-
Masaru Morita,
Yasushi Toh,
Hiroshi Saeki, Masahiko Sugiyama,
Kippei Ohgaki,
Shin-Ichiro Maehara,
Kazuhito Minami,
Yasuharu Ikeda,
Yoshihisa Sakaguchi,
Takeshi Okamura,
Satoru Uehara,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: To clarify the clinical significance of definitive chemoradiotherapy (CRT) and CRT followed by esophagectomy for cT4 esophageal cancer.
The treatment results for cT4 esophageal cancer were examined in 81 patients who received definitive CRT [radiation 50-70 Gy, cisplatin and 5-fluorouracil; group I] and 19 patients who underwent esophagectomy after preoperative CRT [40Gy, Group II].
Among the 81 patients in group I, toxicities (grade 3 or 4) were observed in 32 patients, while partial response and complete response were recognized in 8 and 47 patients, respectively. Of the 19 group II patients, an R0 resection was performed in 16 patients, and the mortality rate was 5%. The 5-year survival rates were 19% and 42% in groups I and II, respectively.
Long-term survival can be expected after multimodal therapy, even for patients with cT4 esophageal cancer. Esophagectomy is therefore a valid treatment option when down-staging can be achieved.
Anticancer research 08/2012; 32(8):3275-82. · 1.73 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: The purpose of this study was to clarify the surgical indications for gastrectomy combined with distal or partial pancreatectomy (GP) in patients with gastric cancer.
From January 1994 to December 2009, 29 patients with primary gastric cancer surgically invading the pancreas without distant organ metastasis underwent GP for R0 resection. The patients' characteristics, surgical data, and clinicopathological features were used for the analysis of survival and prognostic factors.
The median disease-free survival and median survival time (MST) of all patients were 15 and 30 months, respectively. Only pN3 status (characterized by 7 or more pathologically metastatic lymph nodes) according to the Japanese Classification of Gastric Carcinoma, 14th edition, was shown to be a prognostic factor in a multivariate analysis. The MST of the patients with pN3 and the other patients were 12 and 51 months, respectively (p < 0.001).
We suggest that pancreas invasion should not be considered a contraindication for gastrectomy and that patients with a small number of lymph node metastases (six or fewer) might be candidates for GP in the case of gastric cancer that requires pancreatectomy for R0 resection.
World Journal of Surgery 06/2012; 36(10):2412-9. · 2.36 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: AimPrimary esophageal small cell carcinoma is a comparatively rare disease. It is thought to have a poor prognosis, and no standard
treatment strategy has yet been established. Surgical cases of small cell carcinoma of the thoracic esophagus were reviewed
with regard to clinical characteristics and treatment strategy.
Patients and methodsAmong the 993 patients who underwent an esophagectomy for thoracic esophageal cancer from 1965 to 2007, 12 cases (1.2%) demonstrated
a diagnosis of small cell carcinoma based on the histopathology findings.
ResultsThere were 3 cases of Stage I, 1 case of Stage II, 4 cases of Stage III, and 4 cases of Stage IVa. Five cases (42%) were treated
preoperatively (chemoradiotherapy, 4 cases; radiotherapy, 1 case), and the pathological criteria for the effects of preoperative
therapy were 3 cases of Grade 3. Eleven patients died of cancer; only 1 patient achieved long-term survival and complete response
for treatment with chemoradiation after recurrence. The median survival time was 7.6 months, the 1-year survival rate was
33%, and the 3-year survival rate was 8.3%.
ConclusionsThe prognosis of surgically resected cases of esophageal small cell carcinoma is poor; therefore, either chemotherapy or chemoradiotherapy
should be administered to such cases. Furthermore, improved understanding of the biological characteristics of this type of
tumor will result in the development of new therapeutic strategies, which are expected to improve patient outcome.
Esophagus 04/2012; 6(3):161-165. · 0.66 Impact Factor
-
Masahiko Sugiyama,
Masaru Morita,
Rintaro Yoshida,
Koji Ando,
Akinori Egashira,
Ohga Takefumi,
Hiroshi Saeki,
Eiji Oki,
Yoshihiro Kakeji,
Yoshihisa Sakaguchi,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: The results and outcomes of surgical resection for esophageal carcinoma have improved remarkably in recent years; however, recurrence still frequently develops, even after complete resection. The purpose of this study is to clarify the characteristics of recurrence in this patient population.
