Shuji Takiguchi

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (240)597.1 Total impact

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    ABSTRACT: A 58-year-old man presented with anorexia and weight loss in April 2010. Endoscopic examination revealed a type 3 tumor extending from the gastric cardia to the antrum. Preoperative imaging showed liver metastasis(S8; 2 cm)and direct invasion of the cancer into the pancreas. We administered 4 courses of chemotherapy(DCS)for the unresectable tumor; the impact of the therapy was partial response(PR). We performed total gastrectomy, D2 dissection, splenectomy, distal pancreatectomy, and partial hepatectomy(S8)in April 2011. The patient was treated with 8 courses of adjuvant chemotherapy with S-1. In April 2012, abdominal computed tomography(CT)revealed a solitary recurrent lesion in the liver(S2). After 7 courses of chemotherapy(weekly paclitaxel), abdominal CT and magnetic resonance imaging(MRI)revealed a tumor thrombus in the portal vein extending from P2 to the umbilical portion(UP). We performed left hepatectomy and cholecystectomy due to the absence of new lesions. Histopathological findings revealed that the poorly differentiated adenocarcinoma had metastasized to the liver. Abdominal CT revealed the presence of multiple recurrent metastases in the liver, 4 months after the surgery. The patient died 27 months after the initial surgery and 7 months after the last operation.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):2136-8.
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    ABSTRACT: Amale patient in his 40s presented with abdominal pain and mass palpitation. He was diagnosed with a submucosal gastric tumor and referred to our clinic. Computed topography(CT)scan revealed a large gastric tumor and multiple hepatic metastases. He was diagnosed with unresectable gastrointestinal stromal tumor(GIST)and began imatinib treatment. However, 2 weeks later, the patient developed a high fever and abdominal pain. Tumor necrosis and abscess formation was observed on the CT scan. We performed emergency surgery, which comprised partial gastrectomy, distal pancreatectomy, and splenectomy, combined with radiofrequency ablation(RFA)for the hepatic metastases. Subsequently, he continued imatinib therapy. However, a new lesion developed in the liver and was diagnosed as imatinib-resistant disease. The new lesion was treated with RFA. Eight years after the treatment, a new lesion occurred in the liver, which was difficult to excise owing to the location. Accordingly, a right-hepatic lobectomy was performed. Currently, he is alive and continues on imatinib therapy.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):2399-401.
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    ABSTRACT: Ghrelin was discovered as an intrinsic ligand for the growth hormone (GH)-secretagogue receptor (GHS-R) in 1999. The endogenous production of ghrelin occurs mainly in the stomach. Ghrelin has multiple functions; it has orexigenic action, stimulates GH secretion, has anti-inflammatory activities, stimulates gastrointestinal activity, stabilizes heart function and has other metabolic roles. Moreover, ghrelin is the only gastrointestinal hormone known to stimulate appetite. In the past decade, clinical applications of ghrelin have been attempted for various pathologies, based on its anabolic function, including applications for patients with anorexia nervosa and cachexia due to chronic heart, renal or pulmonary diseases. In the field of surgery, we have conducted several clinical trials using exogenous ghrelin in patients undergoing total gastrectomy, esophagectomy and neoadjuvant chemotherapy, including cisplatin treatment, and consistently obtained unique and striking benefits in these patients. Ghrelin comprehensively improves the patients' general conditions and quality of life via its pleiotropic physiological functions. This characteristic is unique and different from the existing drugs; therefore, ghrelin may be an indispensable supplement to prevent surgical stress and postoperative sequelae. This review summarizes the recent advances toward the clinical application of ghrelin.
