Rintaro Koga

Japanese Foundation for Cancer Research, Edo, Tōkyō, Japan

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Publications (35)57.17 Total impact

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    ABSTRACT: To describe the details of the surgical technique of pancreatoduodenectomy (PD) with systematic mesopancreas dissection (SMD-PD), using a supracolic anterior artery-first approach. An artery-first approach in PD has been advocated in pancreatic cancer to judge resectability, clear the superior mesenteric artery margin from invasion, or reduce blood loss. However, the efficacy of an artery-first approach in mesopancreas dissection remains unclear. This study involved 162 consecutive patients who underwent PD with curative intent. The patients were divided into 82 SMD-PDs and 80 conventional PDs (CoPD) and then stratified further according to the dissection level, that is, level 1 was applied to 24 simple mesopancreas divisions for early inflow occlusion including 11 SMD-PDs, level 2 for 63 en bloc mesopancreas resections (26 SMD-PDs), and level 3 for 75 patients who underwent a hemicircumferential superior mesenteric artery plexus resection to keep the margin free from cancer invasion (45 SMD-PDs). The clinical and imaging results were collected to assess the feasibility and validity of SMD-PD with an artery-first approach. Blood loss and operation duration were significantly less in the SMD-PD group than in the CoPD group among the total 162 patients. The imaging analysis showed that four fifths of pancreatic arterial branches came from the right dorsal aspect of the superior mesenteric artery and cancer abutment occurred exclusively from the same direction indicating the validity of an artery-first approach. SMD-PD using an SAA is feasible across PD cases, with acceptable short-term outcomes, and we propose this procedure as a promising option for PD.
    Annals of surgery. 01/2015;
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    ABSTRACT: The rate of recurrence after liver resection for colorectal liver metastases (CLM) is high, and repeat resection (RR) is reserved with curative intent in selected patients. This study evaluated the benefit of RR for recurrence after liver resection for CLM.
    Annals of Surgical Oncology 06/2014; · 3.94 Impact Factor
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    ABSTRACT: The efficacy of repeat hepatectomy for recurrent hepatocellular carcinoma and colorectal liver metastases is widely accepted. However, the benefits of such treatment for intrahepatic recurrence of gastric cancer liver metastasis remain unknown. This study sought to clarify the survival benefit for patients undergoing repeat hepatectomy for gastric cancer liver metastasis. A total of 73 patients underwent hepatectomy for gastric cancer liver metastasis from January 1993 to January 2011. Macroscopically curative surgery was performed in 64 patients. Among them, repeat hepatectomy was performed in 14 of the 37 patients with intrahepatic recurrence. Among these 14 patients, clinicopathologic factors were evaluated by univariate and multivariate analysis to identify the factors affecting survival. The overall 1-, 3-, and 5-year survival rates after a second hepatectomy were 71, 47, and 47 %, respectively. The median survival was 31 months. Operative morbidity and mortality rates of repeat hepatectomy were 29 and 0 %, respectively. Multivariate analysis identified the duration of the disease-free interval as the only independent significant factor predicting better survival. In selected patients, repeat hepatectomy for recurrent gastric cancer liver metastasis may offer the same chance of cure as the primary hepatectomy. Disease-free intervals exceeding 12 months predict good patient survival after repeat hepatectomy.
    World Journal of Surgery 08/2013; · 2.35 Impact Factor
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    ABSTRACT: Liver resection is now widely accepted as a potentially curative treatment for colorectal liver metastasis. However, the efficacy of surgical resection for gastric cancer liver metastasis(GLM)remains unclear. Based on our 18-year experience with 64 patients who underwent curative hepatectomy for GLM, we discuss the indication and efficacy of surgical resection for GLM. From January 1993 to January 2011, 73 patients underwent hepatectomy for GLM in the Department of Gastroenterological Surgery, Cancer Institute Ariake Hospital(Japanese Foundation for Cancer Research), Japan. The actuarial1 -, 3-, and 5-year overall survival rates and 1-, 3-, and 5-year recurrence-free survival rates of those 64 patients who achieved curative resections were 84, 50, and 37%, and 42, 27, and 27%, respectively. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor(>5 cm in diameter)were found to be independent indicators of poor prognosis. Based on the multivariate analysis results, all patients were divided into three groups no poor prognostic factor(n=38), one poor prognostic factor(n=24), and two poor prognostic factors(n=2). The actuarial overall survival rates of each group were 63, 36, and 0% at 3 years, and 53, 15, and 0% at 5 years. GLM patients having hepatic tumors with the maximum diameter of <5 cm, and without serosalinvasion of the primary gastric cancer, are the best candidates for hepatectomy.
