary outcome was recurrence-free survival assessed after database cut-off on Nov 29, 2013. We analysed efficacy in the intention-to-treat population and safety in randomly assigned patients receiving at least one study dose. The final analysis is reported. This study is registered with, number NCT00692770. Findings: We screened 1602 patients between Aug 15, 2008, and Nov 17, 2010, and randomly assigned 1114 patients. Of 556 patients in the sorafenib group, 553 (>99%) received the study treatment and 471 (85%) terminated treatment. Of 558 patients in the placebo group, 554 (99%) received the study treatment and 447 (80%) terminated treatment. Median duration of treatment and mean daily dose were 12·5 months (IQR 2·6-35·8) and 577 mg per day (SD 212·8) for sorafenib, compared with 22·2 months (8·1-38·8) and 778·0 mg per day (79·8) for placebo. Dose modification was reported for 497 (89%) of 559 patients in the sorafenib group and 206 (38%) of 548 patients in the placebo group. At final analysis, 464 recurrence-free survival events had occurred (270 in the placebo group and 194 in the sorafenib group). Median follow-up for recurrence-free survival was 8·5 months (IQR 2·9-19·5) in the sorafenib group and 8·4 months (2·9-19·8) in the placebo group. We noted no difference in median recurrence-free survival between the two groups (33·3 months in the sorafenib group vs 33·7 months in the placebo group; hazard ratio [HR] 0·940; 95% CI 0·780-1·134; one-sided p=0·26). The most common grade 3 or 4 adverse events were hand-foot skin reaction (154 [28%] of 559 patients in the sorafenib group vs four [<1%] of 548 patients in the placebo group) and diarrhoea (36 [6%] vs five [<1%] in the placebo group). Sorafenib-related serious adverse events included hand-foot skin reaction (ten [2%]), abnormal hepatic function (four [<1%]), and fatigue (three [<1%]). There were four (<1%) drug-related deaths in the sorafenib group and two (<1%) in the placebo group. Interpretation: Our data indicate that sorafenib is not an effective intervention in the adjuvant setting for hepatocellular carcinoma following resection or ablation. Funding: Bayer HealthCare Pharmaceuticals and Onyx Pharmaceuticals.
    The Lancet Oncology 09/2015; DOI:10.1016/S1470-2045(15)00198-9 · 24.69 Impact Factor
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    Annals of Surgery 03/2015; 261(5). DOI:10.1097/SLA.0000000000001209 · 8.33 Impact Factor
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    ABSTRACT: The 3rd version of Clinical Practice Guidelines for Hepatocellular Carcinoma was revised by the Japan Society of Hepatology, according to the methodology of evidence-based medicine, which was published in October 2013 in Japanese. Here, we briefly describe new or changed recommendations with a special reference to the two algorithms for surveillance, diagnosis, and treatment. © 2015 The Japan Society of Hepatology.
    Hepatology Research 02/2015; 45(2). DOI:10.1111/hepr.12464 · 2.74 Impact Factor
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    ABSTRACT: A 57-year-old woman with familial amyloid polyneuropathy (FAP) was scheduled to undergo living-donor liver transplantation (LDLT), but the operation was cancelled because the only potential donor had chronic alcohol-related liver disease (ALD). One year later, FAP-related neurological symptoms progressed rapidly, and emergency LDLT was planned. The donor's hepatic function had returned to normal range after 1 year of abstinence. The left liver graft volume was equivalent to 37.7% of the standard liver volume (SLV) of the recipient. However, a liver biopsy revealed mild fibrosis (score: F1). LDLT was successfully performed without any complications. The recipients' neurological findings returned to normal. One year after LDLT, the liver graft volume was equivalent to about 90% of the SLV, and the fibrosis had improved. LDLT using a graft with a fibrosis score of up to F1 might be an acceptable alternative for recipients with normal hepatic function. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.
