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Hidetoshi Eguchi,
Hiroaki Nagano,
Masahiro Tanemura, Yutaka Takeda,
Shigeru Marubashi,
Shogo Kobayashi,
Koichi Kawamoto,
Hiroshi Wada,
Naoki Hama,
Hirofumi Akita,
Masaki Mori,
Yuichiro Doki
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ABSTRACT: Background/Aims: In order to improve the poor prognosis of pancreatic cancer, a combination therapy consisting of preoperative chemoradiotherapy, surgery and postoperative chemotherapy may be an ideal strategy; nevertheless, the influence of preoperative therapy to postoperative therapy is not investigated. Methodology: Thirty patients with resectable pancreatic ductal adenocarcinoma were enrolled. A 40Gy of radiation (2Gy/day x 20 fractions/4 weeks) was administered together with intravenous infusion of gemcitabine (800mg/m2, days 1, 8 and 15) before surgery. Surgery was performed 3-7 weeks after the final fraction of radiation, and postoperative chemotherapy consisting of 1000mg/m2 gemcitabine (days 1, 8 and 15 every 4 weeks for 6 cycles) was started within 8 weeks after surgery. Results: All 30 patients successfully completed preoperative therapy. Re-staging after such therapy showed radiologically unresectable disease in 4 patients and 1 patient rejected surgery. Among the 25 patients who underwent laparotomy, 21 underwent curative resection. After curative resection, 4 were inadequate in performance status, thus postoperative therapy could not be started. Ten patients completed postoperative adjuvant therapy. Conclusions: The combination therapy for resectable pancreatic cancer seems a feasible and effective approach, though preoperative therapy may reduce the feasibility of postoperative therapy.
Hepato-gastroenterology 01/2013; 60(126). · 0.66 Impact Factor
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ABSTRACT: Chyluria is leakage of lymphatic fluid into the urine, following trauma to or obstruction of the lymphatic system. We herein report a rare case of chyluria after esophagectomy for esophageal cancer. A 69-year-old male complaining of epigastric pain and reflux symptoms was diagnosed with advanced esophageal cancer and regional lymph node metastases. After receiving neoadjuvant chemotherapy to control the regional lymph node metastases, the patient underwent transthoracic excision of the esophagus assisted by thoracoscopy, with excision of the azygos vein and thoracic duct, esophagostomy and tube gastrostomy. On postoperative day 22, the urine appeared ivory white in color, and urine tests showed a high triglyceride level, thus confirming the diagnosis of chyluria. The chyluria decreased temporarily after switching the patient from enteral nutrition (EN) to parental nutrition, but it emerged again after the resumption of EN. Lymphangiography at that stage showed the flow of lipiodol into the pelvis of the left kidney. Resolution of the chyluria was noted after lymphangiography. He underwent esophageal reconstruction with a gastric tube through an anterior mediastinal route, and was discharged 36 days after the second operation. He was thereafter followed up at the outpatient clinic with radiotherapy.
Surgery Today 12/2012; · 1.22 Impact Factor
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ABSTRACT: Background/Aims: Fibrin sealing are used to prevent postoperative hemorrhage and biliary leakage. However, the use of fibrin sealant alone is insufficient, thus requiring a kind of supportive material. Polyglycolic acid (PGA) felt was developed as a synthetic material to cover tissue defects. We performed preliminary evaluation of fibrin sealing combined with PGA felt (PGA-FS) as hemostat and to prevent biliary leakage, in comparison with the conventional fibrin-coated collagen fleece (FC-CF), retrospectively.Methodology: Between 2007 and 2008, PGA-FS was used in 34 patients, while FC-CF in 39 patients. We compared the incidence of biliary leakage, postoperative hemorrhage, surgical site infection, volume of ascites and the duration of hospital stay between the groups. Biliary leakage was diagnosed when the drain fluid/serum bilirubin ratio was >5. Results: There were no significant differences of the patients' characteristics between the groups except for the surgical procedure. None of the patients experienced postoperative hemorrhage. Biliary leakage was noted in 4 of 39 patients with FC-CF but in none of the PGA-FS group (p<0.05). Various other postoperative parameters were similar in the two groups. Conclusions: The results showed that the PGA-FS would be effective in preventing biliary leakage, compared with the FC-CF.
