Nobutoshi Ando

Publications (34)87.94 Total impact

• Source

  Available from: Ken Kato

  Article: Three-arm Phase III Trial Comparing Cisplatin Plus 5-FU (CF) Versus Docetaxel, Cisplatin Plus 5-FU (DCF) Versus Radiotherapy with CF (CF-RT) as Preoperative Therapy for Locally Advanced Esophageal Cancer (JCOG1109, NExT Study)

  Kenichi Nakamura, Ken Kato, Hiroyasu Igaki, Yoshinori Ito, Junki Mizusawa, Nobutoshi Ando, Harushi Udagawa, Yasuhiro Tsubosa, Hiroyuki Daiko, Shuichi Hironaka, Haruhiko Fukuda, Yuko Kitagawa
  [show abstract] [hide abstract]
  ABSTRACT: A three-arm Phase III trial was started in November 2012. Preoperative chemotherapy with cis-platin plus 5-fluorouracil is the current standard treatment for locally advanced esophageal cancer in Japan, while preoperative chemoradiotherapy with cisplatin plus 5-fluorouracil is the standard in Western countries. Preoperative chemotherapy with docetaxel, cisplatin plus 5-fluorouracil is another promising regimen. The purpose of this study is to confirm the superiority of docetaxel, cisplatin plus 5-fluorouracil over cisplatin plus 5-fluorouracil and the superiority of cisplatin plus 5-fluorouracil with chemoradiotherapy over cisplatin plus 5-fluorouracil as pre-operative therapy for squamous cell carcinoma of esophagus. A total of 501 patients will be accrued from 41 Japanese institutions within 6.25 years. The primary endpoint is overall sur-vival and the secondary endpoints include progression-free survival, %R0 resection, response rate, pathologic complete response rate and adverse events.
  Japanese Journal of Clinical Oncology 05/2013; · 1.78 Impact Factor
• Article: Which is the Optimal Response Criteria for Evaluating Preoperative Treatment in Esophageal Cancer: RECIST or Histology?

  Yukinori Kurokawa, Taro Shibata, Nobutoshi Ando, Shiko Seki, Hidenori Mukaida, Haruhiko Fukuda
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: Preoperative treatment is a promising strategy for improving long-term outcomes in advanced esophageal cancer. Two tumor response evaluation criteria for preoperative treatment are available: response evaluation criteria in solid tumors (RECIST) and histological criteria. This prospective study aimed to identify which was a better surrogate end point for survival in the preoperative setting. METHODS: We analyzed all eligible patients (n = 164) from the preoperative treatment group in a phase III trial comparing preoperative versus postoperative 5-fluorouracil plus cisplatin for clinical stage II or III esophageal cancer. Intercriteria reliability was evaluated with the proportion of agreement and the kappa coefficient. For validity analyses, hazard ratios (HR) of response to nonresponse and differences in response rates between short- and long-term survivors were evaluated. RESULTS: The clinical and histological response rates were 37.8 % (62 of 164) and 20.1 % (33 of 164), respectively. The proportion of agreement for response to nonresponse between the 2 criteria was 70.3 %, and the kappa coefficient was 0.34. The HR for death in patients with histological response (0.22, 95 % confidence interval 0.09-0.55, P < 0.001) was lower than for those with RECIST response (0.55, 95 % confidence interval 0.33-0.91, P = 0.018). The difference in response rates between short- and long-term survivors according to histological criteria (27 vs. 7 %, P < 0.001) was larger than with RECIST (42 vs. 30 %, P = 0.13). CONCLUSIONS: Intercriteria agreement was relatively low, and histological criteria yielded more valid assessments of response than RECIST. Histological response rate seemed to be the better surrogate end point of survival in the preoperative setting.
  Annals of Surgical Oncology 03/2013; · 4.17 Impact Factor
• Article: Incidence and risk factors of postoperative delirium in patients with esophageal cancer.