    Surgery Today 11/2014; DOI:10.1007/s00595-014-1040-z · 1.21 Impact Factor
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    ABSTRACT: The patient was a 69-year-old man. He underwent chemoradiotherapy for advanced esophageal cancer, and achieved a complete response. However, 16 months after chemoradiotherapy, lymph nodes metastases were detected along the celiac artery. He underwent chemotherapy followed by radiotherapy. Positron emission tomography(PET)-computed tomography (CT)at 3 months after radiotherapy showed new uptake of fluorodeoxyglucose(FDG)at the cardiac region of the stomach. Endoscopy revealed a tumor that was diagnosed as squamous cell carcinoma by biopsy. Under the diagnosis of gastric intramural recurrence of esophageal cancer, he was referred to our hospital. Proximal gastrectomy and resection of lymph nodes along the celiac artery were performed. The patient is alive without recurrence 1 year after surgery. Metachronous gastric intramural recurrence of esophageal cancer is very rare. We report this case with a review of the literature.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):2003-5.
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    ABSTRACT: Objective: A prospective randomized phase II trial was conducted to evaluate the efficacy of ghrelin administration in reducing systemic inflammatory response syndrome (SIRS) duration after esophagectomy. Background: Esophagectomy for esophageal cancer is highly invasive and leads to prolonged SIRS duration and postoperative complications. Ghrelin has multiple effects, including anti-inflammatory effects. Methods: Forty patients undergoing esophagectomy were randomly assigned to either the ghrelin group (n = 20), which received continuous infusion of ghrelin (0.5 [mu]g/kg/h) for 5 days, or the placebo group (n = 20), which received pure saline for 5 days. The primary endpoint was SIRS duration. The secondary endpoints were the incidence of postoperative complications, time of a negative nitrogen balance, changes in body weight and composition, and levels of inflammatory markers, including C-reactive protein (CRP) and interleukin-6 (IL-6). Results: The ghrelin group had a shorter SIRS duration and lower CRP and IL-6 levels than did the placebo group. The incidence of pulmonary complications was lower in the ghrelin group than in the placebo group, whereas other complications did not differ between the groups. Although time of the negative nitrogen balance was shorter in the ghrelin group than in the placebo group, changes in total body weight and lean body weight did not differ significantly. Conclusions: Postoperative ghrelin administration was effective for inhibiting inflammatory mediators and improving the postoperative clinical course of patients with esophageal cancer.
    Annals of Surgery 10/2014; DOI:10.1097/SLA.0000000000000986 · 7.19 Impact Factor
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    ABSTRACT: Although some small-scale studies have suggested that human epidermal growth factor receptor 2 (HER2)-positive status in gastric cancer is associated with poor outcomes, the prognostic value of HER2 is still controversial. Since intratumoral HER2 heterogeneity is also an important issue, a multicenter large-scale study was conducted to evaluate the prognostic impacts of HER2 expression and intratumoral heterogeneity in gastric cancer.
    Gastric Cancer 09/2014; DOI:10.1007/s10120-014-0430-7 · 4.83 Impact Factor
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    ABSTRACT: Objective: To examine the clinical implications of supraclavicular (SC) lymph node (LN) metastasis in patients with esophageal squamous cell carcinoma (ESCC) who receive neoadjuvant chemotherapy, followed by surgery. Background: Indications for surgery for esophageal cancer often do not include cases with SCLN metastasis because the latter is considered distant metastasis. However, neaodjuvant therapy may change the clinical importance of SCLN metastasis. Methods: In 323 patients with ESCC who underwent neoadjuvant chemotherapy, the correlations between SCLN metastasis and clinicopathological factors including survival were examined. Results: The incidence of SCLN metastasis was 17.6% before therapy and 14.6% after therapy. In patients with SCLN metastasis at baseline, the incidence of posttherapy SCLN metastasis was significantly lower in major responders to chemotherapy than in minor responders. The total number of metastatic LNs was significantly higher in patients with posttherapy SCLN metastasis than in patients with metastatic LN but no SCLN (10.9 vs 3.9; P <= 0.001). Survival was shorter in patients with SCLN metastasis than in those with metastatic LN without SCLN (3-year overall survival rate; 20.1% vs 45.7%; P = 0.003). However, there was no significant difference in survival between patients with SCLN metastasis before but not after therapy and patients without SCLN metastasis before and after chemotherapy (3-year overall survival rate; 64.9% vs 58.2%; P = 0.2071). Conclusions: This study showed that SCLN metastasis in ESCC reflects the number of metastatic LNs. SCLN metastasis should not be considered as contraindication to curative surgery in multimodal treatment of ESCC because preoperative treatment can change SC nodal status.