    Gan to kagaku ryoho. Cancer & chemotherapy 12/2012; 39(13):2455-9.
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    ABSTRACT: A 70-year-old woman was referred to our hospital because of abdominal pain. Abdominal computed tomography(CT)and colonoscopy revealed transverse colon cancer with multiple liver metastases, with involvement of the hepatic pedicle and superior mesenteric artery lymph nodes. The patient received eight courses of XELOX plus bevacizumab, and CT showed a decrease in the size of the liver metastases and hepatic pedicle lymphadenopathy. Right hemicolectomy, partial hepatectomy, and hepatic pedicle lymph node resection were performed. Histopathological examination of the resected tissue revealed no residual cancer cells, suggesting a pathological complete response. The patient remains well 7 months after operation, without any signs of recurrence. Surgical resection should be considered for patients with initially unresectable colon cancer with liver metastases and hepatic pedicle lymph nodes involvement if systemic chemotherapy is effective.
    Gan to kagaku ryoho. Cancer & chemotherapy 12/2012; 39(13):2561-3.
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    ABSTRACT: Key Words: Hepatocellular carcinoma; Preoperative transarterial chemoembolization recurrent; Prognosis. Abbreviations: Hepatocellular Carcinoma (HCC); Transarterial Chemoembolization (TACE); Retention Rate of indocyanine green 15 minutes after the injection (ICG-R15); Alpha- Fetoprotein (AFP); Des-Gamma-Carboxy Prothrombin (DCP); Hepatitis B Virus (HBV); Hepatitis C Virus (HCV).Background/Aims: The effects of transarterial chemoembolization (TACE) prior to hepatectomy for patients with hepatocellular carcinoma (HCC) are controversial. Methodology: Clinicopathological profiles and prognosis were compared between patients who underwent hepatic resection following preoperative TACE (Group A, 69 patients) or only resection (Group B, 158 patients). Univariate and multivariate analyses were used to evaluate whether TACE influenced patient prognosis. Results: Profiles of Group A were comparable with those of Group B except for younger age, higher frequency of major hepatectomy, higher incidence of positive surgical margin, vascular invasion and poorly differentiated HCC. Overall survival was significantly worse in Group A than in Group B (5- year survival rate; 29% vs. 69%; p<0.001). A subset of patients in Group A with complete tumor necrosis by TACE showed comparable survival with Group B. Multivariate analysis revealed that preoperative TACE (hazard ratio (HR)=4.3; 95% confidential interval (CI), 2.8-6.6), non-anatomic resection (HR=1.6; 95% CI, 1.1-2.4), blood loss >1L (HR=1.8; 95% CI=1.1- 2.8) and vascular invasion (HR=2.3; 95% CI=1.4- 3.6) were independent predictors of poor survival. Preoperative TACE was also an independent predictor of extrahepatic metastases (odds ratio, 2.8; 95% CI=1.1- 7.1). Conclusions: Preoperative TACE should not be routinely applied for HCC.
    Hepato-gastroenterology 10/2012; 59(119):2295-9. · 0.91 Impact Factor
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    ABSTRACT: Key Words: Hepatocellular carcinoma; Recurrent; Persistent; Hepatic resection. Abbreviations: Hepatocellular Carcinoma (HCC); Recurrent HCC (HCCR); Transarterial Chemoembolization (TACE); Percutaneous Ethanol Injection (PEI); Radiofrequency Ablation (RFA); Hepatitis B Virus Surface Antigen (HBs-Ag); Hepatitis C Virus Antibody (HCVAb); Computed Tomography (CT); Magnetic Resonance Imaging (MRI); Overall Survival (OS); Recurrence Free Survival (RFS).Background/Aims: The safety and effectiveness of hepatic resection for recurrent or refractory hepatocellular is not established, particularly in cases treated by non-surgical treatment. Methodology: Surgical outcomes of 38 patients who underwent curative hepatic resection for recurrent or refractory disease after previous treatment were evaluated. Univariate and multivariate analyses were performed to identify prognostic predictors. Results: There were no postoperative deaths, morbidity occurred in 9 patients (prolonged ascites retention, 5; biliary fistula, 3; intraabdominal abscess, 1), and all of them were treated conservatively. Recurrence-free and overall 1, 3 and 5-year-survival rate was 54, 28 and 24%, and 78, 60 and 55%, respectively. Multivariate analysis revealed hepatitis B or C virus infection (HR=12.8; 95% CI=2.3-245.1), tumor size >5cm (HR=5.9; 95% CI=5.9-25.6), and vasculo- biliary invasion (HR=5.2; 95% CI=1.4-21.0) were independent predictors of poor overall survival. Type of previous treatment did not influence prognosis. Conclusions: Hepatic resection for recurrent or refractory hepatocellular carcinoma is safe and achieves long survival in selected patients.
