Masahiko Yano

Publications (158)373.14 Total impact

• Article: Efficacy of subcutaneous penrose drains for surgical site infections in colorectal surgery.

  Shinya Imada, Shingo Noura, Masayuki Ohue, Tatsushi Shingai, Toshinori Sueda, Kentaro Kishi, Terumasa Yamada, Hiroaki Ohigashi, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: To investigate whether a subcutaneous penrose drain would decrease the superficial surgical site infection (s-SSI) rate in elective colorectal surgery. This is a comparative study of the historical control type. Intervention consisted of the use of penrose drain in elective open colorectal surgical wounds. The outcome was an incidence of s-SSI. The patients were risk stratified according to the depth of subcutaneous tissue. There were 131 patients (40 patients with high s-SSI risk) in the prior period (from July 2008 to June 2009, when no penrose drains were inserted) and 151 patients (75 patients with high s-SSI risk) in the latter period (from June 2010 to November 2011, when penrose drains were inserted). The overall s-SSI rate was 6.1% and 5.3% during the two periods (P = 0.770), and the s-SSI rate in the high s-SSI risk group was 15.0% and 8.0% (P = 0.242). Although penrose drain was not observed to significantly reduce s-SSI, there tended to be a reduced risk of s-SSI in the high s-SSI risk group.
  World journal of gastrointestinal surgery. 04/2013; 5(4):110-4.
• Article: Is Preservation of the Remnant Stomach Safe During Distal Pancreatectomy in Patients Who Have Undergone Distal Gastrectomy?

  Hidenori Takahashi, Satoshi Nara, Hiroaki Ohigashi, Yoshihiro Sakamoto, Kunihto Gotoh, Minoru Esaki, Terumasa Yamada, Kazuaki Shimada, Masahiko Yano, Tomoo Kosuge, Osamu Ishikawa
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  ABSTRACT: BACKGROUND: Whether the remnant stomach can be safely preserved when performing distal pancreatectomy (DP) in patients with a prior distal gastrectomy (DG) remains unclear because the remnant stomach and pancreatic body/tail share an arterial blood supply via the splenic artery (SPA). METHODS: A total of 18 patients with prior DG who underwent DP were enrolled in this study. Clinicopathologic data were retrospectively analyzed with a focus on management of the remnant stomach and complications related to ischemia of the remnant stomach. Additionally, intraoperative indocyanine green (ICG) fluorescence angiography was performed to visualize the blood flow and circulation in the remnant stomach. RESULTS: Ten patients underwent a standard DP (DP in conjunction with splenectomy and division of the SPA) with preservation of the remnant stomach. The entire stomach was preserved in seven patients, and three underwent concomitant partial resection of the remnant stomach. No patients in whom the entire remnant stomach was preserved developed postoperative complications associated with it, whereas two of the three patients who underwent partial resection of the remnant stomach developed severe ischemic complications. Intraoperative ICG fluorescence angiography revealed a caudally directed circulation of blood from the esophagogastric junction through the intramural capillary network in the remnant stomach. CONCLUSIONS: When performing DP in patients with a prior DG, preservation of the entire remnant stomach was a safe procedure because of the presence of an intramural network that supplies blood to the remnant stomach. In contrast, partial resection of the remnant stomach could be dangerous because of the potential for severe ischemic complications.
  World Journal of Surgery 11/2012; · 2.36 Impact Factor
• Article: [A case of rectal cancer with long-term disease-free survival following resection of the right iliac artery due to isolated para-aortic lymph node recurrence].

  Toshinori Sueda, Shingo Noura, Masayuki Ohue, Tatsushi Shingai, Shinya Imada, Kunihito Gotoh, Masaaki Motoori, Hidenori Takahashi, Kentaro Kishi, Terumasa Yamada, Yoshiyuki Fujiwara, Hiroaki Ohigashi, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: A 79-year-old man was diagnosed with infrarenal abdominal aortic aneurysm extending to the right common iliac artery and rectal cancer. He underwent a Y graft replacement for abdominal aortic aneurysm and an anterior resection for rectal cancer after 1 month. No adjuvant therapy was performed. Eleven months after the operation to remove the rectal cancer, computed tomography examination revealed isolated para-aortic lymph node recurrence. The mass involved the right bundle branch of the synthetic graft and the right external and internal iliac artery. Therefore, we resected the area from the right bundle branch of the synthetic graft to the right external and internal iliac artery en bloc. Pathological examination of the resected specimen showed metastatic adenocarcinoma. No additional therapy was performed. As of 10 years after the second operation, the patient is alive and recurrence free. Isolated aortic lymph node recurrence may be cured by resection; hence, surgical resection should be considered if possible.
  Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2258-60.
• Article: Evaluation of Dysphagia and Diminished Airway Protection after Three-Field Esophagectomy and a Remedy.