    Annals of Surgery 09/2014; DOI:10.1097/SLA.0000000000000933 · 7.19 Impact Factor
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    ABSTRACT: Steady pressure automatically controlled endoscopy is a new insufflation concept, achieving a laparoscopy-like steady environment in the upper GI tract, recently reported in the esophagus.
    Diseases of the Colon & Rectum 09/2014; 57(9):1120-1128. DOI:10.1097/DCR.0000000000000190 · 3.20 Impact Factor
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    ABSTRACT: Recent advances in laparoscopic surgical technology have made it possible to perform advanced high-level surgery, such as lymph node dissection for malignancy. Grasping the anatomy during such procedures is important for a safe operation. We have developed a new image information system that provides three-dimensional (3D) reconstructed CT images synchronized with the motion of the laparoscope. This study assesses this new navigation system.
    Surgery Today 08/2014; DOI:10.1007/s00595-014-0983-4 · 1.21 Impact Factor
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    ABSTRACT: Objectives The purpose of this study was to determine the optimal cut-off value of lymph node size for diagnosing metastasis in gastric cancer with multidetector-row computed tomography (MDCT) after categorizing perigastric lymph nodes into three regions. Methods The study included 90 gastric cancer patients who underwent gastrectomy. The long-axis diameter (LAD) and short-axis diameter (SAD) of all visualized lymph nodes were measured with transverse MDCT images. The locations of lymph nodes were categorized into three regions: lesser curvature, greater curvature, and suprapancreatic. The diagnostic value of lymph node metastasis was assessed with receiver operating characteristic (ROC) analysis. Results The area under the curve was larger for SAD than LAD in all groups. The optimal cut-off values of SAD were determined as follows: overall, 9 mm; differentiated type, 9 mm; undifferentiated type, 8 mm; lesser curvature region, 7 mm; greater curvature region, 6 mm; and suprapancreatic region, 9 mm. The diagnostic accuracies for lymph node metastasis using individual cut-off values were 71.1 % based on histological type and 76.6 % based on region of lymph node location. Conclusions The diagnostic accuracy of lymph node metastasis in gastric cancer was improved by using individual cut-off values for each lymph node region. Key points • Multidetector-row computed tomography is widely used to predict pathological nodal status. • An optimal cut-off value of lymph node size has not been determined. • Cut-off values were assessed according to histology and nodal location. • The optimal cut-off values differed based on histology and nodal location. • Diagnostic accuracy was improved by using individual cut-off values for each region.
    European Radiology 08/2014; 25(2). DOI:10.1007/s00330-014-3373-9 · 4.34 Impact Factor
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    ABSTRACT: Traditionally, surgery is considered the best treatment for esophageal cancer in terms of locoregional control and long-term survival, but survival after surgery alone for locally advanced esophageal cancer is not satisfactory. A multidisciplinary approach that includes surgery, radiotherapy, and chemotherapy, alone or in combination, has been developed to improve the prognosis. Multiple clinical trials have addressed the preferred treatment strategy, such as neoadjuvant or adjuvant and chemotherapy, radiotherapy, or chemoradiotherapy, in managing locally advanced esophageal cancer. In this review, we provide an update on treatment strategies for locally advanced esophageal cancers. Recent studies indicate that neoadjuvant chemoradiotherapy or chemotherapy has a survival benefit over surgery alone in this patient group. Neoadjuvant chemoradiotherapy is an accepted standard of care in the United States while neoadjuvant chemotherapy is regarded as standard treatment in Japan and the United Kingdom. The standard treatment differs among countries because two large randomized controlled trials that evaluated the effectiveness of neoadjuvant chemotherapy reported conflicting results and no trial has made a comparison between neoadjuvant chemoradiotherapy and neoadjuvant chemotherapy directly. Future trials in locally advanced esophageal cancer should focus on identifying the optimum strategy and its regimen and aim to minimize treatment toxicities and effects on quality of life.