Hepato-gastroenterology 11/2012; 59(120):2564-8. · 0.66 Impact Factor
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ABSTRACT: A man in his 60s was diagnosed with a rectal carcinoid tumor(15 mm in diameter) with SM invasion. We performed radical resection of the tumor, and 1 year later, abdominal computed tomography(CT) revealed multiple enhanced liver tumors. Liver biopsy revealed those tumors to be metachronal metastases of the rectal carcinoid. Operation was not indicated because of the spread in the liver, Transcatheter arterial embolization (TAE) was selected as the first-line therapy. Four months after 2 series of TAE, CT/magnetic resonance imaging revealed remarkable (80%) shrinkage of the tumors. Chemotherapy is known to be ineffective against liver metastasis of rectal carcinoid tumors. When surgery is not indicated, TAE may be the first-line therapy of choice because of its low invasiveness, repeatability, and efficacy.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2289-91.
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Michiko Hamanaka,
Shin Nakahira, Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Takeshi Kanemura,
Chieko Uchiyama,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Hirokazu Taniguchi,
Chiyomi Egawa,
Ken Nakata,
Hirofumi Miki,
Takeshi Kato,
Teruaki Nagano,
Shinichi Nakatsuka,
Shigeyuki Tamura
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ABSTRACT: A 74-year-old man presented to a physician with a chief complaint of jaundice. He was diagnosed with bile duct carcinoma and admitted to our hospital. Laboratory data revealed abnormally elevated levels of total bilirubin, serum hepatic transaminase, and CA19-9. Endoscopic retrograde cholangiopancreatography revealed neoplastic stenosis from the hilus hepatis to the common bile duct. Abdominal computed tomography (CT) revealed an enhancing tumor in the hilus hepatis bile duct, and positron emission tomography-CT (PET-CT) revealed abnormal fluorodeoxyglucose accumulation in the tumor. Under a diagnosis of hilar cholangiocarcinoma, the patient underwent an extended right hepatectomy and left hepatico -jejunostomy. Immunohistochemically, the tumor cells were positive for neuroendocrine markers such as chromogranin A, synaptophysin, and CD56. The tumor was diagnosed as primary neuroendocrine carcinoma of the bile duct. The patient exhibited multiple liver metastasis 6 months after the operation. Transcatheter arterial chemoembolization (TACE) was performed for the liver metastasis. Although TACE exerted a cytoreductive effect temporarily, multiple liver abscesses developed. The patient died of liver failure 16 months after the operation. We report this rare case of primary neuroendocrine carcinoma of the bile duct.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2125-7.
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Hiroshi Kawashima, Yutaka Takeda,
Shin Nakahira,
Yosuke Mukai,
Michiko Hamanaka,
Chieko Uchiyama,
Takeshi Kanemura,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Hirokazu Taniguchi,
Ken Nakata,
Chiyomi Egawa,
Hirofumi Miki,
Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: A 57-year-old woman who was diagnosed with cholangiolocellular carcinoma underwent neoadjuvant chemotherapy with gemcitabine (GEM). The clinical stage was cT3N1M1 (right adrenal grand),cStage IVB (JPS) with invasion to the inferior vena cava (IVC). We were willing to perform hepatectomy if the response to chemotherapy was stable disease (SD) or better according to the Response Evaluation Criteria In Solid Tumors. After 2 courses of preoperative chemotherapy with GEM, SD was obtained. She underwent right lobectomy of the caudate lobe and resection of the right adrenal gland. The IVC was also resected and reconstructed. The pathological diagnosis was as follows: cholangiolocellular carcinoma, im (-), eg, fc(-), sf(-), s0, n0, vp0, vv0, va0, b1, p0, sm(-), 200 μm, pT2N0M0, pStage II, and Cur A2. The IVC was not invaded and the right adrenal gland was diagnosed with adrenocortical adenoma. She underwent continuing adjuvant chemotherapy with GEM for 4 months without recurrence. Therapy for cholangiolocellular carcinoma has not yet been established, but multimodal treatment with GEM and surgical resection is potentially effective for cholangiolocellular carcinoma.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2113-5.