  Takushi Yasuda, Masahiko Yano, Hiroshi Miyata, Makoto Yamasaki, Shuji Takiguchi, Yoshiyuki Fujiwara, Yuichiro Doki
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  ABSTRACT: BACKGROUND: Recently, reports from the West have indicated three-field lymphadenectomy (3FL) for esophageal cancer increases the accuracy of tumor staging and survival. However, this cervical procedure is likely to lead to swallowing dysfunction and aspiration, which are barriers to introducing this procedure in clinical practice. METHODS: Our goal is to elucidate the etiology of swallowing dysfunction after 3FL and devise a remedy. First, based on evaluation of swallowing function in ten patients with two-field lymphadenectomy (2FL) and ten with 3FL, we hypothesized that the scarred sternohyoid and sternothyroid muscles might be impairing laryngeal elevation after 3FL; thus, complete division of the bilateral infrahyoid muscles attached to the sternum (CDBIMS) could be an effective remedy. Next, the utility of this additive procedure was examined in 20 patients with 3FL. Swallowing function was evaluated by the distance of total laryngeal elevation (TLE) and the frequency of incomplete airway protection (IAP) (laryngeal penetration or aspiration) on videofluoroscopic study. RESULTS: The average TLE and frequency of IAP were, respectively, 0.37 cm and 70 % in the 3FL group, showing significant deterioration (p < 0.001 and 0.025), in contrast to 1.79 cm and 20 % in the 2FL group. The 3FL + CDBIMS group showed significant improvements in the average TLE and the frequency of IAP (1.70 cm and 25 %), compared with the 3FL group (p < 0.001 and 0.018). Multivariate logistic regression identified additive CDBIMS as a significant suppressor of IAP after 3FL. CONCLUSIONS: Laryngeal elevation was significantly impaired after 3FL. Adding CDBIMS might improve swallowing function in these patients.
  World Journal of Surgery 10/2012; · 2.36 Impact Factor
• Article: Role of (18)F-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Predicting the Pathologic Response to Preoperative Chemoradiation Therapy in Patients With Resectable T3 Pancreatic Cancer.

  Hirotada Kittaka, Hidenori Takahashi, Hiroaki Ohigashi, Kunihito Gotoh, Terumasa Yamada, Yasuhiko Tomita, Yoshihisa Hasegawa, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: BACKGROUND: The purpose of this study was to evaluate whether (18)F-fluorodeoxyglucose positron emission tomography in combination with computed tomography (FDG-PET/CT) could correctly predict the pathologic response to preoperative chemoradiation therapy (CRT) for resectable pancreatic cancer. METHODS: Each of the 40 patients underwent FDG-PET/CT before and after preoperative CRT. The maximum standard uptake value (SUV) was measured for the primary tumor before and after preoperative CRT, defined as pre-CRT SUV and post-CRT SUV, respectively. The proportional alteration of the SUV decline (regression index) between post-CRT SUV and pre-CRT SUV was also calculated. These three indicators were associated with the pathologic response. RESULTS: Patients were classified as 21 responders and 19 nonresponders according to the histologic features. A pre-CRT SUV ≥4.7 was seen in 15 (71 %) of 21 responders and in 6 (32 %) of 19 nonresponders (p = 0.03). A regression index ≥0.46 was seen in 15 (71 %) responders and 5 (26 %) nonresponders (p = 0.01). CONCLUSIONS: A better pathological response can be expected for pancreatic cancer patients who have a high regression index (≥0.46) and a high pre-CRT SUV (≥4.7). The SUV measurement using FDG-PET/CT is a useful tool for predicting the pathologic response to preoperative CRT.
  World Journal of Surgery 09/2012; · 2.36 Impact Factor
• Article: Intraoperative Diagnosis Using Sentinel Node Biopsy with Indocyanine Green Dye in Gastric Cancer Surgery: An Institutional Trial by Experienced Surgeons.