    Hepato-gastroenterology 10/2012; 59(119):2255-9. · 0.91 Impact Factor
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    ABSTRACT: The indication for hepatectomy in cases of gastric cancer liver metastases (GLM) remains unclear and it remains controversial whether surgical resection is beneficial for GLM. The objective of this retrospective study was to clarify the indications for and benefit of hepatectomy for GLM. Seventy-three patients underwent hepatectomies for GLM from January 1993 to January 2011. Macroscopically complete (R0 or R1) resection was achieved in 64 patients. Among them, 32 patients underwent synchronous hepatectomy with gastrectomy and the remaining 32 patients underwent metachronous hepatectomy. Repeat hepatectomy was done in 14 patients for resectable intrahepatic recurrences. Clinicopathological factors were evaluated by univariate and multivariate analyses among patients who received macroscopically complete resection for those affecting survival. The overall 1-, 3-, and 5-year survival rates after macroscopically complete (R0 or R1) liver resection (n = 64) for GLM were 84, 50, and 37 %, respectively, with a median survival of 34 months. Univariate analysis identified serosal invasion of the primary gastric cancer and blood transfusions during surgery as poor prognosis indicators. By multivariate analysis, serosal invasion of the primary gastric cancer and larger hepatic tumor (>5 cm in diameter) were found to be independent indicators of poor prognosis. GLM patients with the maximum diameter of hepatic tumors of <5 cm and without serosal invasion of the primary gastric cancer are the best candidate for hepatectomy.
    Langenbeck s Archives of Surgery 05/2012; 397(6):951-7. · 1.89 Impact Factor
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    ABSTRACT: In general, with large mesenteric tumors it may be rather difficult to determine whether infiltration into adjacent large vessels occurred. We wish to stress the importance of preparation for microsurgery when a huge lesion appears close to a large artery in preoperative images, based on our experience of successful microscopical reconstruction of a superior mesenteric artery (SMA) and marked improvement of blocked vascular flow to the small intestine during the surgery. We have experienced a case of mesenteric fibromatosis (MF) invading the SMA and vein, contrary to preoperative expectation. The patient underwent extirpation of a MF, 21 cm in size, with reconstruction of the SMA by microsurgery. The sacrificed small intestine was only 80 cm of the distal ileum with the benefit of microscopic anastomosis between the SMA and a major jejunal artery. Preparations for microscopic surgery must be made with resection of large lesions, because involvement of mesenteric large vessels may be expected. It is possible for microsurgery to extend indications for surgical resection of huge mesenteric tumors.
    Surgery Today 05/2012; 42(7):703-7. · 1.21 Impact Factor
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    ABSTRACT: The clinical implications of peritoneal lavage cytology (CY) status in patients with potentially resectable pancreatic cancer have not been established. We retrospectively reviewed clinical data from 254 consecutive patients who underwent macroscopically curative resection for pancreatic cancer from February 2003 to December 2010 in our institution. Correlations between CY status and survival and clinicopathological findings were investigated. Of the 254 patients, 20 were CY+ (7.9 %). There were no significant differences between CY+ and CY- patients in background data (age, sex, the level of preoperative tumor marker, and adjuvant chemotherapy). Patients with positive serosal invasion were more likely to be CY+ than those with negative serosal invasion (P < 0.001) by univariate analysis. The median overall survival of CY+ patients and CY- patients was 23.8 months (95 % CI = 17.6-29.8) and 26.5 months (95 % CI = 20.7-32.3), respectively (P = 0.302). The median recurrence-free survival of CY+ and CY- patients was 8.1 months (95 % CI = 0.0-17.9) and 13.5 months (95 % CI = 11.5-15.5), respectively (P = 0.089). CY+ status without other distant metastasis does not necessarily preclude resection in patients with pancreatic cancer.