  Mari Takeuchi, Hiroya Takeuchi, Daisuke Fujisawa, Kaya Miyajima, Kimio Yoshimura, Saori Hashiguchi, Soji Ozawa, Nobutoshi Ando, Joichiro Shirahase, Yuko Kitagawa, Masaru Mimura
  [show abstract] [hide abstract]
  ABSTRACT: Postoperative delirium is a common complication after major surgery and is characterized by acute confusion with fluctuating consciousness. The aim of this study was to investigate the incidence and risk factors of postoperative delirium in patients with esophageal cancer. We conducted a retrospective cohort analysis of 306 consecutive patients who had undergone an esophagectomy at Keio University Hospital from January 1998 to December 2009. All data were assessed by psychiatrists, and delirium was diagnosed according to criteria of the Diagnostic and Statistical Manual Disorder, fourth edition. Univariate and multivariate analyses were performed. Postoperative delirium developed in 153 (50.0 %) of 306 patients. One hundred fourteen (37.3 %) of the 306 patients required psychoactive medication for symptoms associated with delirium. Univariate analyses showed that older age, male gender, additional flunitrazepam for sedation in intensive care unit (ICU) after surgery, longer periods of time under mechanical ventilation after surgery, longer ICU stays, occurrence of postoperative complications, and longer hospital stays were significantly associated with postoperative delirium. Multivariate analysis revealed that development of delirium was linked to older age, additional flunitrazepam in ICU, and occurrence of postoperative complication. The development of postoperative delirium in patients with esophageal cancer is a problem that cannot be ignored. Our results suggest that the risk of developing delirium is associated with older age, use of flunitrazepam in ICU, and postoperative complications.
  Annals of Surgical Oncology 06/2012; 19(12):3963-70. · 4.17 Impact Factor
• Article: Estrogen deficiency attenuates neovascularization in a murine model of hindlimb ischemia.

  Kentaro Matsubara, Hirohisa Harada, Nobutoshi Ando, Susumu Watada, Hideaki Obara, Kenji Matsumoto, Yuko Kitagawa
  [show abstract] [hide abstract]
  ABSTRACT: BACKGROUND: The possible relation between menopause and the development of peripheral arterial disease, especially lower extremity disease, has not been fully studied. To explore this issue, we investigated whether estrogen deficiency affected neovascularization in a murine model of hindlimb ischemia. METHODS: Ischemia was surgically induced in one hindlimb of oophorectomized and control female BALB/c mice. Neovascularization in the ischemic hindlimbs was evaluated using laser Doppler blood flow analysis and capillary density analysis of the adductor muscle. The expression of endothelial nitric oxide synthase protein in the adductor muscle of the ischemic hindlimbs was assessed. RESULTS: The plasma 17-β estradiol levels were significantly lower in the oophorectomized mice than in the control mice. The oophorectomized mice also had a significantly reduced blood perfusion index and capillary density on day 21 after the induction of hindlimb ischemia and significant suppression of endothelial nitric oxide synthase protein expression on day 3 after ischemia induction. CONCLUSIONS: Estrogen deficiency attenuated neovascularization in a murine model of hindlimb ischemia. Impaired neovascularization in oophorectomized mice might correlate with a reduction in endothelial nitric oxide synthase expression caused by estrogen deficiency.
  Journal of Surgical Research 05/2012; · 2.25 Impact Factor
• Article: The role of adjuvant chemotherapy for localized squamous cell esophageal cancer: current Japanese standard and the unending role of the drawing board.

  Yuko Kitagawa, Nobutoshi Ando, Kenichi Nakamura, Taro Shibata, Haruhiko Fukuda
  Annals of Surgical Oncology 03/2012; 19(5):1425-7. · 4.17 Impact Factor
• Article: [A case of bone marrow carcinomatosis from breast cancer treated with weekly Paclitaxel].

  Shin Takayama, Hanako Ueno, Shinji Kawaguchi, Fumitaka Asahara, Sojun Hoshimoto, Hirohisa Harada, Shinji Ogawa, Michio Sato, Junichi Matsui, Nobutoshi Ando
  [show abstract] [hide abstract]
  ABSTRACT: We report a case of bone marrow carcinomatosis originating from breast cancer that was treated with weekly paclitaxel (PTX). A 42-year-old female patient underwent mastectomy with axillary lymph node dissection for breast cancer in 2001. Multiple bone metastases were diagnosed in 2008, but she remained stable with chemotherapy and hormonal therapy for about two years. In 2010, thrombocytopenia occurred, and she was diagnosed with bone marrow carcinomatosis after bone marrow biopsy. She was treated with weekly PTX(80 mg/m2), and recovered successfully after treatment. About one year has elapsed since initiation of therapy, and there has been no recurrence. Bone marrow carcinomatosis originating from breast cancer is very rare, and is regarded as a disease with a poor prognosis. However, weekly PTX could be a valid treatment for prolonging survival of bone marrow carcinomatosis originating from breast cancer.
  Gan to kagaku ryoho. Cancer & chemotherapy 01/2012; 39(1):99-101.
• Article: Upper gastrointestinal tract cancers as double-cancers in elderly patients with oral squamous cell carcinoma.