Among 208 patients, who underwent R0 resection for esophageal carcinoma, recurrence developed in 61. Clinical data were available for 56 of these patients, who were the subjects of this study. We evaluated the time, patterns, and treatment of recurrence in these patients.
Recurrence developed within 1 and 2 years after esophagectomy in 71 and 84% of the patients, respectively, and was classified as loco-regional (54%), hematogenous (36%), or mixed type (10%). The prognosis of patients with loco-regional recurrence tended to be better than that of those with distant metastasis, although the difference was not significant (P = 0.088). Patients with recurrence treated by chemotherapy alone or multimodal therapy, such as radiation or surgery combined with systemic chemotherapy, survived significantly longer than those with untreatable recurrence (P = 0.016).
These findings reinforce the importance of careful follow-up for both loco-regional and hematogenous recurrence after esophagectomy, particularly during the first 2 years.
Surgery Today 02/2012; 42(8):752-8. · 1.22 Impact Factor
-
Yasuo Sakamoto,
Yoshihisa Sakaguchi,
Hisafumi Akimoto,
Yoshiki Chinen,
Miyako Kojo, Masahiko Sugiyama,
Kazutoyo Morita,
Hiroshi Saeki,
Kazuhito Minami,
Yuji Soejima,
Yasushi Toh,
Takeshi Okamura
[show abstract]
[hide abstract]
ABSTRACT: Laparoscopic gastrectomy is commonly performed for gastrointestinal stromal tumors (GISTs). Partial gastrectomy is usually achieved with a wedge resection to preserve gastric function; however, performing a wedge resection to excise a large tumor located close to the esophagogastric junction (EGJ) can result in deformation of the stomach and/or the stenosis of the EGJ if the gastric wall resection is excessive. We describe our procedure, in which the whole layer of the gastric wall was cut, maintaining a sufficient margin and confirming the distance between the tumor and the EGJ, by endoscopy and laparoscopy. The defect in the gastric wall was closed using linear staplers by hanging up the stay sutures. Five patients with GIST close to EGJ underwent this procedure, followed by a good postoperative course. Thus, we consider our procedure to be safe and effective for gastric GISTs close to the EGJ.
Surgery Today 01/2012; 42(7):708-11. · 1.22 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: Both squamous cell carcinomas and adenocarcinomas can develop in the esophagogastric junction. To clarify the appropriate lymph node dissection range, lymph node metastases from cancers in the esophagogastric junction were investigated.
The nodal metastases were analyzed in 64 patients with squamous cell carcinoma and 129 with adenocarcinoma according to Siewert's classification, which is based on topographic anatomical criteria for adenocarcinoma.
The squamous cell carcinomas located above the esophagocardial junction had more frequent metastasis to the lower and middle mediastinal lymph nodes in proportion to the depth of the tumor. Nodal metastasis was also often detected in the abdominal lymph nodes. In contrast, adenocarcinomas metastasized less frequently to the mediastinal lymph nodes, and the metastatic rates in the abdominal nodes were higher than those from squamous cell carcinoma.
Esophagectomy with mediastinal and abdominal lymph node dissection is considered to be an appropriate approach for surgical resection of squamous cell carcinomas, whereas transhiatally extended gastrectomy with lower mediastinal and abdominal lymph node dissection is recommended for the treatment of adenocarcinomas.
Surgery Today 01/2012; 42(4):351-8. · 1.22 Impact Factor
-
Koji Ando,
Eiji Oki, Masahiko Sugiyama,
Yan Zhao,
Aya Kojima,
Hidetaka Yamamoto,
Yoichi Yamashita,
Hiroshi Saeki,
Akinobu Taketomi,
Masaru Morita,
Yoshihiro Kakeji,
Shunichi Tsujitani,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: Extra-gastrointestinal stromal tumors (EGISTs) that do not originate in the digestive tract are rare. We report a case of multiple EGISTs, which was monitored closely by KIT gene mutation analysis and other investigations. The patient was a 52-year-old man in whom multiple tumors in the abdominal cavity were diagnosed as EGISTs. Immunohistochemical analysis revealed positive staining for c-kit; however, no mutations were found in the KIT gene. The tumors decreased in size remarkably following treatment with imatinib mesylate, but after 2 years of this treatment, multiple liver metastases and some regrowth of the abdominal masses were found simultaneously. The liver metastasis and the abdominal masses were excised, and further analysis of the KIT gene revealed the same mutation in exon 11 in the KIT gene in the metastatic tumors. We speculate that the treatment might have triggered development of the imatinib mesylate-resistant clone, which may have existed in the primary lesion as a KIT gene mutant. This report provides valuable insight into the mechanisms of recurrent GISTs after treatment with imatinib mesylate.