    General Thoracic and Cardiovascular Surgery 07/2014; DOI:10.1007/s11748-014-0458-y
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    ABSTRACT: Abstract Purpose: Single-incision laparoscopic surgery (SILS) provides more cosmetic benefits than conventional laparoscopic surgery but presents operational difficulties. To overcome this technical problem, we have developed a locally operated master-slave robot system that provides operability and a visual field similar to conventional laparoscopic surgery. Material and methods: A surgeon grasps the master device with the left hand, which is placed above the abdominal wall, and holds a normal instrument with the right hand. A laparoscope, a slave robot, and the right-sided instrument are inserted through one incision. The slave robot is bent in the body cavity and its length, pose, and tip angle are changed by manipulating the master device; thus the surgeon has almost the same operability as with normal laparoscopic surgery. To evaluate our proposed system, we conducted a basic task and an ex vivo experiment. Results: In basic task experiments, the average object-passing task time was 9.50 sec (SILS cross), 22.25 sec (SILS parallel), and 7.23 sec (proposed SILS). The average number of instrument collisions was 3.67 (SILS cross), 14 (SILS parallel), and 0.33 (proposed SILS). In the ex vivo experiment, we confirmed the applicability of our system for single-port laparoscopic cholecystectomy. Conclusion: We demonstrated that our proposed robot system is useful for single-incision laparoscopic surgery.
    Minimally Invasive Therapy & Allied Technologies 07/2014; DOI:10.3109/13645706.2014.942321 · 1.18 Impact Factor
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    ABSTRACT: Purpose 18F-fluorodeoxyglucose positron emission tomography-positive lymph nodes (PET-N positive) in patients with resectable thoracic esophageal squamous cell carcinoma (TESCC) are associated with a high rate of postoperative distant recurrence. The purpose of this study was to evaluate the systemic control and survival benefit of neoadjuvant chemotherapy (NAC, cisplatin + doxorubicin + 5-fluorouracil) in these patients. Methods Of 77 patients with resectable TESCC who were PET-N positive, we evaluated 51 treated with NAC + surgery in this study and 26 who had undergone surgery alone (SA) in a previous study. Historical comparisons of the groups were made, and the response to treatment was evaluated in the NAC group. Results The NAC group had a higher rate of pN0-1 and a lower rate of postoperative recurrence (p p p = 0.008) and a lower rate of distant recurrence (p = 0.021), even with cT3 disease. A multivariate analysis identified the post-treatment PET-N evaluation to be the only significant predictor of the RFS in cT3 cases. Conclusions NAC significantly suppressed postoperative recurrence in TESCC PET-N-positive patients, but the survival benefit was unclear. However, post-treatment PET-N-negative patients were likely responders to NAC.
    Surgery Today 06/2014; 45(3). DOI:10.1007/s00595-014-0956-7 · 1.21 Impact Factor
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    ABSTRACT: LigaSure, a bipolar electronic vessel sealing system, has become popular in abdominal surgery but few clinical studies have been conducted to evaluate its effectiveness in radical gastrectomy for gastric cancer. In this multicenter, prospective, randomized controlled trial, patients with curative gastric cancer were randomly assigned to undergo gastrectomy either with LigaSure or a conventional technique. Of the 160 patients enrolled, 80 were randomized to the LigaSure group and 78 to the conventional group. Patient characteristics were well balanced in the two groups. There were no significant differences between the LigaSure and conventional groups in blood loss (288 vs. 260 ml, respectively; P = 0.748) or operative time (223 and 225 min, respectively; P = 0.368); nor in the incidence of surgical complications or duration of postoperative hospital stay. In a subgroup analysis of patients who underwent gastrectomy that preserved the distal part of the greater omentum, the use of LigaSure significantly reduced blood loss (179 vs. 245 ml; P = 0.033), and the duration of the operation (195 vs. 221 min; P = 0.039). LigaSure did not contribute to reducing intraoperative blood loss, operative time, or other adverse surgical outcomes. The usefulness of the device may be limited to a specific part of the surgical procedure in open gastrectomy.
