Publications (137)338.36 Total impact
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Article: Morbidity and mortality results from a prospective randomized controlled trial comparing Billroth I and Roux-en-Y reconstructive procedures after distal gastrectomy for gastric cancer.
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ABSTRACT: Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed after distal gastrectomy. Which reconstruction procedure is superior remains controversial. We conducted a randomized controlled trial to compare the clinical efficacy of B-I and R-Y. Between August 2005 and December 2008, a total of 332 patients with potentially curable gastric cancer enrolled from 18 institutions were intraoperatively randomized to either the B-I group or the R-Y group. Postoperative morbidity and hospital mortality were recorded prospectively in a fixed format and were compared between these two groups. The operating time was significantly longer in the R-Y group than in the B-I group (214 vs. 180 minutes, P < 0.0001). Regarding clinical symptoms during the postoperative hospital stay, the incidence of nausea, vomiting, and discontinuance of food intake was significantly higher in the R-Y group than in the B-I group (12.4% vs. 3.7%, P = 0.0027; 8.9% vs. 3.1%, P = 0.022; and 12.4% vs. 4.3%, P = 0.0064, respectively). There was no significant difference in the overall operative morbidity rate between the R-Y and B-I groups (13.6% vs. 8.6%, respectively, P = 0.14). Anastomotic leakage occurred in two patients (1.2%) in the B-I group and in none in the R-Y group; the difference did not reach statistical significance (P = 0.09). Postoperative hospital stay was significantly longer in the R-Y group than in the B-I group (16.4 vs. 14.1 days, P = 0.019). We concluded that B-I reconstruction was superior to R-Y reconstruction in terms of perioperative complications.World Journal of Surgery 03/2012; 36(3):632-7. · 2.36 Impact Factor -
Article: Clinical relevance of induction triplet chemotherapy for esophageal cancer invading adjacent organs.
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ABSTRACT: There is no consensus on treatment for esophageal cancer invading adjacent organs (T4), but induction multidrug chemotherapy may be a beneficial, especially when surgery is considered as adjuvant treatment. We classified 169 patients with T4 esophageal cancer without distant metastasis into those undergoing chemotherapy using cisplatin and 5-FU (CF) plus adriamycin or CF plus docetaxel (79 patients) and those undergoing chemoradiotherapy using CF (90 patients). For the former group, chemoradiation was subsequently applied when surgical resection was not indicated. Thirty-four patients in the chemotherapy group (43.0%) received chemoradiotherapy following chemotherapy. Although the response rate tended to be higher in the chemoradiotherapy group, there was no significant difference in the response rate between the groups (63.3% vs. 68.9%). Esophageal perforation during treatment was more frequent among the chemoradiotherapy group than the chemotherapy group (16.7% vs. 6.3%, P=0.0379). The rate of surgical resection was consequently higher for the induction chemotherapy group compared to the chemoradiotherapy group (72.1% vs. 45.6%, P=0.0005). Induction triplet chemotherapy reduced esophageal perforation and increased the resectability of T4 esophageal cancers by combining second-line chemoradiotherapy. This strategy might increase the chance of curative resection for patients with T4 esophageal cancer.Journal of Surgical Oncology 02/2012; 106(4):441-7. · 2.10 Impact Factor -
Article: Recent trend of internal hernia occurrence after gastrectomy for gastric cancer.
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ABSTRACT: The incidence of internal hernia after gastrectomy can increase with the increasing use of laparoscopic surgery, although this trend has not been elucidated. Clinical information was collected from medical records and by questionnaire for 18 patients who underwent surgical treatment for internal hernia after gastrectomy for gastric cancer in 24 hospitals from January 2005 to December 2009. Gastrectomy for gastric cancer was open/distal gastrectomy (DG) in five (28%) patients, open/total gastrectomy (TG) in seven (39%), laparoscopy-assisted/DG in three (17%), and laparoscopy-assisted/TG in 3 (17%). Reconstruction was by Roux-Y methods in all patients. The hernia orifice was classified as a jejunojejunostomy mesenteric defect in eight patients (44%), dorsum of the Roux limb (Petersen's space) in eight (44%), and one (5%) each of esophageal hiatus and mesenterium of the transverse colon. Among 8,983 patients who underwent gastrectomy for gastric cancer, a postoperative survey revealed that 13 patients underwent surgical treatment for internal hernia in the same hospitals. The 3-year incidence rate of the internal hernia was 0.19%, which was significantly higher after laparoscopy-assisted than open gastrectomy (0.53 vs. 0.15%, p = 0.03). Patients with an internal hernia had a mean (±SD) low weight at hernia operation (body mass index 17.9 ± 1.6 kg/m(2)) and marked weight loss after gastrectomy (weight reduction 15.6 ± 5.8%). Gastrectomy with Roux-Y reconstruction for gastric cancer leaves several spaces that can cause internal hernia formation. Laparoscopic surgery and postoperative body weight loss are potential risk factors.World Journal of Surgery 02/2012; 36(4):851-7. · 2.36 Impact Factor -
Article: Effects of ghrelin administration during chemotherapy with advanced esophageal cancer patients: A prospective, randomized, placebo-controlled phase 2 study.