Surgery Today 09/2011; 41(9):1290-3. · 1.22 Impact Factor
-
Yasuo Sakamoto,
Hisafumi Akimoto,
Miyako Kojo,
Hiroyuki Kawano,
Yoshiki Chinen,
Kazutoyo Morita, Masahiko Sugiyama,
Hiroshi Saeki,
Kazuhito Minami,
Yuji Soejima,
Yoshihisa Sakaguchi,
Yasushi Toh,
Takeshi Okamura
[show abstract]
[hide abstract]
ABSTRACT: We report a case of imatinib-resistant GIST, successfully treated by sunitinib. A 62-year-old man with high-grade fever and a huge abdominal tumor was diagnosed with malignant GIST and multiple liver metastases. We performed total gastrectomy combined with distal pancreatectomy, and splenectomy for palliation. Imatinib at a dose of 300mg/day was administered postoperatively, and the liver metastases was well controlled. After nine months, abdominal dissemination increased, and we raised the dose of imatinib to 400mg/day for the progressive state. Subsequently, we had to discontinue imatinib due to its adverse effects. Because the tumors progressed greatly while imatinib was discontinued, we changed to sunitinib. After wards, tumors reduced and his general condition improved remarkably. Although tumors progressed after five months, he was able to obtain good QOL during the administration of sunitinib. Sunitinib is useful for imatinib-resistant GIST, and may be a promising treatment even for patients with poor PS.
Gan to kagaku ryoho. Cancer & chemotherapy 05/2011; 38(5):827-30.
-
Masahiko Sugiyama,
Yoshihiro Kakeji,
Shunichi Tsujitani,
Yui Harada,
Mitsuho Onimaru,
Kumi Yoshida,
Sakura Tanaka,
Yasunori Emi,
Masaru Morita,
Yosuke Morodomi,
Mamoru Hasegawa,
Yoshihiko Maehara,
Yoshikazu Yonemitsu
[show abstract]
[hide abstract]
ABSTRACT: Malignant ascitis (MA) is a highly intractable and immunotherapy-resistant state of advanced gastrointestinal and ovarian cancers. Using a murine model of MA with CT26 colon cancer cells, we here determined that the imbalance between the VEGF-A/vascular permeability factor and its decoy receptor, soluble fms-like tryrosine kinase receptor-1 (sFLT-1), was a major cause of MA resistance to dendritic cell (DC)-based immunotherapy. We found that the ratio of VEGF-A/sFLT-1 was increased not only in murine but also in human MA, and F-gene-deleted recombinant Sendai virus (rSeV/dF)-mediated secretion of human sFLT-1 by DCs augmented not only the activity of DCs themselves, but also dramatically improved the survival of tumor-bearing animals associated with enhanced CTL activity and its infiltration to peritoneal tumors. These findings were not seen in immunodeficient mice, indicating that a VEGF-A/sFLT-1 imbalance is critical for determining the antitumor immune response by DC-vaccination therapy against MA.
Molecular Cancer Therapeutics 01/2011; 10(3):540-9. · 5.23 Impact Factor
-
Hiroshi Saeki,
Takanobu Masuda,
Satoko Okada,
Koji Ando, Masahiko Sugiyama,
Keiji Yoshinaga,
Kazuya Endo,
Noriaki Sadanaga,
Yasunori Emi,
Yoshihiro Kakeji,
Masaru Morita,
Natsumi Yamashita,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: Prediction of the postoperative course of esophagectomy is an important part of the strict perioperative management of patients undergoing surgery for esophageal cancer.
To evaluate their clinical importance, peripheral blood values, including white blood cell count (WBC), lymphocyte count, and the levels of total protein, transferrin, factor XIII, D-dimer, fibrin, and fibrinogen degradation products (FDP) were measured before and after esophagectomy for esophageal cancer in 24 patients.
The preoperative WBC and the pre- and postoperative lymphocyte count were decreased remarkably in patients who received preoperative chemoradiotherapy. The values of perioperative serum transferrin were significantly lower in patients with postoperative pneumonia than in those without. The activity of plasma factor XIII was suppressed on postoperative day (POD) 7 in patients with pneumonia and on POD 14 in patients with leakage.