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Yosuke Mukai, Yutaka Takeda,
Shin Nakahira,
Hiroshi Kawashima,
Michiko Hamanaka,
Chieko Uchiyama,
Takeshi Kanemura,
Atsushi Takeno,
Masatsugu Okishiro,
Rei Suzuki,
Chiyomi Egawa,
Hirokazu Taniguchi,
Ken Nakata,
Hirofumi Miki,
Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: A 69-year-old man with recurrent hepatocellular carcinoma (HCC) in S7/8 after radiofrequency ablation therapy (RFA)was admitted to our hospital. Serum alpha-fetoprotein and protein induced by vitamin K absence or antagonists (PIVKA-II) were elevated to 367 ng/mL and 18,973 mAU/mL, respectively. Abdominal computed tomography scan revealed that the size of the tumor was 56 mm and a portal vein tumor thrombus progressed from the right anterior branch to the left main branch(Vp3). The clinical stage was cT3N0M0, cStage III(JPS). He received 3 courses of intra-arterial infusion chemotherapy with cisplatin(CDDP IA-call)into the right hepatic artery at a dose of 65 mg/m2 every 2 months. Elevated serum alpha-fetoprotein(AFP)and PIVKA-II markedly decreased and returned to normal levels after the second course of treatment. The liver tumor and portal vein tumor thrombus disappeared, and only arterioportal shunting remained. The response to treatment was partial response (PR) and complete response (CR), according to the Response Evaluation Criteria In Solid Tumors and the modified version, respectively. He has been alive for more than 1 year without recurrence. CDDP is an effective treatment for advanced HCC with portal vein tumor thrombus.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1815-8.
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Masatsugu Okishiro,
Chiyomi Egawa,
Yosuke Mukai,
Hiroshi Kawashima,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takashi Kanemura,
Atsushi Takeno,
Shin Nakahira,
Rei Suzuki,
Ken Nakata,
Hirofumi Miki, Yutaka Takeda,
Takeshi Kato,
Yuji Asada,
Shigeyuki Tamura,
Yuichi Takatsuka
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ABSTRACT: Mastectomy is recommended for ipsilateral breast tumor recurrence (IBTR) after breast-conserving surgery plus radiotherapy(breast-conserving treatment). However, the number of patients who receive radiation therapy such as breast- conserving treatment in the hope of breast reconstruction is increasing. Radiation therapy has a significant magnifying effect on the difficulties of breast reconstruction. In the study presented here, we compared the patients who underwent mastectomy+ breast reconstruction with a tissue expander and an implant after IBTR and breast-conserving treatment (irradiation group, n=5) with patients who underwent mastectomy+breast reconstruction with a tissue expander and an implant at the time of the first breast cancer operation (non-irradiation group, n=21). The parameters compared were background, complications, reconstruction success rate, and capsular contraction. A significant difference was not observed between the 2 groups. Complications after operation, specifically capsular contracture, are reported to be more frequent in the radiation group than in the non-irradiation group. However, with appropriate explanation of the risks, this surgery is an option for patients who strongly desire breast reconstruction.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2030-2.
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Shin Nakahira, Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Chieko Uchiyama,
Takashi Kanemura,
Masatsugu Okishiro,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Chiyomi Egawa,
Hirofumi Miki,
Takeshi Kato,
Shinichi Nakatsuka,
Shigeyuki Tamura
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ABSTRACT: We report 2 rare cases of lower bile duct recurrence resected by pancreatoduodenectomy after hepatectomy for hilar cholangiocarcinoma. Case 1: A 74-year-old man underwent extended right hepatectomy for hilar cholangiocarcinoma (JSBS classification: pT1N0M0, fStage I, fCur A, negative cut end). The serum carbohydrate antigen 19-9 level was elevated 18 months after hepatectomy, but abdominal computed tomography showed no signs of recurrence. However, lower bile duct recurrence was revealed by subsequent magnetic resonance imaging, positron-emission tomography, and endoscopic retrograde cholangiopancreatography. Twenty months after hepatectomy, pancreatoduodenectomy was performed, and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT3N0M0, fStage III, fCur A). The patient survived without recurrence 12 months after a secondary operation. Case 2: A 68-year-old woman underwent extended right hepatectomy for hilar cholangiocarcinoma(JSBS classification: pT3N2M0, fStage IVa, fCur B, negative cut end). Twelve months after hepatectomy, dilatation of the remaining lower bile duct was observed by abdominal computed tomography. Endoscopic retrograde cholangiopancreatography revealed lower bile duct stenosis with suspected malignancy, and positron-emission tomography scan detected increased fluorodeoxyglucose uptake at the stenosis. Fourteen months after the hepatectomy, pancreatoduodenectomy was performed and the pathological findings showed lower bile duct carcinoma(JSBS classification: pT4N2M0, fStage IVb, fCur B). The patient died of local recurrence 6 months after the secondary operation.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):2119-21.