    Surgery Today 05/2014; 44(9). DOI:10.1007/s00595-014-0930-4 · 1.21 Impact Factor
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    ABSTRACT: Esophageal squamous cell carcinoma (ESCC) has a poor prognosis because invasion and metastasis are prevalent. To improve diagnosis, it is important to identify and characterize tumor-specific molecular markers in ESCC. FOXM1 is overexpressed and correlates with pathogenesis in a variety of human malignancies. We aimed to investigate the clinical significance of FOXM1 overexpression in ESCC. FOXM1 expression was assessed in ESCC specimens from 174 curatively-resected cases. The relationships between FOXM1 expression, clinicopathological parameters, and prognoses were examined. Immunohistochemical analysis showed that 94 (54.0%) tumors were positive for FOXM1 expression. FOXM1 positivity did not correlate with any clinicopathological parameter. However, FOXM1-positive cases had poorer prognoses than FOXM1-negative ones (p=0.0037, log-rank test). In multivariate analysis, the following were independent prognostic factors: pT, pN, neoadjuvant chemotherapy, and FOXM1 expression (hazard ratio=1.69, 95% confidence interval=1.06-2.75, p=0.027). FOXM1 may be a novel prognostic factor in patients with ESCC who undergo curative resection.
    Anticancer research 05/2014; 34(5):2427-32. · 1.87 Impact Factor
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    ABSTRACT: The efficacy and feasibility of laparoscopic surgery (LAP) for gastric GISTs >5 cm has not been adequately assessed. Here we investigated the clinical outcomes of these patients. Twenty-seven consecutive patients who underwent resection for gastric GISTs >5 cm were enrolled in this retrospective study. We assessed the tumor characteristics, surgical outcomes, tumor recurrence, and patient survival in the open surgery (OPEN) group and in the LAP group. The tumor size in the OPEN group was larger than that in the LAP group, but there were no differences in the mitotic count. There were no differences in operative complications. Finally, there were no differences in the disease-free and no patients in the LAP group died. In patients with gastric GISTs >5 cm, LAP can be performed with outcomes equivalent to those of OPEN if patient selection and intraoperative judgment are appropriate.
    Surgical laparoscopy, endoscopy & percutaneous techniques 04/2014; DOI:10.1097/SLE.0000000000000039 · 0.94 Impact Factor
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    ABSTRACT: Various kinds of molecular targeted drugs to inhibit receptor tyrosine kinases (RTKs) have been recently developed. The relationship between the expression status of major RTKs and prognosis in gastric cancer remains unclear. We conducted a multicenter study to evaluate the prognostic impact of the expression of epidermal growth factor receptor (EGFR), c-Met, platelet-derived growth factor receptor (PDGFR), and c-Kit in gastric cancer. This study included 153 gastric cancer patients who underwent gastrectomy at 9 institutions between 2000 and 2006. Expression status of EGFR, c-Met, PDGFR, and c-Kit were evaluated with immunohistochemistry (IHC) centrally. Overall survival based on RTK expression status was statistically compared. Cox multivariate analysis was conducted to adjust for potentially confounding factors. The positive rates for EGFR, c-Met, PDGFR, and c-Kit were 14.4, 24.8, 41.2, and 11.1 %, respectively. Significant interactions with expression status were observed for pathological N stage with EGFR; HER2-status with c-Met; tumor location, histology, and pathological N stage with PDGFR; and no examined variables with c-Kit. Concomitant HER2 positivity was observed for 0.7 % of tumors positive for EGFR, 3.9 % for c-Met, 4.6 % for PDGFR, and 1.3 % for c-Kit. There were some differences in overall survival between patients with or without RTK expression, but only c-Kit expression showed a significant survival difference in Cox multivariate analysis (P = 0.046). Our multicenter study indicated that IHC expression of 4 RTKs had some prognostic impact and that c-Kit-positive status may be a significant indicator of good prognosis in gastric cancer patients.