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ABSTRACT: Cisplatin reduces plasma ghrelin levels through the 5-hydroxytryptamine (5-HT) receptor. This may cause cisplatin-induced gastrointestinal disorders and hinders the continuation of chemotherapy. The authors of this report conducted a prospective, randomized phase 2 trial to evaluate the effects of exogenous ghrelin during cisplatin-based chemotherapy. Forty-two patients with esophageal cancer who were receiving cisplatin-based neoadjuvant chemotherapy were assigned to either a ghrelin group (n = 21) or a placebo group (n = 21). They received either intravenous infusions of synthetic human ghrelin (3 μg/kg) or saline twice daily for 1 week with cisplatin administration. The primary endpoint was changes in oral calorie intake, and the secondary endpoints were chemotherapy-related adverse events; appetite visual analog scale (VAS) scores; changes in gastrointestinal hormones and nutritional status, including rapid turnover proteins, and quality of life (QoL) estimated with the European Organization for Research and Treatment of Cancer QoL core questionnaire (QLQ-C30). Two patients were excluded from the final analysis: One patient suspended ghrelin administration because of excessive diaphoresis, and another patient in the placebo group failed to monitor the self-questionnaire. Food intake and appetite VAS scores were significantly higher in the ghrelin group than in the placebo group (18.2 ± 5.2 kcal/kg/day vs 12.7 ± 3.4 kcal/kg/day [P = .001] and 6.2 ± 0.9 vs 4.1 ± 0.9 [P < .0001], respectively). Patients in the ghrelin group had fewer adverse events during chemotherapy related to anorexia and nausea than patients in the control group. Significant deterioration was noted after chemotherapy in the placebo group in QoL scores, appetite, nausea and vomiting, and global health status. Short-term administration of exogenous ghrelin at the start of cisplatin-based chemotherapy stimulated food intake and minimized adverse events. Cancer 2012. © 2012 American Cancer Society.Cancer 01/2012; 118(19):4785-94. · 4.77 Impact Factor -
Article: Clinical Trial of Ghrelin Synthesis Administration for Upper GI Surgery.
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ABSTRACT: Appetite and weight loss following gastrectomy or esophagectomy is one of the major problems that affect the postoperative QoL. Ghrelin, mainly secreted from the stomach, is related to appetite, weight gain, and positive energy balance. This hormone level had been shown to become low for a long time after upper GI surgery. The efficacy of ghrelin synthesis administration for postoperative weight loss was investigated from a clinical trial to develop a new strategy for weight gain. In addition to this treatment for appetite and weight loss, we focused on the anti-inflammatory role of ghrelin. For the purpose of controlling postoperative cytokine storm after esophagectomy, this hormone was introduced in the clinical trial. Finally, ghrelin replacement therapy during chemotherapy in patients with esophageal cancer is also presented. Our clinical trials and their results are presented in this chapter.Methods in enzymology 01/2012; 514:409-31. · 1.90 Impact Factor -
Article: Assessment of stanniocalcin-1 as a prognostic marker in human esophageal squamous cell carcinoma.