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Tadafumi Asaoka,
Shigeru Marubashi,
Shogo Kobayashi,
Naoki Hama,
Hidetoshi Eguchi, Yutaka Takeda,
Masahiro Tanemura,
Hiroshi Wada,
Ichiro Takemasa,
Hidenori Takahashi,
Phillip Ruiz,
Yuichiro Doki,
Masaki Mori,
Hiroaki Nagano
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ABSTRACT: BACKGROUND: Liver transplantation has been a life-saving and well-established treatment for acute liver failure and various end-stage liver diseases. However, acute cellular rejection (ACR) is one of the key factors that determine long-term graft function and survival after liver transplantation, and there are still no specific biomarkers available to monitor the alloimmune response. The aim of the present study was to identify molecular biomarkers for ACR in liver allograft. METHODS: We analyzed the gene expression profile using an oligonucleotide microarray covering 44,000 human probes in 35 liver biopsy samples after living donor liver transplant, which consisted of 13 samples with ACR (ACR group; moderate/mild, 6/7), 13 samples with other dysfunctions (non-ACR group; recurrent hepatitis C / ischemia/reperfusion injury (IRI)/ nonspecific inflammation / small-for-size syndrome, 5/4/3/1), and 9 samples without liver dysfunction (protocol group). We selected 113 informative genes based on microarray results and adopted the network analysis to visualize key modulators in ACR. We selected 6 modulators (CXCL9, GZMB, CCL19, GBP2, LAIR1, and CDC25A) and confirmed the reproducibility in 23 independent biopsy samples and investigated the response to the rejection treatment in sequential samples. RESULTS: Network analysis revealed the top three subnetworks, which had NF-κB, MAPK, and IFNG as central hubs. Among selected modulators, intragraft expression levels of CXCL9 mRNA was most upregulated and sensitive to alloimmune status. CONCLUSION: Intragraft CXCL9 mRNA has a functionally important role in T-cell activation in liver allograft and serves as biomarker for ACR.
Journal of Surgical Research 07/2012; · 2.25 Impact Factor
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Chieko Uchiyama,
Shigeyuki Tamura,
Shinichi Nakatsuka,
Atsushi Takeno,
Hirofumi Miki,
Takashi Kanemura,
Shin Nakahira,
Rei Suzuki,
Ken Nakata, Yutaka Takeda,
Takeshi Kato
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ABSTRACT: Gastric neuroendocrine carcinoma (G-NEC) is a rare, highly malignant tumor that exhibits aggressive growth leading to vascular invasion, distant metastasis and extremely poor prognosis. We studied the clinicopathological findings of seven patients at our institute to better under this disease.
Seven cases of G-NEC were identified among 1,027 cases of gastric carcinoma that underwent gastrectomy at Kansai Rousai Hospital between 2002 and 2010. We studied the pathological and immunohistochemical features of gastric neuroendocrine carcinomas at both the primary site and metastatic lymph nodes.
The mean patient age was 73 years (range 63 to 86 years). There were no females in this series. The final staging was Stage I in one case, Stage II in two, Stage III in two and Stage IV in two. A total of 31 metastatic lymph nodes were found in these patients. This study revealed that the ratio of neuroendocrine cells was similar between the primary and metastatic sites, which tended to show the same expression patterns of neuroendocrine markers.
Metastatic lymph nodes showed heterogeneous immunohistochemical expression patterns similar to the primary sites. G-NEC is far advanced at diagnosis and rapidly reaches the lymph nodes retaining its heterogeneity, carrying a worse prognosis than common gastric cancer. MINI ABSTRACT: G-NEC grows rapidly and metastasizes to the lymph nodes, retaining its pathological and immunohistochemical heterogeneity even at the metastatic sites.
