Shuji Takiguchi

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (258)677.66 Total impact

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    ABSTRACT: Background and objectiveTumor-associated macrophages (TAMs) are well known to have distinct roles in tumor progression and metastasis. However, the role of TAMs in chemoresistance has not been fully investigated. The aim of this study is to examine whether TAMs, especially M2 macrophages, are associated with the tumor response to chemotherapy with esophageal cancers.Methods Using 210 tissues from patients with esophageal cancer who underwent surgery, we calculated the number of intratumoral CD68+ macrophages, CD163+ macrophages, and CD8+ lymphocytes using immunohistochemistry. CD68 and CD163 were used as markers for whole macrophages and M2 macrophages, respectively.ResultsInfiltration of CD68+ macrophages and CD163+ macrophages was significantly associated with tumor depth, lymphatic invasion, and venous invasion. High infiltration of CD68+ macrophages and CD163+ macrophages was significantly associated with poor prognosis for patients undergoing neoadjuvant chemotherapy. Regarding the response to chemotherapy, high infiltration of CD68+ and CD163+ macrophages had a significant association with poor response to chemotherapy, both clinically and pathologically (P < 0.001, P < 0.001). Multivariate analysis showed that infiltration of CD163+ macrophages was an independent prognostic factor in patients undergoing neoadjuvant chemotherapy.Conclusions Infiltration of TAMs, especially M2 macrophages, is associated with a poor response to chemotherapy and poor prognosis of patients with esophageal cancer. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    Journal of Surgical Oncology 03/2015; 111(6). DOI:10.1002/jso.23881 · 3.24 Impact Factor
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    ABSTRACT: Bursectomy, a traditional operative procedure to remove the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has been performed for serosa-positive gastric cancer in Japan and Eastern Asia. We conducted a multicenter, randomized, controlled trial to demonstrate the noninferiority of the omission of bursectomy. Between July 2002 and January 2007, 210 patients with cT2-3 gastric adenocarcinoma were randomized intraoperatively to D2 gastrectomy with or without bursectomy. The primary endpoint was overall survival (OS). We provide the results of the final analysis of the complete 5-year follow-up data. After the median follow-up of 80 months, 5-year OS was 77.5% for the bursectomy group and 71.3% for the nonbursectomy group (2-sided P = .16 for superiority; 1-sided P = .99 for noninferiority). The hazard ratio for death in the nonbursectomy group was 1.40 (95% CI, 0.87-2.25). The 5-year recurrence-free survivals were 73.7% and 66.6% in the bursectomy and nonbursectomy groups, respectively (2-sided P = .33 for superiority; 1-sided P = .99 for noninferiority). Cox multivariate analysis revealed that bursectomy was an independent prognostic factor of good OS (P = .033). Subgroup analysis showed a trend toward improved survival after bursectomy for tumors in the middle or lower third of the stomach and for pathologically serosa-positive tumors. The final analysis could not demonstrate the noninferiority of the omission of bursectomy. Bursectomy should not be abandoned as a futile procedure. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 02/2015; 157(6). DOI:10.1016/j.surg.2014.12.024 · 3.38 Impact Factor
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    ABSTRACT: This is a case report of chylothorax after esophagectomy for esophageal cancer cured by intranodal lymphangiography in the groin. A 62-year-old man was admitted to our Hospital with dysphagia. The diagnosis was made of advanced esophageal cancer (T3N1M0, stage IIIA). After neoadjuvant chemotherapy, radical surgery was performed. On postoperative day (POD) 9, left pleural effusion drainage increased sharply and changed to a milky white color, leading to a diagnosis of chylothorax. Although chylothorax was managed with conservative treatment, there was an inadequate response to it. On POD 15, lymphangiography was performed. Inguinal nodes were directly accessed under ultrasound guidance and lipiodol was injected into nodes. After the lymphangiography, the left pleural effusion drainage immediately decreased. On POD 40, the patient was discharged. To the best of our knowledge, this is the first report of a chylothorax after esophagectomy for esophageal cancer to be cured by ultrasound-guided intranodal lymphangiography in the groin. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    Anticancer research 02/2015; 35(2):891-5. · 1.83 Impact Factor
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    ABSTRACT: Purpose: This study aimed to assess the efficacy of daikenchuto (DKT), a commonly prescribed, traditional Japanese herbal medicine, on postoperative intestinal dysfunction after gastric cancer surgery. Methods: Patients with gastric cancer scheduled for a total gastrectomy were randomly assigned before surgery to receive either no treatment (n = 40; control group) or DKT (7.5 g/day, t.i.d.) for 3 months (n = 41) postoperatively. We examined gastrointestinal motility, stool attributes, the quantity of bowel gas, the quality of life, and the incidence of postoperative ileus. Results: During the hospital stay, significant differences were observed between the DKT group and controls in the number of stools per day (1.1 ± 0.6 vs 0.8 ± 0.4, respectively; P = 0.037) and stool consistencies (Bristol scale ratings were 3.7 ± 0.8 vs 3.1 ± 0.8, respectively; P = 0.041). The DKT group showed significant reductions in gas volume scores, calculated from abdominal radiographs, at 7 days, 1 month, and 3 months after surgery. The groups did not show significant differences in quality of life scores (based on the Gastrointestinal Symptom Rating Scale) or in the incidence of postoperative ileus. Conclusion: DKT improved bowel movements, stool properties, and bowel gas. These results suggested that DKT promoted early postoperative bowel functions after total gastrectomy.