  Isao Miyashiro, Masahiro Hiratsuka, Kentaro Kishi, Ko Takachi, Masahiko Yano, Akemi Takenaka, Yasuhiko Tomita, Shingo Ishiguro
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  ABSTRACT: BACKGROUND: Reliable indicators that can intraoperatively determine the absence of nodal metastasis are in great demand to avoid unnecessary lymphadenectomy. However, little has been reported about the intraoperative diagnostic performance of sentinel node (SN) biopsy. METHODS: Sentinel node biopsy by subserosal or submucosal injection of indocyanine green (ICG) was performed in 241 patients with American Joint Committee on Cancer tumor, node, metastasis staging system, 7th edition, clinical T1 (n = 190) and T2 (n = 51) gastric cancer by two experienced surgeons. All nodes that stained green (green node, GN), representing SNs, were excised before gastrectomy and were sliced into 2-mm sections for intraoperative histological examinations with hematoxylin and eosin staining. The sliced GNs were also examined simultaneously by imprint cytology. RESULTS: The GNs were detectable in 240 patients (3.8 ± 2.4 nodes per patient; range 1-17 nodes; median 3 nodes), and the success rate of detection was 99.6 % (240 of 241). Of 240 patients with a successful detection, 29 were found to have lymph node (LN) metastases; 16 were diagnosed with LN metastases in both GNs and non-GNs, 12 in GNs alone, and 1 in non-GNs alone. The false-negative rate based on the SN concept was 3.4 % (1 of 29). However, two patients with cT1 gastric cancer were diagnosed as intraoperative GN negative but were later confirmed as GN positive by histological examinations of paraffin sections. As an intraoperative diagnosis, the false-negative rate was 10.3 % (3 of 29). CONCLUSIONS: Sentinel node biopsy using ICG could be performed intraoperatively within reasonable limits under certain conditions, such as multiplanes for detection, combination use of imprint cytology, and open surgery by experienced surgeons.
  Annals of Surgical Oncology 09/2012; · 4.17 Impact Factor
• Article: The features of late local recurrences following curative surgery for rectal cancer.

  Mamoru Ulemura, Masataka Ikeda, Mitsugu Sekimoto, Shingo Noura, Masayuki Ohue, Tsunekazu Mizushima, Hirofumi Yamamoto, Ichiro Takemasa, Masahiko Yano, Osamu Ishikawa, Yuichiro Doki, Masaki Mori
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  ABSTRACT: Rectal cancers are characterized by high incidence of local recurrence after curative surgery, in some cases it occurs after 5 years. To determine the features of late locally recurrent rectal cancer (LRRC) is important for its management. The medical records of 110 patients with LRRC after curative surgery were reviewed. We examined the relationship between the interval between surgery and appearance of LRRC and various clinicopathological factors by dividing patients into the early (recurrence before 5 years after surgery) and late (recurrence after more than 5 years) recurrence groups. In the late-recurrence group (n=7), well-differentiated adenocarcinoma was significantly higher (p=0.0031) and venous invasion was significantly lower (p=0.0105) than the early-recurrence group (n=113). Multivariate Cox regression analysis identified histological grade and venous invasion of primary lesion as independent predictors for early-onset LRRC (p=0.0396 and p=0.0009, respectively). The presence of symptoms at the time of diagnosis was the only factor that significantly related to resectability of LRRC (p=0.015). For detection of asymptomatic LRRC, which can lead to curative resection, follow-up program after curative resection of rectal cancer should be designed based on the histological grade and venous invasion of primary tumor.
  Hepato-gastroenterology 09/2012; 59(118):1800-3. · 0.66 Impact Factor
• Article: A case of isolated lateral lymph node recurrence occurring after TME for T1 lower rectal cancer treated with lateral lymph node dissection: report of a case.