World Journal of Surgical Oncology 06/2012; 10:115. · 1.12 Impact Factor
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ABSTRACT: The clinical features of Allen's type C of combined hepatocellular and cholangiocarcinoma (cHCC-CC) are not well known. In this study, we aim to define the clinicopathologic features of cHCC-CC and to evaluate the preoperative diagnosis and surgical treatment results in comparison with those of hepatocellular carcinoma (HCC) and cholangiocellular carcinoma (CCC). We retrospectively analyzed 13 patients with cHCC-CC, 509 patients with HCC, and 41 patients with CCC treated in our hospital within past two decades. Viral hepatitis B or C backgrounds were more prominent in HCC and cHCC-CC groups than in the CCC group. Elevated serum alpha-fetoprotein (AFP) levels were found in 60.3% of HCC patients and in 46.2% of cHCC-CC patients. Only one patient of cHCC-CC was correctly diagnosed before surgery. The postoperative survival rates between the cHCC-CC and HCC or the CCC group were not significantly different. Both intrahepatic and extrahepatic postoperative recurrences were frequent in cHCC-CC patients, and CCC component recurrences were more frequently seen. In conclusion, the preoperative diagnosis is difficult; liver masses similar to those of HCC, together with moderately elevated serum AFP and CA19-9 levels, are reliable indicators of cHCC-CC. Surgical resection of this tumor yields results intermediate between those of HCC and CCC in character. More cases are needed to further define the characteristics of this tumor.
Journal of Gastrointestinal Surgery 04/2012; 10(7):987-98. · 2.83 Impact Factor
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Shu Okamura,
Ken Nakata,
Rei Suzuki,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takashi Kanemura,
Masayoshi Kobayashi,
Yasumasa Yoshioka,
Ayako Yanai,
Atsushi Takeno,
Shin Nakahira,
Hirofumi Miki, Yutaka Takeda,
Shigeyuki Tamura
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ABSTRACT: In July 1999, a 79-year-old man underwent sigmoidectomy and D3 lymphadectomy for sigmoid colon cancer (ss, n(-), stage II, cur A). In September 2000, hepatectomy of right lobe and cholecystectomy were performed for his liver metastasis. Every three to six months follow-up had been kept since adjuvant chemotherapy (200 mg/day of 5-FU per os for two years) completed. Eleven years and two months after sigmoidectomy (in September 2010), a chest X-ray examination detected a small nodule in upper area of his right lung, which was diagnosed as either primary lung cancer or metastatic lung tumor followed by chest CT scan and PET-CT examination. In November 2010, laparoscopy-assisted partial resection of his right lung was performed. Histochemical examination of the resected lung tumor resulted cytokeratin 7(-), cytokeratin 20(+) and TTF-1(-), confirming its final diagnosis as lung metastasis from sigmoid colon cancer. He has been alive for six months without any recurrence since resection of his lung metastasis. It was a very rare case to have more than ten-year interval between colon cancer resection and detection of its lung metastasis. However, when we diagnosed the patient with lung tumor, who had undergone a colorectal resection, we should consider if he had a lung metastasis from colorectal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2054-6.
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Shigeyuki Tamura,
Atsushi Takeno,
Hirofumi Miki,
Chieko Uchiyama,
Takashi Kanemura,
Hisako Ono,
Michiko Hamanaka,
Rei Suzuki,
Shin Nakahira,
Ken Nakata, Yutaka Takeda
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ABSTRACT: Brain metastasis from gastric cancer is uncommon and difficult to treat. Patients with brain metastasis had a poor prognosis with simultaneous and multiple metastases to other organs. Four patients with brain metastasis were reported. All patients were male with the median age of 76 years and the diagnosis was stage IA in one, stage IIIA in 2 and stage IV in one. Three patients underwent gastrectmy and one patient in stage IV received chemotherapy as the initial treatment. An interval between the initial treatment and the diagnosis of brain metastasis was 11, 24, 30 and 83 months, respectively. The symptoms of brain metastasis were stagger in two, unconsciousness in one and headache in one. The treatment for brain metastases were a surgical resection for two lesions larger than 3 cm and gamma-knife radiotherapy was performed for the other lesions. The duration of survival from the treatment for brain metastasis was 45, 48, 58 and 94 days, respectively. Multidisciplinary treatment, including a surgical resection and stereotactic radiosurgery such as gamma-knife for brain metastasis is thought to improve the quality of life, but not prolong survival due to metastases to other organs. The development of effective systemic treatment will be necessary in order to prolong survival.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2093-6.