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ABSTRACT: Stanniocalcin-1 (STC1) is a secreted glycoprotein hormone and highly expressed in various types of human malignancies. Although evidence points to the role of STC1 in human cancers, the clinical significance of STC1 expression in esophageal cancer has not been well established. Quantitative reverse transcriptase-polymerase chain reaction and immunohistochemistry were performed to assess the expression of STC1 in the cancer cell line TE8 and esophageal cancer tissues from 229 esophageal squamous cell carcinomas (ESCC). Surgically-resected tissue sections were immunostained for potential regulators of STC1 expression, hypoxia-inducible factor-1α (HIF-1α) and p53. Marked increase in STC1 mRNA and protein expression was noted in TE8 cells cultured under hypoxic conditions. Overexpression of STC1 mRNA was noted in ESCC tumors compared to normal counterparts. Positive immunohistochemical staining for STC1 protein was observed in 38.9% of patients, and correlated significantly with advanced pT status (p=0.019), poor prognosis [overall survival (p<0.0006) and disease-free survival (p<0.0002) of ESCC patients who had undergone curative surgery]. Positive staining for HIF-1α and p53 proteins in ESCC did not correlate with STC1 expression. The results showed marked induction of STC1 expression under hypoxia in cultured cells and in esophageal cancer cells and that overexpression of STC1 was an independent prognostic factor in patients with esophageal cancer who had undergone curative surgery. STC1 is a potentially useful biomarker for ESCC treatment.Oncology Reports 12/2011; 27(4):940-6. · 1.84 Impact Factor -
Article: Authors' reply: should we inherit bursectomy or discard it?
Gastric Cancer 12/2011; 15(2):226-7. · 2.42 Impact Factor -
Article: Mapping analysis of ghrelin producing cells in the human stomach associated with chronic gastritis and early cancers.
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ABSTRACT: The majority of ghrelin producing cells (GPC) are present in the fundic gland of the stomach and recognized as X/A like cells. The detailed distribution of GPC in the stomach is still unknown in healthy and pathological subjects. We investigated the detailed distribution of GPC in the stomach, especially in relation with chronic gastritis, using surgical specimens from 12 patients with early gastric cancer. Either the anterior or posterior half of the whole stomach, which was a counterpart of the tumor bearing side, was subjected for immunohistochemistry of ghrelin, and the number of total GPC were semi quantitatively evaluated as GPC score. GPC score was compared with the degree of chronic gastritis, serum ghrelin concentration and body weight. GPC was not observed in the pyloric gland, but heterogeneously distributed in the fundic gland mainly in upper body and the greater curvature. The GPC score showed about nine-fold difference, which correlated well with the degree of chronic gastritis by Sydney score (r = -0.84, P < 0.001). The serum ghrelin concentration was basically determined by the GPC score (r = 0.75, P = 0.0047); however, the obese patients showed low serum ghrelin concentration in spite of the presence of abundant GPCs. In the low GPC score patients, serum ghrelin was constantly low regardless of their body weight. GPC was inversely correlated with progression of chronic gastritis. Its quantification using immunohistochemistry of the whole stomach was useful to comprehensively evaluate ghrelin profile.Digestive Diseases and Sciences 12/2011; 57(5):1238-46. · 2.12 Impact Factor -
Article: DOK2 as a marker of poor prognosis of patients with gastric adenocarcinoma after curative resection.
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ABSTRACT: DOK2 is known as the substrate of chmeric p210bcr/abl oncoprotein characterizing chronic myelogenous leukemia with Philadelphia chromosome. Reduced DOK2 expression was recently reported in lung adenocarcinoma, suggesting that this protein acts as a tumor suppressor in solid tumors. The purpose of this study was to determine the significance of DOK2 in gastric cancer. The study subjects were 118 patients who underwent curative surgery for gastric cancer, as well as 7 gastric cancer cell lines. The tissues and cell lines were analyzed for DOK2 gene and protein expressions by histopathology and immunohistochemistry, and also using a microsatellite marker for loss of heterozygosity. Correlation of survival with clinicopathological parameters was investigated by univariate and multivariate analyses. DOK2 expression was confirmed in the normal gastric mucosa. Considerable differences in the gene expression were noted among the gastric cell lines. Positive DOK2 expression was noted in the noncancerous regions of all pathological specimens, whereas 59 (50.0%) specimens of 118 patients were negatively stained in the tumor. Loss of heterozygosity was observed in 54.5% of DOK2(-) cases. DOK2(-) patients were more likely to develop recurrence than DOK2(+) and showed poorer 5-year overall survival (59.1%) than DOK2(+) (76.4%, P = .0403). Multivariate analysis identified pT (hazard ratio [HR] = 2.748, 95% confidence interval [95% CI] = 1.061-8.927, P = .0361), pN (HR = 2.486, 95% CI = 1.264-4.932, P = .0086), and DOK2(-) (HR = 2.343, 95% CI = 1.211-4.727, P = .0112) as significant and independent determinants of poor survival. Our data suggest the potential usefulness of DOK2 as a marker of poor prognosis in patients with gastric cancer after curative resection.Annals of Surgical Oncology 12/2011; 19(5):1560-7. · 4.17 Impact Factor -
Article: [Combination chemotherapy using docetaxel, cisplatin, and S-1 for far advanced gastric cancer].