  Toshinori Sueda, Shingo Noura, Masayuki Ohue, Tatsushi Shingai, Shinya Imada, Yoshiyuki Fujiwara, Hiroaki Ohigashi, Masahiko Yano, Yasuhiko Tomita, Osamu Ishikawa
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  ABSTRACT: We experienced a rare case of isolated lateral lymph node (LLN) recurrence after laparoscopic intersphincteric resection with total mesorectal excision for T1 lower rectal cancer that was successfully treated using LLN dissection with en bloc resection of the left superior vesical artery, the left ovary and the left obturator nerve, artery and vein. There are no guidelines for treating patients with isolated LLN recurrence because isolated LLN recurrence is rare, especially in patients with T1 rectal cancer. However, in patients with pT1N0 lower rectal cancer, follow-up examinations of the pelvis should be performed periodically. Patients with isolated LLN recurrence treated with surgery might have good long-term prognoses. Therefore, for such patients, surgical resection should be considered as a curative treatment only.
  Surgery Today 07/2012; · 1.22 Impact Factor
• Article: Recurrence of hepatocellular carcinoma presenting as an asymptomatic appendiceal tumor: report of a case.

  Shinya Imada, Shingo Noura, Masayuki Ohue, Tatsushi Shingai, Toshinori Sueda, Kunihito Gotoh, Terumasa Yamada, Yasuhiko Tomita, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: This report presents the case of a 66-year-old male with appendicular metastasis from hepatocellular carcinoma. He had a clinical history of right lobectomy of the liver after the diagnosis of hepatocellular carcinoma 3 years prior, and was admitted because of an asymptomatic appendiceal tumor detected by computed tomography. The appendiceal tumor was preoperatively suspected to be a recurrence of hepatocellular carcinoma, because of the patient's elevated level of serum α-fetoprotein and protein induced by vitamin K absence or antagonist II, and based on the magnetic resonance imaging findings. An appendectomy was thus performed, and the histopathological findings confirmed the diagnosis of a metastatic tumor from hepatocellular carcinoma. Appendicular metastasis is extremely rare. This is only the second case of a metastatic appendiceal tumor from hepatocellular carcinoma reported in the English literature.
  Surgery Today 07/2012; · 1.22 Impact Factor
• Article: Relationship between immunological parameters and the severity of neutropenia and effect of enteral nutrition on immune status during neoadjuvant chemotherapy on patients with advanced esophageal cancer.

  Masaaki Motoori, Masahiko Yano, Takushi Yasuda, Hiroshi Miyata, Ying Feng Peng, Makoto Yamasaki, Osamu Shiraishi, Koji Tanaka, Osamu Ishikawa, Hitoshi Shiozaki, Yuichiro Doki
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  ABSTRACT: Chemotherapy may cause various toxicities as well as impair immunological function. However, little is known about the relationship between toxicities and immunological parameters or the effect of enteral nutrition (EN) on immunological status during chemotherapy. 91 patients who received neoadjuvant chemotherapy (NACT) for esophageal cancer were randomly assigned to receive either EN or parenteral nutrition (PN). Immunological parameters, including total lymphocyte count (TLC), type 1 and type 2 CD4-positive T cells (Th1/Th2) balance, human leukocyte antigen (HLA)-DR expression on monocytes, natural killer cell activity, and phytohemagglutinin-stimulated lymphocyte proliferation were measured at baseline and day 14 of the first chemotherapy cycle. In the PN group, patients with grade 3-4 neutropenia showed significantly lower TLC, HLA-DR expression, and Th1/Th2 balance at day 14 compared to those with grade 0-2 neutropenia. Among pretherapeutic factors, Th1/Th2 balance was the only factor significantly associated with the severity of neutropenia. Concerning the comparison of immunological parameters between the EN and PN groups, HLA-DR expression at day 14 was significantly higher in the EN group. Baseline Th1/Th2 balance predicted the severity of neutropenia, and EN significantly reduced the decline of monocyte HLA-DR expression in patients with esophageal cancer receiving NACT.
  Oncology 07/2012; 83(2):91-100. · 2.27 Impact Factor
• Article: Multimodal treatment of hepatic metastasis in the form of a bile duct tumor thrombus from pancreatic acinar cell carcinoma: case report of successful resection after chemoradiation therapy.