    Hepatology Research 01/2015; DOI:10.1111/hepr.12490 · 2.74 Impact Factor
  • Takeshi Takamoto · Yasuhiko Sugawara · Takuya Hashimoto · Masatoshi Makuuchi ·

    Bioscience trends 01/2015; 9(5):280-283. DOI:10.5582/bst.2015.01131 · 1.66 Impact Factor
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    ABSTRACT: Background: To resect tumors infiltrating to the right hepatic vein at its root, right hemihepatectomy or that following portal vein embolization (PVE) is applied. If the IRHV is sizable, the IRHV preserving liver resection can be another option. Methods: Between 1994 and 2007, the IRHV preserving liver resection was performed in 21 patients (IRHV group). The short-term outcomes after surgery of them p. Results: There were no mortality and no significant difference between the IRHV and RH groups concerning the blood loss, the morbidity rates and the duration of hospital stay. The median operation time was shorter in the IRHV group than in the RH group (393 vs. 480 min, p = 0.0409). The median weight of resected specimen of the IRHV group was 293 g (range: 20-982), which was significantly lighter than that of the RH group (median: 680 g [250-4,300], p < 0.001). The median percentage of resected volume to standard liver volume was significantly smaller in the IRHV group than in the RH group (25.8 vs. 52.2%, p < 0.001). Conclusion: The IRHV preserving liver resection remains a safe and useful procedure.
    Digestive surgery 12/2014; 31(4-5):377-383. DOI:10.1159/000369498 · 2.16 Impact Factor
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    Canhong Xiang · Zhe Liu · Jiahong Dong · Keiji Sano · Masatoshi Makuuchi ·
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    ABSTRACT: Introduction Anatomical resection of the ventral part of Segment VIII (S8vent) is demanding and there are no accurate methods to identify the demarcation line inside the liver. The current authors have proposed a method to solve the problem. Presentation of Case The tumor was located in the S8vent and was 4 cm in size. One tributary of the middle hepatic vein (MHV), designated V8i, was running between S8vent and the dorsal part of Segment VIII (S8dor). Another tributary of the MHV, designated V8-5i, was running between S8vent and the ventral part of S5 (S5vent). About 5 ml of indigo carmine dye was injected into the proximal part of P8vent. After the small tributary of V8-5i was exposed, it was followed all the way to the main trunk of the MHV. The portal pedicle of S8vent was then ligated and divided. Next, the V8i was gradually exposed from the distal MHV to its trunk. Discussion A recent study showed that the subsegmental border visualized between the ventral and dorsal region always coincided with the plane of V8i, so the subsegmental plane can be divided along with V8i by preserving the very small tributaries near the liver surface and following them to determine where they meet as they run into V8i. Also, the landmark vein of V8-5i in the transverse S8-S5 intersegmental plane was determined for the first time. Conclusion Proposed here is a more accurate method of dividing the liver parenchyma along the intersegmental and intersubsegmental demarcation.
    International Journal of Surgery Case Reports 10/2014; 5(12). DOI:10.1016/j.ijscr.2014.10.041
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    ABSTRACT: Background This study examined the effects of peretinoin, an acyclic retinoid, on the survival of patients with hepatitis C virus-related hepatocellular carcinoma (HCC) who had completed curative therapy and participated in a randomized, placebo-controlled trial. Methods This study was an investigator-initiated retrospective cohort study. Subjects were all patients who were administered the investigational drug (peretinoin 600 mg/day, peretinoin 300 mg/day, or placebo) in the randomized trial. Survivals between the groups were compared using the log-rank test, and hazard ratios were estimated by Cox regression. Results Survey data were collected from all patients (n = 392) who participated in the randomized trial, all of whom were then divided into the peretinoin 600 mg/day (n = 132), peretinoin 300 mg/day (n = 131), and placebo (n = 129) groups. At the median follow-up of 4.9 years, 5-year cumulative survival rates for patients in the 600 mg/day, 300 mg/day, and placebo groups were 73.9, 56.8, and 64.3 %, respectively. Comparison of overall survival among patients classified as Child-Pugh A revealed that survival of the 600 mg/day group (n = 105) was significantly longer than that of the placebo group (n = 108) (hazard ratio 0.575, 95 % CI 0.341–0.967; P = 0.0347). Conclusions Administration of 600 mg/day peretinoin to patients with hepatitis C virus-related HCC who have completed curative therapy may improve survival for those classified as Child-Pugh A, for whom liver function is relatively stable.