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ABSTRACT: Combination of docetaxel, cisplatin, and S-1 (DCS) is expected as a new treatment regimen for far advanced gastric cancer. We performed DCS chemotherapy for six patients, including four cases with invasion to pancreas, three cases with para-aortic lymph node metastasis, and two cases with liver metastasis. Clinical stages were either IIIC or IV for all of the patients. The patients received 2-4 courses of docetaxel (40 mg/m²) and cisplatin (60 mg/m²) on day 1, and S-1 (80 mg/m²) on days 1-14 every 4 weeks. The response rate was 83% (5 PR and 1 SD), and the disease control rate was 100%. Grade 3/4 neutropenia, grade 3 febrile neutropenia, and grade 3 diarrhea were observed in three cases (50%), one case (17%), and one case (17%), respectively. Four of six patients underwent R0 surgery after DCS chemotherapy, and no severe complication was occurred. Histological responses were Grade 2 for two cases, Grade 1b for one case, and Grade 1a for one case, respectively. DCS regimen showed a high objective tumor response, and also is one of the promising regimens as neoadjuvant setting for far advanced gastric cancer.Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2342-4. -
Article: [Peritoneal lavage cytology under local anesthesia for detection of peritoneal recurrence after surgery].
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ABSTRACT: Gastric cancer with positive peritoneal lavage cytology shows a very poor prognosis due to frequent peritoneal recurrence after surgery. Therefore, we have introduced neoadjuvant intra-peritoneal and systemic chemotherapy( NIPS) for gastric cancer with peritoneal microscopic and/or microscopic dissemination before surgery. In patients subjected to the strategy, we have experienced two cases of advanced gastric cancer with CY1, which had been treated with NIPS and curative surgery, had been performed with second peritoneal lavage cytology two years after surgery. In those two cases, S-1 was discontinued due to the negative results of peritoneal lavage cytology. We will present the cases.Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2363-5. -
Article: Oncofetal protein, IMP-3, a potential marker for prediction of postoperative peritoneal dissemination in gastric adenocarcinoma.
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ABSTRACT: The aim of this study was to determine the expression of insulin-like growth factor-II messenger RNA (mRNA)-binding protein-3 (IMP-3) and its clinical significance in gastric cancers, as well the prognostic value of its expression in the peritoneal lavage fluid after surgery. IMP-3 expression was examined by immunohistochemistry in 96 primary gastric tumors. IMP-3 mRNA expression in peritoneal lavage fluid obtained at laparotomy was determine by real-time quantitative reverse transcriptase-polymerase chain reaction (RT-PCR). Positive staining for IMP-3 was observed in 74% (71/96) of the tumors. IMP-3 expression in gastric tumors correlated significantly with worst overall survival (OS) and recurrence-free survival. Multivariate analyses identified pathological N stage and IMP-3 expression as significant independent prognostic factors for disease-free survival. Eight (28%) of 36 peritoneal lavage samples were cytologically negative but positive for IMP-3 mRNA expression by RT-PCR. The OS of patients with IMP-3-positive peritoneal lavage was significantly worse than of those with negative expression. IMP-3 expression in primary gastric tumors was an independent poor prognostic factor. IMP-3 mRNA expression in peritoneal lavage fluid was a predictor of recurrence after surgery in gastric cancer and a marker of poor prognosis.Journal of Surgical Oncology 10/2011; 105(8):780-5. · 2.10 Impact Factor -
Article: A comparison of postoperative quality of life and dysfunction after Billroth I and Roux-en-Y reconstruction following distal gastrectomy for gastric cancer: results from a multi-institutional RCT.