    Annals of Surgical Oncology 04/2014; DOI:10.1245/s10434-014-3690-x · 3.94 Impact Factor
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    ABSTRACT: The 7th edition of the Union for International Cancer Control-TNM (UICC-TNM) classification for esophageal carcinoma made considerable modifications to the definition of N-staging by the number of involved lymph nodes and the regional node boundary. There were few validations of the regional boundary. We evaluated the nodal status of this classification for esophageal squamous cell carcinoma (ESCC). There were 665 patients reviewed who had ESCC and underwent esophagectomy between 1997 and 2012. We evaluated the impact of the location of lymph node metastasis on overall survival. There were 414 patients (61.7 %) who had lymph node metastases. The overall 5-year survival rate was 54.7 %. There were no significant differences in survival among N2, N3, and M1 patients. Cox regression analysis revealed that common hepatic or splenic node involvements (P = 0.001), pT stage (P = 0.0002), and pN stage (P < 0.0001) were independent predictors of survival, but supraclavicular node involvement (P = 0.29) was not. We propose a modified nodal status that designates supraclavicular node as regional: m-N0 (5-year survival = 79 %; n = 251); m-N1 (5-year = 56 %; n = 212); m-N2 (5-year = 30 %; n = 114); m-N3 (5-year = 18 %; n = 52); m-M1 (5-year = 6.2 %; n = 36). This modified nodal staging predicts survival better than the current staging system. The modification of supraclavicular lymph node from nonregional to regional in the 7th UICC classification of ESCC may allow for better stratification of overall survival.
    Annals of Surgical Oncology 04/2014; 21(9). DOI:10.1245/s10434-014-3696-4 · 3.94 Impact Factor
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    ABSTRACT: Patients with adventitia-invading (T3) tumors, which account for the majority of esophageal cancers, are indicated for surgery but still have a poor prognosis. Subclassifying T3 tumors based on clinical outcome would be useful for selecting adequate adjuvant therapies. Using 268 esophageal cancer specimens from patients without preoperative treatment, the length of the vertical and longitudinal tumor invasion, entire esophageal wall thickness, and interruption of the outer muscle layer were measured. These morphological parameters correlated with clinico-pathological factors and outcome.Patients were classified as T1 (38.4 %), T2 (11.9 %), T3 (38.4 %), and T4 (11.2 %) and T stage correlated well with the four morphological parameters (p p = 0.009). T3 tumors with p = 0.019).T3 esophageal cancer can be classified into subgroups according to the length of MLI. Additional local treatment would be indicated for T3 tumors with >20 mm MLI.
    Esophagus 04/2014; 11(2). DOI:10.1007/s10388-014-0420-1 · 0.74 Impact Factor
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    ABSTRACT: Gastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated. A multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated. Twenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0-9) days and 18 (6-168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients. Gastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay. J. Surg. Oncol. 2014 109:208-212. © 2013 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 03/2014; 109(3):208-12. DOI:10.1002/jso.23486 · 2.84 Impact Factor

Publication Stats

2k Citations
597.10 Total Impact Points


  • 2005–2015
    • Osaka City University
      • • Department of Gastroenterological Surgery
      • • Graduate School of Medicine
      Ōsaka, Ōsaka, Japan
  • 2000–2015
    • Osaka University
      • • Division of Gastroenterological Surgery
      • • Department of Surgery
      • • Department of Mechanical Science and Bioengineering
      • • Graduate School of Medicine
      • • School of Medicine
      Suika, Ōsaka, Japan
  • 1999
    • Niigata Teishin Hospital
      Niahi-niigata, Niigata, Japan