    Journal of Gastrointestinal Surgery 01/2015; 19(3). DOI:10.1007/s11605-014-2730-y · 2.80 Impact Factor
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    ABSTRACT: Purpose Patients with resectable thoracic esophageal squamous cell cancer (TESCC) and positron emission tomography (PET)-positive lymph nodes (PET-N positive) are likely to have ≥3 pathological lymph node metastases (pLNMs) and show a higher rate of postoperative recurrence despite curative resection than PET-N-negative TESCC patients. We examined the prognostic significance of 18F-fluorodeoxyglucose uptake into lymph node metastases after neoadjuvant chemotherapy (NAC) for PET-N positive TESCC and aimed to propose the optimal NAC response criteria for these patients. Methods Fifty-one patients with PET-N positive TESCC underwent two courses of NAC followed by surgery. Metabolic responses of primary tumors and LNs were prospectively evaluated and associations with clinicopathological data and patient survival assessed by univariate and multivariate analyses. Results After NAC, 21 patients were post-treatment (post-) PET-N positive and 30 post-PET-N negative. A significantly (p
    Annals of Surgical Oncology 12/2014; 22(8). DOI:10.1245/s10434-014-4299-9 · 3.93 Impact Factor
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    ABSTRACT: Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4%, 7%, and 11%, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17%. The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm. Copyright © 2015 Elsevier Inc. All rights reserved.
    Surgery 12/2014; 157(3). DOI:10.1016/j.surg.2014.08.099 · 3.38 Impact Factor
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    ABSTRACT: Recent advances in diagnostic techniques have allowed the diagnosis of gastric cancer (GC) at an early stage. Due to the low incidence of lymph node metastasis and favorable prognosis in early GC, function-preserving surgery which improves postoperative quality of life may be possible. Pylorus-preserving gastrectomy (PPG) is one such function-preserving procedure, which is expected to offer advantages with regards to dumping syndrome, bile reflux gastritis, and the frequency of flatus, although PPG may induce delayed gastric emptying. Proximal gastrectomy (PG) is another function-preserving procedure, which is thought to be advantageous in terms of decreased duodenogastric reflux and good food reservoir function in the remnant stomach, although the incidence of heartburn or gastric fullness associated with this procedure is high. However, these disadvantages may be overcome by the reconstruction method used. The other important problem after PG is remnant GC, which was reported to occur in approximately 5% of patients. Therefore, the reconstruction technique used with PG should facilitate postoperative endoscopic examinations for early detection and treatment of remnant gastric carcinoma. Oncologic safety seems to be assured in both procedures, if the preoperative diagnosis is accurate. Patient selection should be carefully considered. Although many retrospective studies have demonstrated the utility of function-preserving surgery, no consensus on whether to adopt function-preserving surgery as the standard of care has been reached. Further prospective randomized controlled trials are necessary to evaluate survival and postoperative quality of life associated with function-preserving surgery.
    World Journal of Gastroenterology 12/2014; 20(46):17297-17304. DOI:10.3748/wjg.v20.i46.17297 · 2.37 Impact Factor
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    ABSTRACT: Background: Circulating tumour DNA (ctDNA) is an emerging candidate biomarker for malignancies and may be useful for monitoring the disease status of gastric cancer. Methods: We performed targeted deep sequencing of plasma cell-free DNA (cfDNA) by massively parallel sequencing in patients with tumours harbouring TP53 mutations. The quantitative values of TP53-ctDNA during the clinical course were compared with the tumour status. Results: Three out of ten patients with TP53 mutations in primary tumours showed detectable TP53 mutation levels in preoperative cfDNA. Although the cfDNA concentrations were not always reflective of the disease course, the ctDNA fraction correlated with the disease status. Conclusions: ctDNA may serve as a useful biomarker to monitor gastric cancer progression and residual disease.