  Hirotada Kittaka, Hidenori Takahashi, Hiroaki Ohigashi, Kunihito Gotoh, Terumasa Yamada, Tatsushi Shingai, Masaaki Motoori, Kentaro Kishi, Shingo Noura, Yoshiyuki Fujiwara, Masayuki Ohue, Yasuhiko Tomita, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: Pancreatic acinar cell carcinoma (ACC) is a rare tumor, and its pathophysiology has not been well understood. Treatment strategies for hepatic metastasis originating from ACC remain controversial. We report the case of a 66-year-old woman who had undergone total pancreatectomy from ACC 7 years prior to clinical presentation. Contrast-enhanced computed tomography imaging revealed a tumorous lesion measuring 7 cm in length and 1 cm in diameter and extending along the intrahepatic bile duct (B6), which showed mild enhancement in the early phase and modest washout in the late phase. This lesion was diagnosed as hepatic metastasis primarily in the form of a bile duct tumor thrombus originating from the prior ACC by the pathological evaluation of the fine needle biopsy specimen. The patient underwent preoperative gemcitabine-based chemoradiation therapy followed by subsequent surgical resection, which included subsegmentectomy (S6) of the liver and complete removal of the bile duct tumor thrombus. The patient has had no recurrence during the past 8 months since her last surgery. Multimodal treatment including preoperative chemoradiation therapy might be beneficial especially for marginally resectable cases of ACC.
  Case Reports in Gastroenterology 05/2012; 6(2):518-22.
• 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

  Shuji Takiguchi, Kazuyoshi Yamamoto, Motohiro Hirao, Hiroshi Imamura, Junya Fujita, Masahiko Yano, Kenji Kobayashi, Yutaka Kimura, Yukinori Kurokawa, Masaki Mori, Yuichiro Doki, Osaka University Clinical Research Group for Gastroenterological Study
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  ABSTRACT: BackgroundBoth 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 1year 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. MethodsGastric 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. ResultsBetween 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). ConclusionsThe 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. KeywordsDistal gastrectomy–Roux-en-Y–Billroth I–QOL–Randomized trial
  Gastric Cancer 04/2012; 15(2):198-205. · 2.42 Impact Factor
• Article: Chemotherapy-induced toxicities and treatment efficacy in advanced esophageal cancer treated with neoadjuvant chemotherapy followed by surgery

  Masaaki Motoori, Masahiko Yano, Takushi Yasuda, Hiroshi Miyata, YingFeng Peng, Makoto Yamasaki, Osamu Shiraishi, Toru Masuzawa, Koji Tanaka, Osamu Ishikawa, Hitoshi Shiozaki, Yuichiro Doki
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  ABSTRACT: BackgroundNeoadjuvant chemotherapy (NACT) followed by surgery is a promising treatment strategy for advanced esophageal cancer. Response to NACT is a strong predictor for prognosis, but no studies have examined the relationship between toxicity and efficacy of NACT. MethodsWe retrospectively analyzed the treatment results of 105 patients with clinically node-positive esophageal cancer treated with NACT followed by surgery and examined the correlation between adverse events and treatment efficacy. Chemotherapeutic response was evaluated by the reduction rate of the primary tumor in CT scans. Adverse events were graded using the Common Terminology Criteria for Adverse Events version 3. ResultsThe clinical response rate was 40%, and responders displayed a significantly better survival than nonresponders. Major adverse events (grade 3 or 4) during NACT were leukopenia (24.8%), neutropenia (42.9%), nausea (30.5%), and mucositis (27.9%). There were no chemotherapy-related deaths. In a univariate analysis, responders had significantly more severe adverse events including leukopenia, neutropenia, anemia, thrombocytopenia, and nausea than nonresponders. A multivariate analysis demonstrated that neutropenia was the only independent factor significantly associated with a clinical response (P=0.027). Concerning prognosis, patients with grade 2–4 neutropenia showed significantly better survival than those with grade 0–1 neutropenia. ConclusionAntitumor efficacy of NACT for advanced esophageal cancer is significantly associated with the severity of neutropenia. To elucidate the mechanisms underlining these observations, pharmacokinetic and genetic chemosensitivity analyses are needed in future studies. KeywordsEsophageal cancer–Neoadjuvant chemotherapy–Adverse events–Treatment efficacy
  Esophagus 04/2012; 8(2):81-87. · 0.66 Impact Factor
• Article: Assessment of neoadjuvant chemotherapy for patients with advanced squamous cell carcinoma of the esophagus