  Hiroaki Ikawa, Morio Tonogi, Gen-Yuki Yamane, Tomohiro Yamauchi, Yoichi Tanaka, Michio Sato, Junichi Matsui, Nobutoshi Ando, Akira Katakura
  [show abstract] [hide abstract]
  ABSTRACT: Against a background of a rapidly aging society, the number of patients with oral cancers in Japan is increasing yearly. The number of double-cancers with oral cancer as the first malignancy is also reportedly on the rise. Esophageal and gastric cancers are the most common second malignancies. At our institution, our policy is to proactively perform upper gastrointestinal (GI) fiberscopy (GIF) in patients with oral cancer. In anticipation of a probable further increase in the number of patients with double-cancers consisting of oral and GI tract malignancies, we retrospectively analyzed the occurrence of upper GI tract cancers in patients with oral squamous cell carcinoma (OSCC). The cohort consisted of 171 patients in whom OSCC had been diagnosed and who had undergone upper GIF between March 1996 and August 2008. Multivariate analysis was performed. Upper GIF identified 8 patients (7 men, 1 woman, totaling 4.7% of 171 patients) with double-cancer in the upper GI tract. One patient had a triple malignancy consisting of oral, esophageal and gastric cancers. Seven patients had esophageal cancer, while two had gastric cancer. An age of over 65 years was significantly higher in patients with double-cancers including esophageal cancer than in patients without esophageal cancer (OR=10.454, 95% CI=1.143-95.621). None of the other analyzed patient factors (sex, smoking habit, drinking habit, site of OSCC, TNM classification, staging results) showed a significant difference. These results indicate that, when treating elderly patients with oral cancers, physicians need to devise suitable treatment plans which take into account the possibility of upper GI tract cancer, particularly esophageal cancer, as a double-cancer.
  The Bulletin of Tokyo Dental College 01/2012; 53(1):9-16.
• Source

  Available from: Tatsuo Kanda

  Article: A randomized trial comparing postoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil versus preoperative chemotherapy for localized advanced squamous cell carcinoma of the thoracic esophagus (JCOG9907).

  Nobutoshi Ando, Hoichi Kato, Hiroyasu Igaki, Masayuki Shinoda, Soji Ozawa, Hideaki Shimizu, Tsutomu Nakamura, Hiroshi Yabusaki, Norio Aoyama, Akira Kurita, Kenichiro Ikeda, Tatsuo Kanda, Toshimasa Tsujinaka, Kenichi Nakamura, Haruhiko Fukuda
  [show abstract] [hide abstract]
  ABSTRACT: Patients with esophageal carcinoma receiving postoperative chemotherapy showed superior disease-free survival than those receiving surgery alone in a Japan Clinical Oncology Group trial (JCOG9204). The purpose of this study was to evaluate optimal perioperative timing-that is, before or after surgery-for providing chemotherapy in patients with locally advanced esophageal squamous cell carcinoma. Eligible patients with clinical stage II or III, excluding T4, squamous cell carcinoma were randomized to undergo surgery followed (group 1) or preceded (group 2) by chemotherapy consisting of two courses of cisplatin plus 5-fluorouracil. The primary end point was progression-free survival. We randomized 330 patients, with 166 assigned to group 1 and 164 to group 2, between May 2000 and May 2006. The planned interim analysis was conducted after completion of patient accrual. Progression-free survival did not reach the stopping boundary, but overall survival in group 2 was superior to that of group 1 (P = 0.01). Therefore, the Data and Safety Monitoring Committee recommended early publication. Updated analyses showed the 5-year overall survival to be 43% in group 1 and 55% in group 2 (hazard ratio 0.73, 95% confidence interval 0.54-0.99, P = 0.04), where the median follow-up of censored patients was 61.6 months. Concerning operative morbidity, renal dysfunction after surgery in group 2 was slightly higher than in group 1. Preoperative chemotherapy with cisplatin plus 5-fluorouracil can be regarded as standard treatment for patients with stage II/III squamous cell carcinoma.
  Annals of Surgical Oncology 08/2011; 19(1):68-74. · 4.17 Impact Factor
• Article: [Neoadjuvant and adjuvant therapy].