    British Journal of Cancer 12/2014; 112(2). DOI:10.1038/bjc.2014.609 · 4.84 Impact Factor
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    ABSTRACT: Laparoscopic partial gastrectomy has become a common procedure for gastric submucosal tumors because of its accepted feasibility, safety, and oncologic outcomes. However, long-term postoperative outcomes have not been determined, especially based on the location of submucosal tumors. We reviewed 52 consecutive gastric submucosal tumor patients who underwent laparoscopic partial gastrectomy between 1999 and 2009. They were divided into a lesser curvature group (LC group, n = 23) and a greater curvature group (GC group, n = 26) according to tumor location. We compared the following postoperative data about gastric function between the two groups: (i) body weight change during the first postoperative year; (ii) gastrointestinal symptoms (e.g. abdominal pain/discomfort, bloating, heartburn, and dyspepsia); (iii) the amount of food residue at endoscopy; and (iv) the need for medications such as histamine H2 -receptor antagonists, proton pump inhibitors, and prokinetic drugs. Only a few patients - one in the LC group and two in the GC group - showed body weight loss (over 10%). Compared to the GC group (n = 0 in all three categories), the LC group showed significantly higher frequency of prolonged postoperative abdominal symptoms (n = 4, P = 0.042), food residue at endoscopic follow-up (n = 4, P = 0.036), and postoperative medication use (n = 5, P = 0.016). Patients who received laparoscopic partial gastrectomy did not have severe body weight loss, which suggests dysfunction of the gastric remnant. However, patients in the LC group should receive special attention, as they have a higher risk of developing postoperative gastrointestinal symptoms. © 2014 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
    Asian Journal of Endoscopic Surgery 12/2014; 8(1). DOI:10.1111/ases.12145
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    ABSTRACT: It is controversial whether the treatment strategy for gastric cancer should be different for elderly patients. We herein evaluated the feasibility of gastrectomy and the risk factors for postoperative complications in octogenarians with gastric cancer. We retrospectively collected data on 441 consecutive patients who underwent total or subtotal gastrectomy for gastric cancer. We divided all of the patients into two groups: the octogenarian group (n = 47), consisting of patients aged 80-89 years, and the younger group (n = 394), consisting of patients under 80 years of age. The postoperative complication rate was 23.1 % (91/394) in the younger group and 36.2 % (17/47) in the octogenarian group (P = 0.049). Octogenarian patients had significantly lower preoperative serum albumin levels (P < 0.001) and higher ASA scores (P < 0.001). Although the rate of each major complication was similar between the two groups, there was a trend toward a higher rate of other miscellaneous complications, mostly non-surgical complications, in the octogenarian group (P = 0.077). A multivariate analysis of the patients in the octogenarian group revealed that only total gastrectomy was a significant risk factor for postoperative complications (P = 0.035). Octogenarian patients with gastric cancer experienced more complications than younger patients. Therefore, closer monitoring is needed for octogenarian patients who will receive total gastrectomy.
    Surgery Today 11/2014; 45(9). DOI:10.1007/s00595-014-1087-x · 1.53 Impact Factor
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    ABSTRACT: Purpose: Ghrelin is a unique gastric hormone, which has pleiotropic biological functions, including anti-inflammatory effects. The aim of this study was to investigate the effects of administering ghrelin on reducing postoperative systemic inflammation in patients undergoing esophagectomy. Methods: The safety and effectiveness of postoperative ghrelin administration were investigated among twenty esophageal cancer patients who underwent esophagectomy between May 2010 and August 2011. Two different regimens of ghrelin administration, twice daily rapid drip infusion (3 μg/kg, twice a day) or continuous infusion (0.5 μg/kg/h), were employed. The duration of the systemic inflammatory response syndrome (SIRS) and the hematological parameters were compared between groups. Results: Patients treated with ghrelin showed shorter SIRS durations than controls (1.6 ± 2.7 vs. 4.1 ± 3.7 days, respectively; p = 0.0065) and also showed lower C-reactive protein concentrations than controls (11.0 ± 4.6 mg/dL vs. 15.3 ± 7.3 mg/mL, respectively, on postoperative day 3, p = 0.030). Ghrelin administration was not associated with any adverse events. The incidence of operative morbidity was equivalent between groups. The two ghrelin administration regimens showed similar durations of systemic inflammatory response (rapid drip: 2.2 ± 3.3 vs. continuous: 1.1 ± 1.9 days, p = 0.17). Conclusions: Postoperative ghrelin administration is safe and may suppress protracted postoperative inflammation in patients who undergo esophagectomies.