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Atsushi Takeno,
Shigeyuki Tamura,
Hirofumi Miki,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takeshi Kanemura,
Rei Suzuki,
Shin Nakahira,
Ken Nakata,
Shu Okamura, Yutaka Takeda,
Takeshi Kato
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ABSTRACT: INTRODUCTION: Wallflex duodenal stent (WDS) placement for gastric outlet obstruction caused by malignant disease has been covered by health insurance in Japan since April 2010. We have placed five-WDS for three gastric outlet obstructions caused by inoperable advanced gastric cancer. CASE 1: A 67-year-old male diagnosed as having Stage IV gastric cancer with liver, lung, and lymph node metastases underwent a WDS placement during first-line chemotherapy. He was able to consume a soft diet orally for about five months thereafter. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor 11 months after the first visit. CASE 2: A 63-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about three months thereafter. He died due to the primary tumor six months after the first visit. CASE 3: A 72-year-old male diagnosed as having Stage IV gastric cancer with liver and lymph node metastases underwent a WDS placement during the first-line chemotherapy. He was able to consume a soft diet orally for about four months and subsequently received the fourth-line chemotherapy. He underwent a WDS replacement for stent obstruction by tumor ingrowth and finally died due to the primary tumor nine months after the first visit. CONCLUSIONS: WDS stent placements for gastric outlet obstruction caused by inoperable advanced gastric cancer were performed safely and enabled the consumption of a soft diet orally for at least three months. This approach is expected to be a safe and effective treatment option.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2134-6.
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Shin Nakahira, Yutaka Takeda,
Hiroshi Kawashima,
Yosuke Mukai,
Michiko Hamanaka,
Hisako Ono,
Chieko Uchiyama,
Takashi Kanemura,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Hirofumi Miki,
Syu Okamura,
Takeshi Kato,
Shigeyuki Tamura
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ABSTRACT: In this study, we evaluate the capability of pure laparoscopic surgery for repeat hepatectomy. From June 2010 through March 2011, 15 cases of primary hepatectomy (hepatocellular carcinoma 11, liver metastasis 4) and 6 cases of re-hepatectomy patients (all cases were hepatocellular carcinoma) were underwent pure laparoscopic hepatectomy. As for the liver function in primary hepatectomy and re-hepatectomy, liver damage A/B was 8/7 and 2/4, median ICG R15 was 18 (4- 42) % and 30 (10-35) %, respectively. As for operative variables in primary hepatectomy and re-hepatectomy, the median operative duration was 265 (105-673) minutes, 296 (157-475) minutes, the median amount of bleeding was 10 (small amount-2,000) cc, 25 (small amount-140) cc, and the median post-operative hospital stay was 10 (6-17) days and 11 (6-24) days, respectively. Primary hepatectomy and re-hepatectomy represented equal clinical outcomes, although re-hepatectomy patients had lower hepatic function compared with primary hepatectomy patients.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2478-80.
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Yutaka Takeda,
Shin Nakahira,
Atsushi Takeno,
Rei Suzuki,
Ken Nakata,
Masatsugu Okishiro,
Chiyomi Egawa,
Shu Okamura,
Hirofumi Miki,
Takeshi Kato,
Yuichi Takatsuka,
Shigeyuki Tamura
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ABSTRACT: Sorafenib is a novel, orally administered multi-kinase inhibitor that has recently been approved for the treatment of advanced hepatocellular carcinoma. We report three cases of hepatocellular carcinoma without distant metastasis effectively treated by sorafenib. Case 1 was a 71-year-old male with multiple hepatocellular carcinomas, Child-Pugh status A, and asthma. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST was partial response. Case 2 was a 75-year-old male with multiple hepatocellular carcinomas and Child-Pugh status A. He previously received surgical resection and transarterial chemoembolization. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST and modified RECIST was partial response and complete response, respectively. Case 3 was a 62-year-old male with multiple hepatocellular carcinomas and Child-Pugh status A. He previously received surgical resection, percutaneous radiofrequency ablation therapy and transarterial chemoembolization. He received sorafenib 400 mg twice daily. The efficacy evaluated by the RECIST was stable disease. The majority of adverse events were grade 1-2 stomatitis and hand-foot skin reaction. No patients discontinued the treatment because of adverse events. Sorafenib might be promising as an effective therapy for advanced hepatocellular carcinoma without distant metastasis.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2011; 38(12):2496-8.
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ABSTRACT: To dissect the high rate of non-curative resection associated with biliary tract cancer, we compared the outcome of non-curative resection with that of inoperable cancer in patients referred for surgery.