  Masahiko Yano, Masaaki Motoori, Koji Tanaka, Kentaro Kishi, Isao Miyashiro, Hidetoshi Eguchi, Terumasa Yamada, Masayuki Ohue, Hiroaki Ohigashi, Osamu Ishikawa
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  ABSTRACT: BackgroundNeoadjuvant chemotherapy for advanced esophageal cancer is beneficial for responders, whereas it may provide no clinical benefits or even prove harmful in non-responders. MethodsThis study retrospectively compared the pathological findings and prognosis of 60 patients with UICC non-T4 stage III and IV, who received chemotherapy followed by surgery, and 96 patients with non-T4 stage III and IV cancer, who underwent surgery alone. The treatment regimen of cisplatin (70 mg/m2/day on day 1), adriamycin (30 mg/m2/day on day 1), and 5-fluorouracil (750 mg/m2/day on days 1–7) was administered for two cycles. Responders represented patients with histological effect of grade 1b-3 following therapy; non-responders represented those with grade 0-1a histological effect. ResultsSurvival was not significantly different between the neoadjuvant chemotherapy group and the surgery-alone group. Responders showed a tendency of earlier postoperative pStages than preoperative cStages (P = 0.08), better survival (P = 0.10), significantly fewer metastatic nodes, and significantly less extensive lymphatic invasion than the surgery-alone group. However, non-responders showed no significant differences in the degree of downstaging, number of metastatic nodes, extent of lymphatic and venous invasion, and survival rate as compared with the surgery-alone group. Comparison of overall survival between the chemotherapy and surgery-alone groups after matching for pathological stage showed that the survival of pStage II patients of the chemotherapy group was significantly better than the pStage II patients of the surgery-alone group (P = 0.04), whereas that of pStage III and IV patients of the chemotherapy group was not significantly different from the same-stage patients of the surgery-alone group. ConclusionsThese results suggest that chemotherapy improves prognosis of responders significantly more than those who show downstaged pathological stage. However, the chemotherapy does not give any clinical benefit for non-responders.
  Esophagus 04/2012; 6(2):111-116. · 0.66 Impact Factor
• Article: Endoscopic classification of local recurrence after definitive chemoradiotherapy for esophageal squamous cell carcinoma

  Sachiko Yamamoto, Ryu Ishihara, Hiroyasu Iishi, Noriya Uedo, Yoji Takeuchi, Koji Tanaka, Masaaki Motoori, Masahiko Yano, Kinji Nishiyama, Shingo Ishiguro
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  ABSTRACT: BackgroundIt is unknown whether the endoscopic appearance of local recurrent squamous cell esophageal cancer treated with definitive chemoradiotherapy is predictive of the subsequent clinical course. MethodsWe conducted a retrospective review of 19 patients with local recurrence. Local recurrence was classified into three types as seen by endoscopy. Of 19 local recurrences, 9 lesions were classified into superficial type, 7 lesions into submucosal tumor type, and 3 lesions into ulcerative type. The association between the endoscopic appearance of T1 local recurrence (rT1) and its clinical course was then evaluated. ResultsOf 19 local recurrences, 13 were diagnosed as rT1 cancer. Three of nine patients with superficial-type recurrence were treated by surgical resection; the other six patients received endoscopic treatment. One of nine patients with a superficial-type recurrence died of abdominal lymph node recurrence. The other eight patients are alive without further recurrence. All four patients with rT1 submucosal tumor type recurrence received endoscopic treatment. After the diagnosis of local recurrence, lung or abdominal lymph node metastasis developed in three patients and two patients died of their disease. The median survival time for the submucosal tumor type was 26 months; median survival of the superficial type was not reached (P = 0.09). ConclusionsSuperficial-type rT1 recurrence had a good prognosis with a low rate of nonlocal recurrence, whereas submucosal tumor type rT1 recurrence had a relatively high nonlocal recurrence rate and mortality.
  Esophagus 04/2012; 6(4):243-248. · 0.66 Impact Factor
• Article: Impact of perioperative administration of synbiotics in patients with esophageal cancer undergoing esophagectomy: A prospective randomized controlled trial.