  Michio Sato, Nobutoshi Ando
  Nippon rinsho. Japanese journal of clinical medicine 08/2011; 69 Suppl 6:335-41.
• Article: [Multi-institutional cooperative clinical trial for esophageal cancer in Japan (JCOG trial)].

  Nobutoshi Ando, Masayuki Shinoda, Haruhiko Fukuda
  Nippon rinsho. Japanese journal of clinical medicine 08/2011; 69 Suppl 6:451-7.
• Article: Radiotherapy quality assurance review for a multi-center randomized trial of locally advanced esophageal cancer: the Japan Clinical Oncology Group (JCOG) trial 0303.

  Naoko Sanuki, Satoshi Ishikura, Masayuki Shinoda, Yoshinori Ito, Kazushige Hayakawa, Nobutoshi Ando
  [show abstract] [hide abstract]
  ABSTRACT: The purpose of this study was to evaluate the radiotherapy (RT) quality assurance (QA) for JCOG 0303. JCOG 0303 was a multi-center phase II/III trial that compared two types of chemotherapy administered concomitantly with RT for locally advanced esophageal cancer. RT requirements included a total dose of 60 Gy in 30 fractions and CTV with a 2-cm margin cranio-caudally to the primary tumor. The QA assessment was given as per protocol (PP), deviation acceptable (DA), violation unacceptable (VU), and incomplete/not evaluable following predefined criteria for quality parameters. A total of 142 cases were accrued. After excluding 36 incomplete/not evaluable, 106 (75%) were fully evaluable for RT quality review. Of these 106, there were 4 VU (4%) and overall RT compliance (PP + DA) was 96%. Comparing the incidence of VU based on the numbers enrolled by institution, the highest quarter of enrollment (≥7 cases) had no VU, while all VU (4; 11%) were from institutions enrolling <7 patients. The results of the RTQA assessment for JCOG 0303 were sufficient to provide reliable results. Additional improvements will be needed for institutions with low accrual rates.
  International Journal of Clinical Oncology 06/2011; 17(2):105-11. · 1.41 Impact Factor
• Article: [Neoadjuvant chemotherapy followed by surgery as standard treatment for stage II + III thoracic esophageal squamous cell carcinoma in Japan].

  Michio Sato, Nobutoshi Ando
  [show abstract] [hide abstract]
  ABSTRACT: In Japan, the overall 5-year survival rates after surgery alone for thoracic esophageal squamous cell carcinoma are 88% in patients with stage I and 52% in patients with stage II + III disease. Because of the poor outcome of stage II + III patients, multimodality approaches based on chemotherapy or chemoradiotherapy have been evaluated as adjuvant therapy. Neoadjuvant chemoradiotherapy has mainly been evaluated in the USA, while adjuvant chemotherapy for systemic effects has mainly been evaluated in Japan. In 2003, the results of a randomized study (Japan Clinical Oncology Group [JCOG] 9204) comparing surgery alone with postoperative chemotherapy with cisplatin and fluorouracil were reported, confirming that adjuvant chemotherapy prevents relapse in patients with esophageal cancer after surgery. In 2008, another study (JCOG 9907) comparing postoperative and preoperative chemotherapy was reported, and those results showed that preoperative chemotherapy induced downstaging and R0 reduction and improved overall survival without additional serious adverse events. Preoperative chemotherapy with cisplatin and fluorouracil followed by surgery can be regarded as the standard treatment for stage II + III thoracic esophageal squamous cell carcinoma in Japan.
  Nippon Geka Gakkai zasshi 03/2011; 112(2):104-10.
• Article: [History of combined modality therapy for esophageal cancer in Japan].

  Nobutoshi Ando, Houichi Kato, Masayuki Shinoda, Haruhiko Fukuda
  Gan to kagaku ryoho. Cancer & chemotherapy 09/2010; 37(9):1674-7.
• Article: Factors influencing the long-term survival in patients with esophageal cancer who underwent esophagectomy after chemoradiotherapy.