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ABSTRACT: Both Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed as standard procedures, but it has yet to be determined which reconstruction is better for patients. A randomized prospective phase II trial with body weight loss at 1 year after surgery as a primary endpoint was performed to address this issue. The current report delivers data on the quality of life and degree of postoperative dysfunction, which were the secondary endpoints of this study. Gastric cancer patients who underwent distal gastrectomy were intraoperatively randomized to B-I or R-Y. Postsurgical QOL was evaluated using the EORTC QLQ-C30 and DAUGS 20. Between August 2005 and December 2008, 332 patients were enrolled in a randomized trial comparing B-I versus R-Y. A mail survey questionnaire sent to 327 patients was completed by 268 (86.2%) of them. EORTC QLQ-C30 scores were as follows: global health status was similar in each group (B-I 73.5 ± 18.8, R-Y 73.2 ± 20.2, p = 0.87). Scores of five functional scales were also similar. Only the dyspnea symptom scale showed superior results for R-Y than for B-I (B-I 13.6 ± 17.9, R-Y 8.6 ± 16.3, p = 0.02). With respect to DAUGS 20, the total score did not differ significantly between the R-Y and B-I groups (24.8 vs. 23.6, p = 0.41). Only reflux symptoms were significantly worse for B-I than for R-Y (0.7 ± 0.6 vs. 0.5 ± 0.6, p = 0.01). The B-I and R-Y techniques were generally equivalent in terms of postoperative QOL and dysfunction. Both procedures seem acceptable as standard reconstructions after distal gastrectomy with regard to postoperative QOL and dysfunction.Gastric Cancer 10/2011; 15(2):198-205. · 2.42 Impact Factor -
Article: Performance comparison of peripherally inserted central venous catheters in gastrointestinal surgery: a randomized controlled trial.
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ABSTRACT: Peripherally inserted central venous catheters (PICC) are long-term vascular access devices inserted through a peripheral vein of the arm and serve as an alternative to traditional central venous catheters. Currently different types of PICCs are available. No data, however, are available in regard to materials and tip designs. We designed a prospective, randomized trial comparing two major PICCs with different material and tip design: a silicone catheter with distal side slits (Groshong Catheter) and a polyurethane catheter with open-end tip (PI Catheter). Twenty-six patients who underwent PICCs placement between August 2010 and December 2010 were enrolled in the study. The primary endpoint was the completion rate of PICC indication. Secondary endpoints were complications rate. The completion rate of PICC indication was not different significantly (81.8% and 92.9%, p = 0.5648) and the total complication rate were also not different significantly (9.1% and 14.3%, P = 1.0000) between two catheters. In detail, PI Catheter were associated with a significantly higher incidence of catheter occlusion, and Groshong Catheter were associated with a significantly hemorrhages after removal. There was no difference in the durability and the complication between Groshong Catheter and PI Catheter. (UMIN Clinical Trial Registry UMIN000005451).Clinical nutrition (Edinburgh, Scotland) 09/2011; 31(1):48-52. · 3.27 Impact Factor -
Article: Development and evaluation of a master-slave robot system for single-incision laparoscopic surgery.
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ABSTRACT: PURPOSE : Single-incision laparoscopic surgery (SILS) brings cosmetic benefits for patients, but this procedure is more difficult than laparoscopic surgery. In order to reduce surgeons' burden, we have developed a master-slave robot system which can provide robot-assisted SILS as if it were performing conventional laparoscopic surgery and confirmed the feasibility of our proposed system. METHODS : The proposed system is composed of an input device (master side), a surgical robot system (slave side), and a control PC. To perform SILS in the same style as regular laparoscopic surgery, input instruments are inserted into multiple incisions, and the tip position and pose of the left-sided (right-sided) robotic instrument on the slave side follow those of the right-sided (left-sided) input instruments on the master side by means of a control command from the PC. To validate the proposed system, we defined four operating conditions and conducted simulation experiments and physical experiments with surgeons under these conditions, then compared the results. RESULTS : In the simulation experiments, we found learning effects between trials (P = 0.00013 < 0.05). Our proposed system had no significant difference from a condition simulating classical laparoscopic surgery (P = 0.23 > 0.1), and the task time of our system was significantly shorter than the simulated SILS (P = 0.011 < 0.05). In the physical experiments, our system performed SILS more easily, efficiently, and intuitively than the other operating conditions. CONCLUSION : Our proposed system enabled the surgeons to perform SILS as if they were operating conventionally with laparoscopic techniques.International Journal of Computer Assisted Radiology and Surgery 09/2011; 7(2):289-96. · 1.48 Impact Factor -
Article: Intraperitoneal docetaxel combined with S-1 for advanced gastric cancer with peritoneal dissemination.
