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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. · 0.66 Impact Factor
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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. · 0.66 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. · 1.81 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. · 1.81 Impact Factor
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Toshiyuki Kosuga,
Atsushi Shiozaki,
Daisuke Ichikawa,
Hitoshi Fujiwara,
Shuhei Komatsu,
Daisuke Iitaka,
Masahiro Tsujiura, Ryo Morimura,
Hiroki Takeshita,
Hiroaki Nagata,
Kazuma Okamoto,
Takashi Nakahari,
Yoshinori Marunaka,
Eigo Otsuji
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ABSTRACT: This study aimed to investigate cytocidal effects of hypotonic shock on esophageal squamous cell carcinoma (ESCC) cell lines, and to apply pleural lavage with distilled water to surgery for ESCC. Three human ESCC cell lines, TE5, TE9 and KYSE170 were exposed to distilled water, and morphological changes in ESCC cells were closely observed under a differential interference contrast microscope connected to a high-speed digital video camera. Further, serial cell volume changes after hypotonic shock were measured using a high-resolution flow cytometer. To investigate the cytocidal effects of hypotonic shock on ESCC cells, re-incubation of ESCC cells was performed after hypotonic shock. Additionally, the effects of 5-nitro-2-(3-phenylpropylamino)-benzoic acid (NPPB), a Cl- channel blocker, during hypotonic shock were analyzed. Video recordings by high-speed digital camera demonstrated that hypotonic shock with distilled water induced cell swelling followed by cell rupture. Measurements of cell volume changes using a high-resolution flow cytometer indicated that severe hypotonicity with distilled water increased broken fragments of ESCC cells within 5 min. Re-incubation experiments demonstrated cytocidal effects of hypotonic shock on ESCC cells. Treatment of cells with NPPB increased cell volumes by the inhibition of regulatory volume decrease, which is observed during hypotonic shock, and enhanced cytocidal effects. These findings demonstrated the cytocidal effects of hypotonic shock on ESCC cells, and clearly support the efficacy of pleural lavage with distilled water during surgery for ESCC.
Oncology Reports 05/2011; 26(3):577-86. · 1.84 Impact Factor
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Hiroaki Nagata,
Daisuke Ichikawa,
Shuhei Komatsu,
Kazuma Okamoto,
Hiroki Takeshita,
Toshiyuki Kosuga,
Daisuke Iitaka, Ryo Morimura,
Atsushi Shiozaki,
Hitoshi Fujiwara,
Osamu Dohi,
Nobuaki Yagi,
Eigo Otsuji
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ABSTRACT: Thanks to recent advances of therapeutic devices, the less invasive surgical explorations such as endoscopic submucosal resection( ESD) and laparoscopic surgery have widely gained an acceptance and become more common. During laparoscopic partial gastrectomy for submucosal tumor such as gastrointestinal stromal tumor (GIST) of the stomach, it is important to avoid an excessive surgical resection of the gastric wall, which causes a deformity of the stomach and has a potential risk to decrease oral intake. We report here a successfully treated case without any deformity of the stomach and complications using laparoscopic and endoscopic cooperative surgery (LECS) for intraluminal type of GIST. LECS is a recently developed procedure and it enables us to resect a tumor with minimum surgical margin. This procedure could be applicable for clinically benign tumor, and it is effective especially for tumors located near esophagogastric junction or pyloric ring of the stomach.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2467-9.
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Katsuya Deguchi,
Daisuke Ichikawa,
Koji Soga,
Kenji Watanabe,
Toshiyuki Kosuga,
Hiroki Takeshita,
Hirotaka Konishi, Ryo Morimura,
Masahiro Tsujiura,
Shuhei Komatsu,
Atsushi Shiozaki,
Kazuma Okamoto,
Hitoshi Fujiwara,
Eigo Otsuji
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ABSTRACT: This study was designed to investigate the clinical significance of lymphangiogenic vascular endothelial growth factors C and D, and chemokine receptor CCR7 in the lymphatic spread of gastric cancer.
The expressions of VEGF-C and -D, and CCR7 were examined in 82 gastric tumors showing a discrepancy between the degree of lymphatic invasion (Ly) and the status of lymph node metastasis (N) (Ly+N-: 72, and Ly-N+: 10 patients).