  Hiroya Takeuchi, Yoshiro Saikawa, Takashi Oyama, Soji Ozawa, Koichi Suda, Norihito Wada, Tsunehiro Takahashi, Rieko Nakamura, Naoyuki Shigematsu, Nobutoshi Ando, Masaki Kitajima, Yuko Kitagawa
  [show abstract] [hide abstract]
  ABSTRACT: Salvage esophagectomy is potentially the only treatment available that can offer a chance of long-term survival when definitive chemoradiotherapy (CRT) fails to achieve local control for patients with esophageal squamous cell carcinoma (ESCC). However, salvage esophagectomy is a highly invasive procedure with various postoperative complications compared to planned esophagectomy after neoadjuvant chemoradiotherapy (CRT). We hypothesize that severe postoperative complications may affect not only surgical mortality but also tumor recurrence and long-term survival for patients with salvage esophagectomy after definitive CRT. For the present study we reviewed the surgical procedures, postoperative complications, and the prognosis of 65 consecutive patients with thoracic ESCC who underwent the esophagectomy after neoadjuvant (neoadjuvant group: n = 40) or definitive (salvage group: n = 25) CRT. Most patients underwent right-transthoracic extended esophagectomy and reconstruction using gastric conduit by way of subcutaneous route with left cervical anastomosis. The incidence of postoperative pneumonia was found to be higher in the salvage group than in the neoadjuvant group. In both groups, the survival of patients with R0 resection was significantly better than those with R1/R2 resection. Moreover, in the salvage group, the postoperative survival rate of patients with pneumonia or bacteremia/sepsis was significantly lower than that for patients who did not suffer the same complications. In the neoadjuvant group, R0 resection was selected to be the only independent prognostic factor in univariate and multivariate analysis. In contrast, in the salvage group, R0 resection and bacteremia/sepsis remained significant and were independent of the other factors in multivariate analysis. This study reveals that postoperative morbidity affects not only the perioperative mortality but also the long-term survival of patients with ESCC who undergo salvage esophagectomy after definitive CRT.
  World Journal of Surgery 02/2010; 34(2):277-84. · 2.36 Impact Factor
• Article: A phase II trial of chemoradiotherapy for stage I esophageal squamous cell carcinoma: Japan Clinical Oncology Group Study (JCOG9708).

  Hoichi Kato, Akihiro Sato, Haruhiko Fukuda, Yoshikazu Kagami, Harushi Udagawa, Akihiko Togo, Nobutoshi Ando, Otsuo Tanaka, Masayuki Shinoda, Hideaki Yamana, Satoshi Ishikura
  [show abstract] [hide abstract]
  ABSTRACT: The study objective was to evaluate the efficacy and toxicity of chemoradiotherapy with 5-fluorouracil (5-FU) plus cisplatin in patients with Stage I esophageal squamous cell carcinoma (ESCC). The primary endpoint was proportion of complete response (%CR). Patients with Stage I (T1N0M0) ESCC, aged 20-75 years, without indication of endoscopic mucosal resection were eligible. Treatment consisted of cisplatin 70 mg/m(2) (day 1) and 5-FU 700 mg/m(2)/day (days 1-4) combined with 30 Gy radiotherapy (2 Gy/day, 5 days/week, days 1-21). The cycle was repeated twice with 1-week split. Salvage surgery was recommended for residual tumor or local recurrence. From December 1997 to June 2000, 72 patients were enrolled. No ineligible patient or major protocol violation was observed. There were 63 CRs for %CR of 87.5% [95% confidence interval (CI): 77.6-94.1]. Six patients with residual tumor successfully underwent esophagectomy. There was no Grade 4 toxicity. Four-year survival proportion was 80.5% (95% CI: 71.3-89.7), and 4-year major relapse-free survival proportion was 68% (95% CI: 57.3-78.8) (mucosal recurrence removed by endoscopy was not counted as an event). High CR proportion and survival proportion with mild toxicity suggest that this regimen could be considered as a candidate of new standard treatment to be compared with surgery in patients with Stage I ESCC.
  Japanese Journal of Clinical Oncology 07/2009; 39(10):638-43. · 1.78 Impact Factor
• Article: Validation study of radio-guided sentinel lymph node navigation in esophageal cancer.