    Journal of Gastroenterology 09/2014; DOI:10.1007/s00535-014-0996-1 · 4.52 Impact Factor
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    ABSTRACT: Objectives: To investigate the feasibility and prognostic benefits of third or more hepatectomy (third or more Hx) for recurrent hepatocellular carcinoma. Background: Second hepatectomy (second Hx) has been accepted as an effective treatment of recurrent hepatocellular carcinoma after first hepatectomy (first Hx). However, the feasibility and efficacy of third or more Hx have not been adequately assessed. Methods: Data were reviewed from 1340 patients with hepatocellular carcinoma who underwent curative hepatectomy. Among them, 941, 289, and 110 underwent first Hx, second Hx, and third or more Hx, respectively. Surgical outcomes and long-term survival were compared among the groups. Results: Surgical duration was significantly longer in third or more Hx (median, 6.4 hours) than in second Hx (median, 5.9 hours). Postoperative bile leakage and wound infection were more frequently observed in third or more Hx versus second Hx (12.5% vs 6.2%, [P = 0.04] and 2.9% vs 0.4% [P = 0.03], respectively). Three and 5-year disease-free survival rates were 36.8% and 27.1% in first Hx, 24.4% and 17.9 % in second Hx, and 26.1% and 12.8% in third or more Hx, respectively (P < 0.01 [first Hx vs third Hx], P = 0.95 [second Hx vs third or more Hx]). The 5-year overall survival rates from each resection were similar among the groups (65.3%, 60.5%, 68.2%, respectively). The 5- and 10-year overall survival rates from initial hepatectomy in patients who received third or more Hx were 91.4% and 75.5%, respectively. Conclusions: Third or more Hx is technically demanding in terms of surgical duration and morbidity compared with second Hx. However, aggressive repeat resection offers a survival similar to second Hx, leading to cumulative long-term survival from initial resection.
    Annals of Surgery 09/2014; 262(2). DOI:10.1097/SLA.0000000000000882 · 8.33 Impact Factor

  • Journal of the American College of Surgeons 09/2014; 219(3):S131. DOI:10.1016/j.jamcollsurg.2014.07.313 · 5.12 Impact Factor
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    ABSTRACT: Solitary hepatocellular carcinoma (HCC) is a good candidate for surgical resection. However, the significance of the size of the tumor in solitary HCC remains unclear. The aim of this study was to evaluate the impact of tumor size on overall and recurrence-free survival of patients with solitary HCC. We retrospectively reviewed 616 patients with histologically confirmed solitary HCC who underwent curative surgical resection between 1994 and 2010. The characteristics and prognosis of patients with HCC were analyzed stratified by tumor size. A total of 403 patients (65 %) had tumors < 5 cm, 172 (28 %) had tumors between 5 and 10 cm, and 41 (7 %) had tumors > 10 cm. The incidence of microvascular invasion, satellite nodules, and advanced tumor grade significantly increased with tumor size. The 5-year overall and recurrence-free survival rates of HCC < 5 cm were 69.6 % and 32 %, respectively, which were significantly better than those of HCC between 5 and 10 cm (58 % and 26 %, respectively) and HCC > 10 cm (53 % and 24 %, respectively). On multivariate analysis, cirrhosis (p = 0.0307), Child-Pugh B (p = 0.0159), indocyanine green retention rate at 15 min > 10 % (p = 0.0071), microvascular invasion (p < 0.0001), and satellite nodules (p = 0.0009) were independent predictors of poor survival, whereas tumor size > 5 cm was not. Although recurrence rates are high, surgical resection for solitary HCC offers good overall survival. Tumor size was not a prognostic factor. Solitary large HCC > 10 cm would be a good candidate for hepatectomy as well as solitary HCC between 5 and 10 cm.
    World Journal of Surgery 08/2014; 38(11). DOI:10.1007/s00268-014-2704-y · 2.64 Impact Factor
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    ABSTRACT: Background The International Study Group for Liver Surgery (ISGLS) proposed a definition for bile leak after liver surgery. A multicentre international prospective study was designed to evaluate this definition.Methods Data collected prospectively from 949 consecutive patients on specific datasheets from 11 international centres were collated centrally.ResultsBile leak occurred in 69 (7.3%) of patients, with 31 (3.3%), 32 (3.4%) and 6 (0.6%) classified as grade A, B and C, respectively. The grading system of severity correlated with the Dindo complication classification system (P < 0.001). Hospital length of stay was increased when bile leak occurred, from a median of 7 to 15 days (P < 0.001), as was intensive care stay (P < 0.001), and both correlated with increased severity grading of bile leak (P < 0.001). 96% of bile leaks occurred in patients with intra-operative drains. Drain placement did not prevent subsequent intervention in the bile leak group with a 5–15 times greater risk of intervention required in this group (P < 0.001).Conclusion The ISGLS definition of bile leak after liver surgery appears robust and intra-operative drain usage did not prevent the need for subsequent drain placement.