These results suggest that patients who receive preoperative chemoradiotherapy are potentially immunosuppressed, the preoperative serum transferrin level is a possible predictive marker of postoperative pneumonia, and suppression of factor XIII activity is related to anastomotic insufficiency.
Surgery Today 07/2010; 40(7):626-31. · 1.22 Impact Factor
-
Masahiko Sugiyama,
Yoshihiro Kakeji,
Nobuhide Kubo,
Tomonori Nakanoko,
Yoshihiko Fujinaka,
Kouji Ando,
Takanobu Masuda,
Kenji Yagi,
Keishi Yoshinaga,
Hiroshi Saeki,
Kazuya Endo,
Yasunori Emi,
Masaru Morita,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: Nowadays, the advancements of systemic chemotherapy for colorectal carcinoma improve a clinical response rate, and expand the possibility of resection which couldn't operable at the initial visit. In addition, the prognoses of the patients, who had a radical operation for metastasis, are clearly longer than the non-operable patients. Bevacizumab, anti-human VEGF monoclonal antibody, is significantly effective when used in combination with one of the systemic multi-agent chemotherapy such as FOLFOX regimen or FOLFIRI regimen. We report here two cases with colon carcinoma, which had initially unresectable liver metastases, were respond to the treatment of systemic multi-agent chemotherapy with bevacizumab. Then, both cases were able to undergo radical resections of primary tumor and liver metastases safely.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2169-71.
-
Masaru Morita,
Keisuke Ikeda, Masahiko Sugiyama,
Hiroshi Saeki,
Akinori Egashira,
Keiji Yoshinaga,
Eiji Oki,
Noriaki Sadanaga,
Yoshihiro Kakeji,
Junichi Fukushima,
Yoshihiko Maehara
[show abstract]
[hide abstract]
ABSTRACT: Anastomotic leakage with an intractable cutaneous fistula frequently develops after an esophagectomy and reconstruction via the subcutaneous route.
A pectoralis major muscle (PMM) flap was used for the treatment of 6 patients with esophageal cancer who developed anastomotic leakage with fistula after reconstruction via the subcutaneous route. A gastric tube and colon had been used for reconstruction in 2 and 4 patients, respectively. A trimming and repair of the leakage site was initially performed and the anastomotic site was then covered with a muscle flap.
Recurrent anastomotic leakage did not develop in 5 patients. Among these patients, oral intake was initiated from 11-15 days after the repair operation in 4 patients. A patient having recurrent anastomotic leakage after a repair operation recovered well with conservative therapy.
The coverage with a PMM flap over the repair site is a simple method for preventing the development of recurrent leakage after a repair operation. Even when recurrent anastomotic leakage has occurred after this operation, healing is normally expected by means of conservative treatment. We, therefore, recommend this method for the repair of intractable anastomotic leakage after reconstruction via the subcutaneous route for esophageal cancer.
Surgery 10/2009; 147(2):212-8. · 3.10 Impact Factor
-
[show abstract]
[hide abstract]
ABSTRACT: A 61-year-old male was found to have a tracheal tumor, which was noted at the time of screening by a chest X-ray study. The tumor arose from the membranous portion 4 cm above the carina and was proven by biopsy to be a leiomyoma. Because the disease is a benign tumor, all methods for resection, including bronchoscopic techniques, were thus considered. We performed an endotracheal operation via a window made by an incision of the cartilagenous portion, and removed the tumor through an anterior approach. This type of endotracheal operation is one of the surgical procedures for the removal of benign tracheal tumors.
Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia. 07/2009; 15(3):206-8.
-
[show abstract]
[hide abstract]
ABSTRACT: Recently, standard therapies for either gastric cancer or colorectal cancer have been established through the development of multidrug systemic chemotherapy and the appearance of molecular targeting drugs. For example, either FOLFIRI or FOLFOX therapy is normally chosen for the treatment of unresectable liver metastasis from colorectal cancer. On the other hand, hepatic artery infusion (HAI) chemotherapy is generally used as only a second-line therapy. There are, however, some cases in which systemic chemotherapy is not indicated due to age and/or the risk of side effects. We herein report three cases that were treated by HAI after initially performing systemic chemotherapy in order to treat liver metastasis from either gastric cancer or colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 12/2008; 35(12):2192-4.