  Hiroya Takeuchi, Hirofumi Fujii, Nobutoshi Ando, Soji Ozawa, Yoshiro Saikawa, Koichi Suda, Takashi Oyama, Makio Mukai, Tadaki Nakahara, Atsushi Kubo, Masaki Kitajima, Yuko Kitagawa
  [show abstract] [hide abstract]
  ABSTRACT: Radio-guided detection of sentinel lymph nodes (SLN) has been used to predict regional lymph node metastasis in patients with melanoma and breast cancer. However, the validity of the SLN hypothesis is still controversial for esophageal cancer. The aim of this study is to evaluate the feasibility and accuracy of radio-guided SLN mapping for esophageal cancer. Seventy-five consecutive patients who were diagnosed preoperatively with T1N0M0 or T2N0M0 primary esophageal cancer were enrolled. Endoscopic injection of technetium-99m tin colloid was performed before surgery and radioactive SLNs were identified with preoperative lymphoscintigraphy and gamma probe. Standard radical esophagectomy with lymphadenectomy was performed in all patients and all resected nodes were evaluated by routine pathologic examination. SLNs were identified successfully in 71 (95%) of 75 patients. The mean number of identified SLNs per case was 4.7. Twenty-nine (88%) of 33 cases with lymph node metastasis showed positive SLNs. The diagnostic accuracy based on SLN status was 94% (67/71). Distribution of identified SLNs was widely spread from the cervical to abdominal areas. This study reveals that radio-guided SLN mapping is an accurate diagnostic procedure for detecting lymph node metastasis in patients with early-stage esophageal cancer.
  Annals of surgery 05/2009; 249(5):757-63. · 7.90 Impact Factor
• Article: Selective targeting by preS1 domain of hepatitis B surface antigen conjugated with phosphorylcholine-based amphiphilic block copolymer micelles as a biocompatible, drug delivery carrier for treatment of human hepatocellular carcinoma with paclitaxel.

  Ryohei Miyata, Masakazu Ueda, Hiromitsu Jinno, Tomohiro Konno, Kazuhiko Ishihara, Nobutoshi Ando, Yuko Kitagawa
  [show abstract] [hide abstract]
  ABSTRACT: Using dithioester-capped 2-methacryloyloxyethyl phosphorylcholine (MPC) as a macro chain transfer agent, a diblock copolymer was synthesized with n-butyl methacrylate (BMA) as hydrophobic core-forming blocks. The MPC-BMA unit was copolymerized with an immobilizable unit, p-nitrophenylcarbonyloxyethyl methacrylate (NPMA). The NPMA moiety then was modified by the addition of preS1 domain of hepatitis B surface antigen (HBsAg). This micelle-forming nanoparticle, the poly (MPC-co-BMA-co-NPMA) (PMBN) conjugated with preS1 enables solubilization of paclitaxel (PTX) with increased hepatotropism. The 50% inhibitory concentration (IC(50)) values of PTX and PTX/PMBN-preS1 against the human hepatocellular carcinoma cell line, HepG2, were 1,008 and 131 nM, respectively (p < 0.05). Conjugation of preS1 to PMBN enhanced strongly the synergistic inhibitory effect of paclitaxel on HepG2 cells in vitro, whereas such a change in IC(50) was not detected against the human squamous cell carcinoma cell line, A431. Tumor growth rates of a HepG2 xenograft in Balb/c nude mice after intraperitoneal injection of PTX, PTX/PMBN and PTX/PMBN-preS1 were +97.9%, -74.3% and -96.2%*, respectively (*p < 0.05 versus PTX). The local paclitaxel levels after administration of the PMBN-preS1 conjugate were determined in the xenografts by high-performance liquid chromatography and were 8 times higher than that after administration of paclitaxel alone. No side effects attributable to PMBN-preS1 were observed histologically in vital organs, and body weight loss was significantly less in the PTX/PMBN-preS1 group. These studies demonstrate that PMBN-preS1 may be used as a human hepatocyte-specific drug delivery carrier without serious adverse effects.
  International Journal of Cancer 01/2009; 124(10):2460-7. · 5.44 Impact Factor
• Article: [Standard radical esophagectomy in thoracic esophageal cancer].