    World Journal of Surgery 05/2012; 36(9):2187-91. · 2.35 Impact Factor
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    ABSTRACT: Preoperative chemotherapy has become more common in the management of multiple resectable colorectal liver metastases; however, the benefit is unclear. This study examined clinical outcomes following liver resection for multiple colorectal liver metastases with the surgery up-front approach. Data collected prospectively over a 16-year period for 736 patients who underwent hepatic resection at two different centers were reviewed. Patients were divided into three groups depending on the number of tumors as follows: group A, between one and three tumors (n = 493); group B, between four and seven tumors (n = 141); and group C, eight or more tumors (n = 102). The 5-year overall and recurrence-free survival rates were 51 and 21 %, respectively, for the entire patient cohort, 56 and 29 % in group A, 41 and 12 % in group B, and 33 and 1.7 % in group C. Multivariate analysis showed that decreased survival was associated with positive lymph node metastasis of the primary tumor, the presence of extrahepatic tumors, a maximum liver tumor size >5 cm, and tumor exposure during liver resection. In patients with multiple liver metastases, the number of liver metastases has less impact on the prognosis than other prognostic factors. Complete resection with repeat metastasectomy offers a chance of cure even in patients with numerous colorectal liver metastases (i.e., those with eight or more nodules). A further prospective study is necessary to clarify the optimal setting of preoperative chemotherapy.
    World Journal of Surgery 05/2012; 36(9):2171-8. · 2.35 Impact Factor
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    ABSTRACT: Repeat hepatectomy is widely accepted as a treatment for primary or metastatic liver malignancy. However, it entails a longer operative time and is associated with additional operative risks. The goal of the present study was to evaluate the impact of previous hepatectomy on the short-term outcomes of repeat hepatectomy, especially in operative time. A retrospective review of prospectively collected data from patients who underwent primary hepatectomy (n=166) and repeat hepatectomy (n=65) in a single institution. Operative time was significantly longer for repeat hepatectomy than for primary hepatectomy (284min vs. 250min, p=0.04). There were no significant differences between the two groups with respect to intraoperative blood loss, intraoperative blood transfusion, morbidity, mortality and length of hospital stay. Multivariate analysis demonstrated that third or subsequent hepatectomy and tumor location in the caudate lobe at the repeat hepatectomy significantly prolonged operative time. Repeat hepatectomy has similar short-term outcomes to primary liver resection. However, repeat hepatectomy is a time-consuming operation, especially in patients with tumors in the caudate lobe or for those undergoing their third or subsequent hepatectomy.
    Hepato-gastroenterology 01/2012; 59(115):809-13. · 0.91 Impact Factor
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    ABSTRACT: Although it remains controversial whether local ablation or surgery is better for early-stage hepatocellular carcinoma (HCC), surgical resection is the first choice for advanced HCC. Anatomic hepatic resection is the preferred procedure to improve prognosis, but to date, its superiority has been demonstrated only for early-stage HCC. This study aimed to evaluate the effect of anatomic resection in advanced HCC in which surgical resection is the first choice. The prognosis of 210 patients who underwent curative resection for primary HCC was analyzed. Sixty-three patients with no more than three tumors, none of which were larger than 3 cm in diameter, and with no macroscopic vascular invasion were classified as early HCC (group E); the other 147 patients were classified as advanced HCC (group A). The 5-year survival rate was better in group E (73% vs. 55%, P < 0.01), but the 5-year recurrence-free survival rate was equivalent between the two groups (E vs. A; 30% vs. 32%, P = 0.19). Multivariate analysis showed that independent predictors of good survival in group E were indocyanine green retention rate at 15 min ≤20% [hazard ratio (HR) = 0.30; 95% confidential interval (CI),  0.10-0.88) and tumor differentiation grade of well or moderate or complete necrosis (HR = 0.14; 95% CI,  0.03-0.95), while predictors in group A were anatomic resection (HR = 0.48; 95% CI,  02.27-0.85) and no macroscopic vascular invasion (HR = 0.35; 95% CI,  0.17-0.72). For advanced HCC, anatomic resection should be performed to improve patient prognosis.