    HPB 08/2014; 17(1). DOI:10.1111/hpb.12322 · 2.68 Impact Factor
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    ABSTRACT: Background: Enhanced recovery programs (ERPs) have been developed in various surgical fields and have been shown to accelerate postoperative recovery without increasing the incidence of adverse events. Whether ERP can be safely applied to patients undergoing complex liver surgery with a risk of liver failure remains unclear. Methods: We created an ERP by rearranging our conventional postoperative treatments and applied this program to patients undergoing major hepatectomy between 2008 and 2013. The ERP elements included greater perioperative education, individualized postoperative fluid therapy, and early mobilization. The success of the ERP was evaluated on postoperative day (POD) 6 based on the criterion of independence from continuous medical intervention with the exception of an abdominal drainage tube. Adherence to each item in the ERP was evaluated, and risk factors for delayed accomplishment were analyzed. Results: Altogether, 200 patients were included, and 165 patients (82.5 %) completed the ERP. Multivariate analyses showed that (1) an age of 65 years or older and (2) a red blood cell transfusion were independent risk factors for delayed accomplishment. The performance of thoracotomy or choledocojejunostomy did not significantly affect accomplishment of the ERP. Oral intake starting on POD 1 was achieved in 179 patients (89.5 %), and termination of intravenous drip infusions on POD 5 was feasible in 72.5 %. Conclusions: An ERP for major hepatectomy was completed in more than 80 % of the patients. Earlier bowel movement can be challenged. The liquid in-out balance should be adjusted on an individual basis, rather than uniformly, especially for patients over 65 years of age or who required a red blood cell transfusion.
    World Journal of Surgery 05/2014; 38(10). DOI:10.1007/s00268-014-2613-0 · 2.64 Impact Factor
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    ABSTRACT: Presence of hepatic vein tumor thrombosis (HVTT) in patients with hepatocellular carcinoma (HCC) is regarded as signaling an extremely poor prognosis. However, little is known about the prognostic impact of surgical treatment for HVTT. Our database of surgical resection for HCC between October 1994 and December 2011 in a tertiary care Japanese hospital was retrospectively analyzed. We statistically compared the patient characteristics and surgical outcomes in HCC patients with tumor thrombosis in a peripheral hepatic vein, including microscopic invasion (pHVTT), tumor thrombosis in a major hepatic vein (mHVTT), and tumor thrombosis of the inferior vena cava (IVCTT). Among 1525 hepatic resections, 153 cases of pHVTT, 21 cases of mHVTT, and 13 cases of IVCTT were identified. The median survival times (MSTs) in the pHVTT and mHVTT groups were 5.27 and 3.95 years, respectively (P=0.77), and the median time to recurrence (TTR) was 1.06 and 0.41 years, respectively (P=0.74). On the other hand, the MST and TTR in the patient group with IVCTT were 1.39 years and 0.25 year respectively; furthermore, the MST of Child-Pugh class B patients was significantly worse (2.39 vs. 0.44 years, P=0.0001). Multivariate analyses revealed IVCTT (risk ratio [RR] 2.54, P=0.024) and R 1/2 resection (RR 2.08, P=0.017) as risk factors for the overall survival CONCLUSIONS: Hepatic resection provided acceptable outcomes in HCC patients with mHVTT or pHVTT when R0 resection was feasible. Resection of HCC may be attempted even in patients with IVCTT, in the presence of good liver function.
    Journal of Hepatology 05/2014; 61(3). DOI:10.1016/j.jhep.2014.04.032 · 11.34 Impact Factor
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    ABSTRACT: Effective prophylactic therapies have not been established for hepatocellular carcinoma recurrence. Peretinoin represents one novel option for patients with hepatitis C virus-related hepatocellular carcinoma (HCV-HCC), and it was tested in a multicenter, randomized, double-blind, placebo-controlled study. Patients with curative therapy were assigned to one of the following regimens: peretinoin 600, 300 mg/day, or placebo for up to 96 weeks. The primary outcome was recurrence-free survival (RFS). Of the 401 patients initially enrolled, 377 patients were analyzed for efficacy. The RFS rates in the 600-mg group, the 300-mg group, and the placebo group were 71.9, 63.6, and 66.0 % at 1 year, and 43.7, 24.9, and 29.3 % at 3 years, respectively. The primary comparison of peretinoin (300 and 600-mg) with placebo was not significant (P = 0.434). The dose-response relationship based on the hypothesis that "efficacy begins to increase at 600 mg/day" was significant (P = 0.023, multiplicity-adjusted P = 0.048). The hazard ratios for RFS in the 600-mg group vs. the placebo group were 0.73 [95 % confidence interval (CI) 0.51-1.03] for the entire study period and 0.27 (95 % CI 0.07-0.96) after 2 years of the randomization. Common adverse events included ascites, increased blood pressure, headache, presence of urine albumin, and increased transaminases. Although the superiority of peretinoin to placebo could not be validated, 600 mg/day was shown to be the optimal dose, and treatment may possibly reduce the recurrence of HCV-HCC, particularly after 2 years. The efficacy and safety of peretinoin 600 mg/day should continue to be evaluated in further studies.