We retrospectively analyzed 447 patients with biliary tract cancer who were referred to our hospital between 1970 and 2008. We compared the background and overall survival (OS) rates accordingly to surgery (curative resection, non-curative resection, or no surgery "inoperable") and alternative therapies (chemotherapy and/or radiotherapy).
The 3-year OS rate was 19% for the non-curative resection group (n=72) and 2% for the inoperable group (n=135, P<0.0001). Among the inoperable cases, the 3-year OS rate for patient who received chemotherapy, including gemcitabine (GEM), was 18% (n=18), which was similar to that of patients of the non-curative resection who were treated with GEM (P=0.7379). There were no significant differences in survival between non-curative resection without GEM and inoperable cases with GEM-based chemotherapy.
Our results indicate that the prognosis of patients who undergo non-curative surgery is better than those with inoperable cancer, but similar to those who receive chemotherapy including GEM.
Journal of Surgical Oncology 05/2011; 104(5):499-503. · 2.10 Impact Factor
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Shoji Nakamori,
Wakio Endo,
Hiroki Ozato,
Takashi Shibata, Yutaka Takeda,
Ken Tohno,
Yasunori Hasuike,
Seizo Masutani,
Takashi Morimoto,
Yuichirou Doki,
Masaki Mori,
Morito Monden
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ABSTRACT: Our objective was to evaluate the efficacy and toxicity of the pre-administration of UFT (uracil/tegafur: prodrug of 5-FU) and GEM combination therapy for unresectable/recurrent pancreatic cancer in the outpatient setting. UFT (250mg/m(2)/day) was orally administered from day 1 through day 6 and from day 8 through 13, and GEM (800mg/m(2), div/30 min) was administered on day 7 and 14, with a one-week rest every 3 weeks based on results of the previous phase I study. Thirty-six pts (24 male, 12 female) were enrolled (median age, 63.8 yrs). There were 8 partial responses (25%). Eighteen pts (56%) had stable disease, and 6 pts (19%) had a progression. The median survival time was 7. 0 months( range 1.5 -66). Grade 3 toxicities were leucopenia (17%), thrombocytopenia (3%), nausea (3%), and liver dysfunctions(3%). There were no Grade 4 toxicities. Pre-administered UFT plus GM is a promising treatment for unresectable/recurrent pancreatic cancer in the outpatient setting.
Gan to kagaku ryoho. Cancer & chemotherapy 05/2011; 38(5):789-92.
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Chiwan Kim,
Shintaro Aono,
Shigeru Marubashi,
Hiroshi Wada,
Shogo Kobayashi,
Hidetoshi Eguchi, Yutaka Takeda,
Masahiro Tanemura,
Nobuaki Okumura,
Toshifumi Takao,
Yuichiro Doki,
Masaki Mori,
Hiroaki Nagano
[show abstract]
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ABSTRACT: Allograft dysfunction after liver transplantation requires histopathologic examination for confirmation of the diagnosis, however, the procedure is invasive and its interpretation is not always accurate. The aim of this study was to find novel protein markers in bile for the diagnosis of acute cellular rejection (ACR) after liver transplantation.
Quantitative proteomic analysis using the (18)O labeling method was used to search for bile proteins of interest. Nine recipients were selected who had liver dysfunction, diagnosed by liver biopsy, either with ACR (ACR group, n = 5) or without (LD group, n = 4). Donor bile samples were obtained from nine independent live liver donors. Enzyme activity in bile samples was assayed and liver biopsy specimens were immunostained for candidate protein of ACR.
The analysis identified 78 proteins, among which alanine aminopeptidase N (APN/CD13) was considered a candidate marker of ACR. Comparative analysis of the ACR and LD groups showed high APN enzyme activity in three (60%) of five cases of the ACR group, while it was as low as donor level in all patients of the LD group. APN enzyme activity in bile samples of liver dysfunction liver transplantation (LDLT) recipients of the ACR group collected within 3 d before biopsy-confirmed ACR (n = 10) was significantly higher (584 ± 434 U/g protein) than in those of recipients free of ACR (n = 96, 301 ± 271 U/g protein) (P = 0.004). APN overexpression along bile canaliculi was observed during ACR in all five cases of the ACR group.
APN in bile seems to be a useful and noninvasive biomarker of ACR after liver transplantation.
Journal of Surgical Research 03/2011; 175(1):138-48. · 2.25 Impact Factor