  Michio Sato, Nobutoshi Ando
  [show abstract] [hide abstract]
  ABSTRACT: In Japan, the standard radical surgical procedure in patients with thoracic esophageal cancer is right thoracoabdominal esophagectomy with lymphadenectomy. However, with the development of endoscopic surgery and improvements in chemotherapy and chemoradiotherapy, the role of radical surgery has been changing. The indications for radical surgery are stage I disease without indications for endoscopic resection (endoscopic mucosal resection or endoscopic submucosal dissection), stage II disease, or stage III disease without T 4 tumors. Because of the favorable results of chemoradiotherapy in the treatment of stage I disease, the Japan Clinical Oncology Group (JCOG) started a randomized, controlled trial comparing surgery and chemoradiotherapy in the treatment of stage I thoracic esophageal cancer. The 5-year overall survival rates in patients who underwent surgery alone for thoracic esophageal cancer were 88% with stage I and 52% with stage II + III disease in Japan. The most important area in lymphadenectomy is the region from the neck to superior mediastinum, and three-field dissection is widely performed in Japan. However, there is no evidence that three-field dissection is necessary or that two-field dissection is sufficient. The efficacy of postoperative adjuvant chemotherapy for the treatment of thoracic esophageal cancer was confirmed in a Japanese randomized, controlled trial and it is expected that the timing of adjuvant chemotherapy will change from post- to pre-surgery (neoadjuvant chemotherapy).
  Nippon Geka Gakkai zasshi 02/2008; 109(1):21-5.
• Article: Vascular pedicled jejunal Roux-en-Y reconstruction with supercharge technique for necrosis of the gastric tube following subtotal esophagectomy

  Michio Sato, Nobutoshi Ando, Hirohisa Harada, Shoichi Tobari, Shinji Ogawa, Seishi Aoki, Ryohei Miyata
  [show abstract] [hide abstract]
  ABSTRACT: Necrosis of the esophageal conduit is a life-threatening complication in esophageal cancer surgery, and secondary reconstruction options for esophageal discontinuity are quite limited. We present a procedure in which we used a long-segment jejunal flap with a supercharged vascular pedicle to treat gastric tube necrosis following subtotal esophagectomy in a 64-year-old man with esophageal cancer. The proximal jejunal flap was pulled up in Roux-en-Y fashion through the subcutaneous route together with the vascular pedicle of the fourth branch of the jejunal vessels, and the cut edges of the second jejunal vessel were anastomosed microscopically to the internal thoracic vessels for supercharging. No problems occurred with either vessel or digestive tract anastomosis. The patient was able to commence oral intake on postoperative day (POD) 10, was discharged on POD 37, and obtained a good quality of life at home. This result suggests that supercharged vascular pedicled jejunum is a suitable alternative conduit for secondary reconstruction following necrosis of the esophageal conduit in esophageal cancer surgery.
  Esophagus 01/2007; 4(2):87-90. · 0.66 Impact Factor
• Article: Role of steroid administration to reduce inflammation after thoracotomy in a rat surgical stress model.

  Eiichi Nakamura, Yuko Kitagawa, Soji Ozawa, Koichi Suda, Nobutoshi Ando, Masakazu Ueda, Masaki Kitajima
  [show abstract] [hide abstract]
  ABSTRACT: Unilateral lung surgical insult can lead to bilateral pulmonary inflammation after transthoracic esophagectomy for esophageal cancer. An inflammatory response of the cytokine network induced by surgical stress followed by neutrophil sequestration is the major mechanism involved in these complications. We examined modulation of the inflammatory cytokine and neutrophil sequestration by preoperative steroid administration in a rat thoracotomy model. Adult male rats were subjected to right thoracotomy with pulmonary compression in the surgical stress model. In the another surgical stress model, 10 mg/kg of methylprednisolone (MP) was administered 1 h before the operation intraperitoneally, and peri-operative biological effects of steroid administration to neutrophil sequestration and cytokine-induced neutrophil chemoattractant (CINC) as an inflammatory cytokine were examined. Sham-operated animals were subjected to intubation only. Surgical insult to the unilateral lung increased local CINC concentration followed by an increase in neutrophil sequestration, wet-to-dry weight ratio in bilateral lungs and systemic CINC concentration. Pre-treatment with methylprednisolone reduced CINC concentration as well as neutrophil sequestration and wet-to-dry weight ratio of both lungs. These data suggest that inflammatory changes induced by the unilateral operative procedure occur in both lungs through local inflammatory response. Pre-operative methylprednisolone administration down-regulates cytokine release and neutrophil sequestration, preventing lung edema, and possibly may act as a prophylactic treatment against acute lung injury caused by a so-called "second attack" theory.
  Journal of Surgical Research 11/2006; 135(2):364-9. · 2.25 Impact Factor