    Journal of Gastroenterology 04/2014; 50(2). DOI:10.1007/s00535-014-0956-9 · 4.52 Impact Factor
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    ABSTRACT: The use of adjuvant systemic chemotherapy for resectable liver metastases from colorectal cancer (CRC) is controversial because no trial demonstrated its benefit. We conducted the phase III trial to evaluate UFT/leucovorin (LV) for colorectal liver metastases (CRLM). The primary endpoint has not been available until 2014, we first report the feasibility and safety data of UFT/LV arm. In this multicenter trial, patients who underwent curative resection of liver metastases from colorectal cancer were randomly assigned to receive surgery alone or surgery followed by adjuvant chemotherapy with UFT/LV. The primary endpoint was relapse-free survival. Secondary endpoints included overall survival and safety. A total of 180 patients were enrolled, 90 were randomly assigned to receive UFT/LV therapy. Eighty two of whom were included in safety analyses. In the UFT/LV group, the completion rate of UFT/LV was 54.9%, the relative dose intensity was 70.8% and grade 3 or higher adverse events occurred in 12.2% of the patients. Elevated bilirubin levels, decreased hemoglobin levels, elevated alanine aminotransferase levels, diarrhea, anorexia were common. Most other adverse events were grade 2 or lower and tolerable. In conclusions, UFT/LV is a safe regimen for postoperative adjuvant chemotherapy in patients who have undergone resection of liver metastases from colorectal cancer. Further studies are warranted to improve completion rate, but UFT/LV is found to be a promising treatment in this setting.
    Drug discoveries & therapeutics 03/2014; 8(1):48-56. DOI:10.5582/ddt.8.48

Publication Stats

26k Citations
3,054.52 Total Impact Points


  • 2007-2015
    • Japanese Red Cross
      Edo, Tōkyō, Japan
    • Kyoto University
      • Department of Health Informatics
      Kioto, Kyōto, Japan
    • Tokyo Medical University
      • Division of Radiology
      Edo, Tōkyō, Japan
  • 2009-2012
    • Japan Red Cross Fukuoka Hospital
      Hukuoka, Fukuoka, Japan
  • 1980-2012
    • The University of Tokyo
      • • Division of Surgery
      • • Department of Hemodialysis and Apheresis
      • • Department of Pediatric Surgery
      Tōkyō, Japan
  • 2011
    • Red Cross
      Washington, Washington, D.C., United States
  • 2010
    • Kinki University
      • Department of Gastroenterology and Hepatology
      Ōsaka, Ōsaka, Japan
  • 2006
    • The University of Hong Kong
      • Department of Surgery
      Hong Kong, Hong Kong
  • 2005
    • Roswell Park Cancer Institute
      • Department of Cancer Genetics
      Buffalo, NY, United States
  • 1991-2003
    • Shinshu University
      • • Department of Surgery
      • • Department of Medicine
      Shonai, Nagano, Japan
    • Nagano University
      長野, Nagano, Japan
  • 2002
    • Niigata University
      Niahi-niigata, Niigata, Japan
    • Matsunami General Hospital
      Gihu, Gifu, Japan
  • 2001-2002
    • University of Ulsan
      • Asan Medical Center
      Ulsan, Ulsan, South Korea
    • Yale University
      New Haven, Connecticut, United States
  • 2000
    • Asahi General Hospital
      Asahi, Chiba, Japan
  • 1999
    • The Jikei University School of Medicine
      • Department of Laboratory Medicine
      Edo, Tōkyō, Japan
  • 1984-1990
    • National Hospital Organization Kyushu Cancer Center
      Hukuoka, Fukuoka, Japan
  • 1989
    • National Cancer Center, Japan
      • Center for Cancer Control and Information Services
      Edo, Tōkyō, Japan
    • Tokyo Metropolitan Institute of Medical Science
      Edo, Tōkyō, Japan