  Koji Tanaka, Masahiko Yano, Masaaki Motoori, Kentaro Kishi, Isao Miyashiro, Masayuki Ohue, Hiroaki Ohigashi, Takashi Asahara, Koji Nomoto, Osamu Ishikawa
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  ABSTRACT: The clinical value of synbiotics in patients undergoing esophagectomy remains unclear. This study investigated the effects of synbiotics on intestinal microflora and surgical outcomes in a clinical setting. We studied 70 patients with esophageal cancer who were scheduled to undergo esophagectomy. They were randomly allocated to 2 groups: 1 group received synbiotics before and after surgery, and the other did not. Fecal microflora and organic acid concentrations were determined. Postoperative infections, abdominal symptoms, and duration of systemic inflammatory response syndrome (SIRS) were recorded. Of the patients, 64 completed the trial (synbiotics, 30; control, 34). The counts of beneficial bacteria and harmful bacteria in the group given synbiotics were significantly larger and smaller, respectively, than those in the control group on postoperative day (POD) 7. The concentrations of total organic acid and acetic acid were higher in the synbiotics group than in the control group (P < .01), and the intestinal pH in the synbiotics group was lower than that in the control (P < .05) on POD 7. The rate of infections was 10% in the synbiotics group and 29.4% in the control group (P = .0676). The duration of SIRS in the synbiotics group was shorter than in the control group (P = .0057). The incidence of interruption or reduction of enteral nutrition by abdominal symptoms was 6.7% in the synbiotics group and 29.4% in the control group (P = .0259). Perioperative administration of synbiotics in patients with esophagectomy is useful because they suppress excessive inflammatory response and relieve uncomfortable abdominal symptoms through the adjustment of the intestinal microfloral environment.
  Surgery 04/2012; 152(5):832-42. · 3.10 Impact Factor
• Article: Staging laparoscopy using ALA-mediated photodynamic diagnosis improves the detection of peritoneal metastases in advanced gastric cancer.

  Kentaro Kishi, Yoshiyuki Fujiwara, Masahiko Yano, Masahiro Inoue, Isao Miyashiro, Masaaki Motoori, Tatsushi Shingai, Kunihito Gotoh, Hidenori Takahashi, Shingo Noura, Terumasa Yamada, Masayuki Ohue, Hiroaki Ohigashi, Osamu Ishikawa
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  ABSTRACT: This study evaluated the usefulness of photodynamic diagnosis (PDD) using oral 5-aminolevulinic acid (ALA) for the detection of peritoneal metastases in advanced gastric cancer. First, the numbers of peritoneal metastatic nodules that were visible under conventional white light (WL) and ALA-induced fluorescence (ALA-F) were quantified in a mouse model of peritoneal metastasis to compare the tumor detection rate. Next, staging laparoscopy (SL) using ALA-PDD was performed in 13 advanced gastric cancer patients with serosa-invading tumors, and the detection sensitivity of ALA-PDD was compared to the observations using WL. The tumor detection rate using ALA-F was significantly higher than the detection rate using WL (72% vs. 39%, respectively, P < 0.0001). Peritoneal metastases were detected in five patients using SL with ALA-PDD, and liver metastases were detected in one patient. These metastases were confirmed using histological examination. Three metastatic lesions that were invisible under WL were detected under ALA-F. This study demonstrated that SL with ALA-PDD improved the detection sensitivity for peritoneal metastases. ALA-PDD may be an important technique for the preoperative staging of advanced gastric cancer, and ALA-PDD will provide useful information for the selection of therapeutic modality.
  Journal of Surgical Oncology 03/2012; 106(3):294-8. · 2.10 Impact Factor
• Article: Subtotal gastrectomy for gastric tube cancer after esophagectomy: a safe procedure preserving the proximal part of gastric tube based on intraoperative ICG blood flow evaluation.