High expression of VEGF-C and -D, and CCR7 was present in 88%, 63% and 67% of cases, respectively. The VEGF-C expression was significantly higher in Ly+N- than Ly-N+ (p<0.05), but VEGF-D and CCR7 were not. CCR7 expression was a prognostic factor in the Ly+N- subgroup (p<0.05), but VEGF-C and -D were not.
VEGF-C and -D and CCR7 may play critical roles in lymphatic invasion in primary tumors. CCR7 expression should provide prognostic information in node-negative gastric cancer patients showing lymphatic invasion.
Anticancer research 06/2010; 30(6):2361-6. · 1.73 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. · 2.36 Impact Factor
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ABSTRACT: The pancreas is an unusual site for metastases. Thus, the efficacy of pancreatic resection in patients with metastatic pancreas cancer remains unclear. This study examined the result of surgical resection for patients with pancreatic metastases.
A retrospective analysis was undertaken of fifteen patients subjected to surgical resection of pancreatic metastases from January 1983 to September 2008.
The median disease-free interval between the primary and metastatic cancer was 59 months (range, 0-180 months). Median survival of the 15 patients was 31 months (95% CI, 26-35 months). The primary histopathology was renal cell carcinoma (RCC) (n=7, 47%), colorectal cancer (n=3), breast cancer (n=1), non-small-cell lung cancer (n=1), ovarian cancer (n=1), cervical cancer (n=l), or leiomyosarcoma (n=1). Surgical procedures included pancreaticoduodenectomy (n=6), distal pancreatectomy (n=8), and medial pancreatectomy followed by total pancreatectomy (n=1). Median survival after pancreatectomy was 45 months in patients with RCC and 31 months in those with non-RCC as primary cancer (p = 0.49).
Surgical resection is the treatment of choice for maximizing long-term survival in patients with pancreatic metastases from RCC. However, resection of pancreatic metastases from non-RCC patients carries a poor prognosis, and pancreatectomy is probably not warranted.
Hepato-gastroenterology 57(104):1549-52. · 0.66 Impact Factor
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Tsutomu Kawaguchi,
Toshiya Ochiai,
Hisashi Ikoma,
Koji Inoue, Ryo Morimura,
Yasutoshi Murayama,
Shuhei Komatsu,
Atsushi Shiozaki,
Yoshiaki Kuriu,
Masayoshi Nakanishi,
Daisuke Ichikawa,
Kazuma Okamoto,
Hitoshi Fujiwara,
Yukihito Kokuba,
Teruhisa Sonoyama,
Eigo Otsuji
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ABSTRACT: Ampullary adenocarcinoma (AmpCA) has a greater overall survival (OS) rate than other periampullary cancers such as pancreatic cancer or bile duct cancer. Nevertheless, the OS of AmpCA is still poor. In the present study we evaluated the clinicopathologic features of AmpCA with respect to its impact on OS.
Records of 28 patients with AmpCA undergoing pancreaticoduodenectomy from 1995 to 2009 in Kyoto Prefectural University of Medicine were reviewed retrospectively. The mean age was 65.6 and mean +/- S.D. tumor size was 2.08 +/- 1.13 cm. Of the 28 patients, nine (32%) were > or = T3 tumors and nine (32%) were pN1 stage. There were seven (25%) cases of pancreatic invasion (Panc-invasion) and 15 (54%) cases of duodenal invasion (Du-invasion). Further, 14 (50%) cases involved lymphatic vessel invasion (ly+) and five (18%) cases involved histological blood vessel invasion (v+). Eleven (39%) patients experienced recurrences, of which eight were liver metastases. The median OS was 37 months (range 0.6-139.6 months) and the five-year survival rate was 56.4%. The clinicopathologic features and prognoses of these patients were analyzed and the prognostic factors determined.
On log-rank testing, Du-invasion (p = 0.029), ly+ (p = 0.022), and v+ (p < 0.001) were significantly associated with worse survival. According to multivariate Cox's hazard analysis using these three factors by Backward Elimination of Stepwise method, blood vessel invasion was the only significant prognostic indicator for survival (p = 0.046; Hazard ratio, 4.40).
Blood vessel invasion was an independent prognostic indicator, while prevention of liver metastases was important for longer survival.
Hepato-gastroenterology 57(104):1347-50. · 0.66 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 59(115):809-13. · 0.66 Impact Factor