    Langenbeck s Archives of Surgery 09/2011; 397(1):85-92. · 1.89 Impact Factor
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    ABSTRACT: Hepatocellular carcinoma (HCC) usually recurs repeatedly and locoregional treatment is attempted unless liver function has deteriorated. This study was aimed to evaluate the effect of repeated treatment on patient prognosis. The HCC recurrence pattern and types of treatment for recurrence after hepatic resection were reviewed in 134 patients. The effects of repeated treatment on prognosis were evaluated. Univariate and multivariate analyses were performed to determine the prognostic predictors after initial recurrence. Median number of treatments after recurrence was 3 (range, 0-12). Transarterial chemoembolization was the most common treatment. The number of treatments, but not the type of treatment, was associated with the prognosis. Multivariate analysis showed that a >20% indocyanine green retention rate at 15 min (hazard ratio [HR] = 2.65; 95% confidential interval [CI], 1.53-5.62), size of primary tumor >5 cm (HR = 1.81; 95% CI, 1.05-3.08), recurrence-free interval <1 year (HR = 2.17; 95% CI, 1.28-3.81), size of recurrent tumor >3 cm (HR = 2.61; 95% CI, 1.03-5.77-0.95), and extrahepatic recurrence (HR = 6.35; 95% CI, 3.49-11.39) were independent predictors of poor survival. The prognosis after recurrence is poor in cases with large tumors or poor liver function. Repeated locoregional treatment contributes to prolong patient prognosis, especially in cases with a small tumor size, long recurrence-free interval, and no extrahepatic metastases.
    Langenbeck s Archives of Surgery 08/2011; 396(7):1093-100. · 1.89 Impact Factor
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    ABSTRACT: Colorectal liver metastases with hepatic vein (HV) involvement may require combined resection of the liver and HV. However, the short- and long-term outcomes of such a procedure remain unclear. We reviewed 16 cases of liver resection with major HV resection and reconstruction. The patients had a median age of 58.5 years (range, 50-74 y). In total, 18 HVs were reconstructed using a customized great saphenous vein graft (n = 10), direct anastomosis (n = 1), external iliac vein (n = 2), portal vein (n = 1), umbilical vein patch graft (n = 3), or ovarian vein patch graft (n = 1). There was no hospital mortality, and the morbidity rate was 50%. With a median follow-up period of 30 months (range, 4-89 mo), 3 patients died of tumor recurrence and 13 were alive with (n = 6) and without (n = 7) disease. Cumulative 1-, 3-, and 5-year survival rates were 93%, 76%, and 76%, respectively. HV resection and reconstruction combined with liver resection can be performed safely with reasonable long-term results.
    American journal of surgery 07/2011; 202(4):449-54. · 2.36 Impact Factor
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    ABSTRACT: Bile leakage is the most common complication after hepatectomy and its incidence is not declining. The aim of the present study was to identify predictive factors for bile leakage. Clinical data from 505 consecutive patients who underwent hepatectomy without extrahepatic bile duct resection in our department between January 2006 and December 2009 were reviewed retrospectively. The incidence of bile leakage was found to be 6.7%. Multivariate analysis identified three independent factors that were significantly correlated with the occurrence of bile leakage: (1) repeat hepatectomy (P = 0.002; odds ratio [OR] 3.439; 95% confidence interval [CI] 1.552-7.618), (2) a cut surface area ≥57.5 cm(2) (P = 0.004; OR 5.296; 95% CI 1.721-16.302), and (3) intraoperative blood loss ≥775 ml (P = 0.01; OR 2.808; 95% CI 1.280-6.160). More meticulous management is needed to prevent bile leakage in high-risk patients.
    World Journal of Surgery 04/2011; 35(8):1898-903. · 2.35 Impact Factor
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    ABSTRACT: Resective therapeutic strategy for left-sided pancreatic adenocarcinoma is open to debate. The post-resection outcomes and factors influencing post-resection survival for adenocarcinoma of the body and tail of the pancreas were analyzed to determine the effectiveness of surgery. A total of 73 patients with adenocarcinoma of the body or tail of the pancreas who underwent resection between 1994 and June 2007 were evaluated for overall survival. Multiple malignancies were present in 34 of 73 patients (47%). Overall 1-, 3- and 5-year survival rates after surgery were 79%, 34%, and 30%, respectively. Presence of symptoms, multiple cancers and level of preoperative tumor marker did not influence post-resection survival. As for tumor characteristics, tumor size, histological tumor differentiation, retroperitoneal invasion, status of residual tumor and UICC staging represented significant prognostic indicators by univariate analysis. Gemcitabine, when administered as an adjuvant settings, strongly worked for improving post-resection outcome (5-year survival rate = 51%). Factors shown to have independent prognostic significance on multivariate analysis were tumor size (<3 vs. >or=3 cm), status of residual tumor (R0 vs. R1, 2), and postoperative administration of gemcitabine. Appropriate patient selection and accurate surgical technique with postoperative adjuvant therapy could benefit survival of patients with carcinoma of the pancreas body and tail.