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ABSTRACT: Our previous phase I study indicated that combination chemotherapy with intraperitoneal docetaxel and S-1 was well tolerated by gastric cancer patients with peritoneal carcinomatosis (PC). This study evaluated the benefits of this combination chemotherapy and subsequent surgery. Neoadjuvant Intra-Peritoneal and Systemic chemotherapy (NIPS) was introduced to gastric cancer patients with positive cytology or with PC. Two cycles of intraperitoneal chemotherapy with docetaxel combined with S-1, were administrated and gastrectomy with lymph node dissection was performed in cases without macroscopic PC at post-NIPS staging laparoscopy. Eighteen patients were enrolled in this study. Eight patients had measurable lymph node metastases by the RECIST criteria and computed tomography (CT) showed that five (62.5%) displayed a major response to the treatment. Out of 18 patients, 14 (78%) showed negative results on peritoneal cytology and no macroscopic PC, while the remaining four were cancer cell positive on peritoneal cytology or showed macroscopic PC even after NIPS. The median survival time of the entire group was 24.6 months. No treatment-related mortality was observed during NIPS and surgery. This study indicated that the NIPS combined with surgery was highly active and well tolerated by advanced gastric cancer patients with PC.Journal of Surgical Oncology 08/2011; 105(1):38-42. · 2.10 Impact Factor -
Article: REGIV as a potential biomarker for peritoneal dissemination in gastric adenocarcinoma.
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ABSTRACT: This study examined the clinical significance of regenerating islet-derived family member 4 (REGIV) in surgically resected gastric tumors. The potential of REGIV as a biomarker in gastric cancer was also assessed including its predictive value for prognosis and recurrence after surgery. Immunohistochemistry was performed to assess the clinical significance of REGIV expression status in surgically resected specimens. The quantitative genetic diagnostic method, transcription-reverse transcription concerted reaction (TRC) that targeted REGIV mRNA was applied for prediction of peritoneal recurrence in gastric cancer. Positive immunostaining for REGIV was observed in 85 cases (52.5%), and correlated significantly with diffuse type histopathology (P = 0.001), advanced T stage (P = 0.022), and frequent peritoneal recurrence (P = 0.009). Multivariate analysis identified advanced T stage (P < 0.001) and REGIV expression (P = 0.034) as independent prognostic factors for peritoneal recurrence-free survival. Overexpression of REGIV protein was evident in the majority of peritoneal tumors (93.8%). REGIV mRNA assessed by TRC could be a predictive marker for peritoneal recurrence after curative operation. REGIV overexpression is common in primary gastric tumors and a potentially suitable marker of diffuse type histopathology and peritoneal dissemination. Overexpression of REGIV mRNA, assessed by the TRC method, is a potentially suitable marker of peritoneal recurrence after curative resection.Journal of Surgical Oncology 07/2011; 105(2):189-94. · 2.10 Impact Factor -
Article: Fall in plasma ghrelin concentrations after cisplatin-based chemotherapy in esophageal cancer patients.
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ABSTRACT: Chemotherapeutic agents, especially cisplatin, cause severe gastrointestinal disorders, including nausea, vomiting, and anorexia, which markedly impair quality of life and encourage discontinuation of chemotherapy. Since cisplatin was recently reported to decrease plasma ghrelin and food intake in rodents, we monitored the plasma ghrelin level and its association with nutritional status and adverse events during chemotherapy in patients with esophageal cancer. Twenty patients with advanced esophageal cancer who underwent cisplatin-based neoadjuvant chemotherapy were enrolled in a prospective observational study. Changes in gastrointestinal hormones including ghrelin were measured and correlated with feeding activity, including appetite and dietary intake, nutritional status including rapid turnover proteins, and adverse events from chemotherapy. Plasma total ghrelin significantly decreased at days 3 and 8 of chemotherapy but recovered at day 28 (baseline: 140 ± 54; day 3: 107 ± 46; day 8: 82 ± 32; day 28: 126 ± 43 fmol/ml; p = 0.023 for day 3 and p = 0.034 for day 8). No changes were noted in plasma leptin (baseline: 3.2 ± 1.8; day 8: 2.5 ± 1.5 ng/ml; p = 0.18). Among blood nutritional parameters, transferrin was the only parameter that decreased significantly and its decline, as well as loss of oral intake and appetite, correlated significantly with plasma ghrelin levels (p = 0.0013, p = 0.0063, and p = 0.013, respectively). Neutropenia and anorexia were more frequent in patients with low plasma ghrelin than in those with high plasma ghrelin (p = 0.015 and p = 0.011, respectively). Cisplatin-based chemotherapy significantly reduced plasma ghrelin and feeding activity. Ghrelin is a potentially useful novel therapy for minimizing the adverse effects of chemotherapy.International Journal of Clinical Oncology 07/2011; 17(4):316-23. · 1.41 Impact Factor -
Article: The impact of ¹⁸F-fluorodeoxyglucose positron emission tomography positive lymph nodes on postoperative recurrence and survival in resectable thoracic esophageal squamous cell carcinoma.