  Takuro Saito, Masahiko Yano, Masaaki Motoori, Kentaro Kishi, Yoshiyuki Fujiwara, Tatsushi Shingai, Shingo Noura, Masayuki Ohue, Hiroaki Ohigashi, Osamu Ishikawa
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  ABSTRACT: Recent improvements in the survival of patients after esophagectomy have led to an increase in the occurrence of gastric tube cancer (GTC). Total resection of the gastric tube with lymphadenectomy is a standard and reliable treatment for GTC, but problems may arise during or after surgery, such as laryngeal nerve injury, reduced selection of organs for reconstruction, and impaired swallowing function. We recently performed a less invasive procedure, subtotal gastrectomy with preservation of the upper region of the gastric tube, in two patients. In these patients, blood supply to the gastric tube was evaluated by indocyanine green fluorescence imaging. Blood flow was confirmed as passing from the remnant esophagus to the upper region of the gastric tube through the esophago-gastric anastomotic site by indocyanine green fluorescence imaging. Therefore, we resected the gastric tube while preserving the upper region of the gastric tube. There was no necrosis of the remnant gastric tube or anastomotic leakage postoperatively, and postoperative swallowing and eating functions were quite good in both patients. In summary, subtotal gastrectomy as a treatment for GTC is potentially safe, curative, and beneficial for the patient's quality of life.
  Journal of Surgical Oncology 02/2012; 106(1):107-10. · 2.10 Impact Factor
• Article: Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer.

  Masaaki Motoori, Masahiko Yano, Ryu Ishihara, Sachiko Yamamoto, Yoshifumi Kawaguchi, Koji Tanaka, Kentaro Kishi, Isao Miyashiro, Yoshiyuki Fujiwara, Tatsushi Shingai, Shingo Noura, Masayuki Ohue, Hiroaki Ohigashi, Satoaki Nakamura, Osamu Ishikawa
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  ABSTRACT: Esophagectomy remains the mainstay treatment for clinical T1bN0M0 esophageal cancer because pathologic lymph node metastases in these patients are not negligible. Recently, chemoradiotherapy (CRT), which can preserve the esophagus, has been reported to be a promising therapeutic alternative to esophagectomy. However, to our knowledge, no comparative studies of esophagectomy and CRT have been reported in clinical T1bN0M0 esophageal cancer. A total of 173 patients with clinical T1bN0M0 squamous cell carcinoma of the thoracic esophagus were enrolled in this study, 102 of whom were treated with radical esophagectomy (S group) and 71 with definitive CRT (CRT group). Treatment results of both groups were retrospectively compared. No statistically significant difference was found in overall survival, but the S group displayed significantly better progression-free survival than the CRT group. Disease recurrence was observed in 12 S group patients and 20 CRT group patients. The incidence of distant recurrence was similar, while local recurrence and lymph node recurrence were significantly more frequent in the CRT group. In the S group, 20 patients had pathologic lymph node metastasis. The progression-free survival of patients with pathologic lymph node metastasis did not differ from those without nodal metastasis. In the CRT group, local recurrence could be controlled by salvage esophagectomy, but treatment results of lymph node recurrence were poor; only 4 of 12 patients with lymph node recurrences were cured. Selection of patients at high risk of pathologic lymph node metastasis is essential when formulating treatment decisions for clinical T1bN0M0 esophageal cancers.
  Annals of Surgical Oncology 02/2012; 19(7):2135-41. · 4.17 Impact Factor
• Article: Brain metastasis from colorectal cancer: prognostic factors and survival.

  Shingo Noura, Masayuki Ohue, Tatsushi Shingai, Ayako Fujiwara, Shinya Imada, Toshinori Sueda, Terumasa Yamada, Yoshiyuki Fujiwara, Hiroaki Ohigashi, Masahiko Yano, Osamu Ishikawa
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  ABSTRACT: Colorectal cancer (CRC) rarely metastasizes to the brain, and the incidence rate has been reported to be 1-2%. Unfortunately, the median survival for patients with brain metastasis (BM) from CRC is short. In this study, we retrospectively investigated the BM from CRC and examined the prognostic factors. We retrospectively analyzed 29 CRC patients who developed BM; the lesions were diagnosed synchronously in 1 patient and metachronously in 28 patients. After BM, the median survival time was 7.4 months. In the groups of patients who underwent surgical resection and radiation therapy, the median survival times were 8.3 and 7.4 months, respectively. The difference between the two groups was not statistically significant. The curability of the therapy for BM, number of BM, number of metastatic organs including the brain, and the CEA level at the time of treatment of the BM were significantly associated with the cancer-specific survival (P = 0.0044, 0.0229, 0.0019, and 0.0205, respectively). The prognosis of patients with BM from CRC was associated with the curability of the therapy for BM, number of metastatic organs, and the serum CEA level. The modality of treatment had no significant impact on the outcome.
  Journal of Surgical Oncology 01/2012; 106(2):144-8. · 2.10 Impact Factor