    Japanese Journal of Clinical Oncology 04/2010; 40(6):530-6. · 1.75 Impact Factor
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    ABSTRACT: The mortality associated with distal pancreatectomy (DP) has declined to <5% in recent years in high-volume centers. However, morbidity remains high, ranging from 32% to 57%. Pancreatic fistula (PF) is the most common complication after DP. The aim of this study was to analyze factors associated with the occurrence of clinical PF. A retrospective review was performed of the medical records of 100 patients who underwent DP in our institution between May 2001 and January 2009. There was no mortality, but morbidity was occurred in 65 patients (65%), with major complications occurring in 9 patients (9%). PF occurred in 50 patients (50%) and clinical PF occurred in 23 patients (23%). Multivariate analysis indicated that independent risk factors for clinical PF were: age younger than 65 years (P = 0.049; odds ratio (OR) 2.958; 95% confidence interval (CI) 1.007-8.688), not ligating the main pancreatic duct (MPD) (P = 0.02; OR 4.933; 95% CI 1.283-18.967), and extended lymphadenectomy (P = 0.008; OR 4.773; 95% CI 1.504-15.145). Age < 65 years, not ligating the MPD, and extended lymphadenectomy are independent risk factors for clinical PF.
    World Journal of Surgery 01/2010; 34(1):121-5. · 2.35 Impact Factor
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    ABSTRACT: It is imperative for prognostic improvement of pancreatic cancer that we try to diagnose carcinoma in situ (CIS) of lesions, i.e., precursors of invasive ductal carcinomas (IDCs) at an early stage, because results of treatment of patients with IDCs themselves continue to be rather unsatisfactory. We report here a case of a patient who received subtotal pancreatectomy for widespread and multifocal CISs of the pancreas after preoperative brushing cytology from the epithelium of dilated main pancreatic duct proved cancer-positive preoperatively. From our experience, we conclude that examination for CIS of the pancreas must be recommended whenever dilatation of relatively large pancreatic ducts is found by ultrasound or computed tomography. We should therefore advance to magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography and then cytological and/or pathological assessment of the pancreatic duct whenever non-continuous narrowing, localized dilatation, or other irregularities are encountered.
    Langenbeck s Archives of Surgery 12/2009; 395(5):589-92. · 1.89 Impact Factor
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    ABSTRACT: Prognosis after resection for intrahepatic cholangiocarcinoma (ICC) remains unsatisfactory. There remains no effective therapy after recurrent ICC. The current study sought to evaluate risk factors associated with recurrent ICC and possible therapies after resection. A review of data from patients who underwent potentially curative resection for ICC was performed. A total of 44 potentially curative resections were performed from 1995 to 2008. Mortality was 0% and morbidity was 35%. The 5-year overall and recurrence-free survival rates were 43% and 39%, respectively. Multivariate analysis identified the presence of multiple nodules and poor histologic grade as independent negative prognostic factors for overall and recurrent-free survival. Postoperative recurrence occurred in 25 patients (57%). Solitary recurrence occurred in 5 patients (liver, n = 4; lung, n = 1), all of who had undergone surgical resection. Three of the 5 patients survived for more than 5 years after 2 resections. Prognosis after curative resection of solitary ICC appears favorable. In selected patients with sequential single hepatic or pulmonary recurrence, repeat resection may prolong survival.
    American journal of surgery 06/2009; 201(2):203-8. · 2.36 Impact Factor

Publication Stats

318 Citations
57.17 Total Impact Points


  • 2005–2013
    • Japanese Foundation for Cancer Research
      • Department of Urology
      Edo, Tōkyō, Japan
  • 2010
    • National Defense Medical College
      • Department of Surgery
      Tokorozawa, Saitama-ken, Japan
  • 2009
    • University Hospital Medical Information Network
      Edo, Tōkyō, Japan