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ABSTRACT: Induction therapy is not always beneficial for all patients. Therefore, it is important to identify the patients with a high rate of recurrence. The occurrence of lymph node metastases (LNMs) strongly influences the postoperative survival in patients with esophageal cancer. We investigated the usefulness of an LN evaluation by initial (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in prediction of postoperative recurrence for patients with resectable esophageal squamous cell carcinoma (ESCC). A total of 76 ESCC patients who did not undergo induction therapy, but who did receive a curative resection were divided into PET-node (PET-N) positive (n = 26) and negative (n = 50) groups according to the presence or absence of FDG uptake in LNs. The PET-N status was compared with the size and the number of LNMs, as well as with the survival and failure patterns. PET positive LNs involved a significantly larger size of metastatic nests than PET negative LNs (P = 0.002). The PET-N negative group showed a higher proportion of patients with 2 or fewer LNMs (92.0%), a higher 5-year relapse-free survival (75.1%) and a higher overall survival (70.0%), and a lower postoperative recurrence (24.0%) than the 15.4, 29.6, 30.3, and 69.2% values in the PET-N positive group, respectively, (P < 0.005). Multivariate analyses identified the PET-N status to be the most significant preoperative risk factor for postoperative recurrence (P = 0.031). The preoperative PET-N status in patients with resectable ESCC was significantly associated with the size and the number of LNMs and was therefore found to reliably identify the high-risk population for postoperative recurrence.Annals of Surgical Oncology 07/2011; 19(2):652-60. · 4.17 Impact Factor -
Article: Pattern of surgical treatment for early gastric cancers in upper third of the stomach.
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ABSTRACT: Various surgical treatments are indicated for early gastric cancers in upper third of the stomach (U-EGC) because of its anatomical property and favorable prognosis. Five hundred and eighty six cases of U-EGCs were collected for 9 years from 19 hospitals in Japan. Surgical procedures were classified as total (TG) and proximal gastrectomy (PG), and the latter was subclassified as esophagogastrostomy (PG-EG) and jejunal interposition (PG-JI) reconstruction. TG was more frequent than PG (76.3% vs. 21.8%, p<0.0001). PG was more frequently performed in high volume hospitals than in low volume hospitals (26.8% vs. 10.2%, p<0.0001), however there were still large difference in frequency of PG even among high volume hospitals, ranging from 5.0% to 72.0%. For reconstruction after PG, PG-EG and PG-JI were representatively performed in 50 (39.1%) and 35 (27.3%) patients. Each institute tended to preferentially employ either PG-EG or PG-JI. Tumor size was significantly larger in TG than in PG (38.8mm vs. 22.3mm, p<0.0001) and diffuse type tended to be more frequent in TG as well. There is a huge variety of surgical treatment for U-ECG in general hospitals in our country. A multi-institutional large cohort randomized trial might be urgent to establish the standard surgical procedure of this infrequent disease.Hepato-gastroenterology 07/2011; 58(110-111):1823-7. · 0.66 Impact Factor
Top co-authors
Top Journals
Institutions
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2002–2013
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Osaka University
- • Gastroenterological Surgery
- • Department of Mechanical Science and Bioengineering
- • Department of Integrated Medicine
Ibaraki, Osaka-fu, Japan
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2012
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Osaka National Hospital
Ōsaka-shi, Osaka-fu, Japan
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2006–2012
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Osaka City University
- Department of Gastroenterological Surgery
Ōsaka-shi, Osaka-fu, Japan
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