    Surgery Today 11/2014; 45(8). DOI:10.1007/s00595-014-1076-0 · 1.53 Impact Factor
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    ABSTRACT: A 62-year-old man presented to our hospital with multiple liver metastases of gastric gastrointestinal stromal tumor(GIST) in 2002.T he patient had undergone imatinib treatment for liver metastases as a participant in a clinical trial, and he had achieved complete response(CR)for 89 months.However, imatinib treatment was disrupted at the request of the patient. Progression of liver metastases was observed 18 months later.Imatinib treatment was reinitiated, and a partial response was obtained.Twenty -five months later, progression of disease was observed in segment 7 of the liver on an abdominal computed tomography(CT)scan.Partial imatinib-resistance was diagnosed, and partial resection of the lesion in S7 of the liver was performed in 2013. Imatinib therapy was continued after surgical intervention, and no progression has been detected for 10 months.Despite the beneficial effects of imatinib in patients with advanced GISTs, almost all patients have been reported to develop disease progression when imatinib is interrupted, even in lesions showing radiographic improvement.In the present case, after treatment with imatinib for 7 years, progression of liver metastases was observed upon discontinuation of therapy. Moreover, progression after disruption of imatinib may lead to the emergence of drug-resistant clones.We reported a case of recurrent GIST progressed after interruption of long-term imatinib therapy, which has been reported few times previously.
    Gan to kagaku ryoho. Cancer & chemotherapy 11/2014; 41(12):2478-80.
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    ABSTRACT: Insulin-like growth factor-II mRNA-binding protein-3 (IMP3) is an important factor in carcinogenesis, although its clinical significance in esophageal squamous cell carcinoma (ESCC) remains unknown. The present study investigated the associations between IMP3 expression and the clinicopathological parameters. IMP3 expression was assessed in 191 resected ESCC specimens, and the associations between IMP3 expression in ESCC, the clinicopathological parameters and patient prognosis were examined. Using immunohistochemistry, 113 (59.2%) tumors were identified as IMP3-positive. IMP3 positivity correlated significantly with high pathological (p)Stage, pT stage and pN stage. The IMP3-positive patients exhibited a poorer prognosis compared with the IMP3-negative patients. In univariate analyses, histology [hazard ratio (HR), 1.94; 95% confidence interval (CI), 1.18-3.49; P=0.0082], pT (HR, 2.34; 95% CI, 1.55-3.62; P<0.0001), pN (HR, 2.85; 95% CI, 1.81-4.69; P<0.0001), lymphatic invasion (HR, 2.08; 95% CI, 1.26-3.70; P=0.0036), venous invasion (HR, 1.79; 95% CI, 1.21-2.64; P=0.0039), neoadjuvant chemotherapy (NAC) (HR, 2.01; 95% CI, 1.35-3.00; P=0.0005) and IMP3 expression (HR, 2.12; 95% CI, 1.40-3.29; P=0.0003) were significantly associated with overall survival. Using multivariate analyses, histology (HR, 1.87; 95% CI, 1.13-3.29; P=0.014), pN (HR, 2.19; 95% CI, 1.36-3.66; P=0.0010), NAC (HR, 1.88; 95% CI, 1.24-2.86; P=0.0028) and IMP3 expression (HR, 1.84; 95% CI, 1.18-2.93; P=0.0064) were significant prognostic factors. IMP3 may therefore be a prognostic factor for patients with ESCC who have undergone a curative resection.
    Oncology letters 11/2014; 8(5):2027-2031. DOI:10.3892/ol.2014.2465 · 1.55 Impact Factor
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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.
  • European Journal of Cancer 11/2014; 50:127. DOI:10.1016/S0959-8049(14)70522-2 · 5.42 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: 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; 45(7). DOI:10.1007/s00595-014-1040-z · 1.53 Impact Factor
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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; 262(2). DOI:10.1097/SLA.0000000000000986 · 8.33 Impact Factor
  • Cancer Research 10/2014; 74(19 Supplement):722-722. DOI:10.1158/1538-7445.AM2014-722 · 9.33 Impact Factor

Publication Stats

2k Citations
677.66 Total Impact Points


  • 2004–2015
    • Osaka City University
      • Department of Gastroenterological Surgery
      Ōsaka, Ōsaka, Japan
  • 2000–2015
    • Osaka University
      • • Division of Gastroenterological 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