Publications (22)48.81 Total impact
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Article: Let-7 Expression Is a Significant Determinant of Response to Chemotherapy through the Regulation of IL-6/STAT3 Pathway in Esophageal Squamous Cell Carcinoma.
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ABSTRACT: Cisplatin-based chemotherapy is widely used for esophageal cancer, sometimes in combination with surgery/radiotherapy, but poor response to chemotherapy is not uncommon. The aim of this study was to examine whether miRNA expression is useful to predict the response to chemotherapy in patients with esophageal cancer. Using pretreatment biopsy samples from 98 patients with esophageal cancer who received preoperative chemotherapy, we measured the expression level of several miRNAs whose expression was altered in cisplatin-resistant esophageal cancer cell lines compared with those parent cell lines and examined the relationship between the miRNA expression and response to chemotherapy. In vitro assays were conducted to clarify the mechanism of miRNA-induced changes in chemosensitivity. The expression levels of 15 miRNAs were altered in cisplatin-resistant cells. Of these, low expression of let-7b and let-7c in before-treatment biopsies from 74 patients of the training set correlated significantly with poor response to chemotherapy, both clinically and histopathologically. Low expression of let-7c also correlated with poor prognosis (P = 0.032). The relationship between let-7b and let-7c expression and response to chemotherapy was confirmed in the other 24 patients of the validation set. In in vitro assay, transfection of let-7c restored sensitivity to cisplatin and increased rate of apoptosis after exposure to cisplatin. Let-7c directly repressed cisplatin-activated interleukin (IL)-6/STAT3 prosurvival pathway. Let-7 expression in esophageal cancer can be potentially used to predict the response to cisplatin-based chemotherapy. Let-7 modulates the chemosensitivity to cisplatin through the regulation of IL-6/STAT3 pathway in esophageal cancer. Clin Cancer Res; 18(18); 5144-53. ©2012 AACR.Clinical Cancer Research 07/2012; 18(18):5144-53. · 7.74 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.
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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: Chemotherapy-induced toxicities and treatment efficacy in advanced esophageal cancer treated with neoadjuvant chemotherapy followed by surgery
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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 efficacyEsophagus 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
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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
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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.
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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: Comparison between radical esophagectomy and definitive chemoradiotherapy in patients with clinical T1bN0M0 esophageal cancer.
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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: Randomized study of clinical effect of enteral nutrition support during neoadjuvant chemotherapy on chemotherapy-related toxicity in patients with esophageal cancer.
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ABSTRACT: Enteral nutrition (EN) is provided for patients with cancer. However, Little is known about the clinical efficacy of EN support during chemotherapy in patients with cancer. Ninety-one patients who received neoadjuvant chemotherapy (5-fluorouracil, cisplatin and adriamycin) for esophageal cancer were enrolled to receive either EN (n = 47) or PN (n = 44) at random. The primary endpoint was the incidence of chemotherapy-related toxicities during chemotherapy. Total and dietary intake calories during chemotherapy were equal in the two groups. There were no significant differences in serum albumin level and body weight change after chemotherapy between the two groups. There was no significant difference in tumor response to chemotherapy between the two groups (EN: 51%, PN: 55%, p = 0.886). Leukopenia and neutropenia of grade 3 or 4, defined according to the Common Toxicities Criteria of the National Cancer Institute, were significantly less frequent in the EN group than PN group (leukopenia: 17% vs 41%, p = 0.011, neutropenia: 36% vs 66%, p = 0.005). Lymphopenia and thrombocytopenia tended to be less frequent in the EN group, albeit insignificantly. Compared with PN support, EN support during neoadjuvant chemotherapy reduced the incidence of chemotherapy-related hematological toxicities in patients with esophageal cancers.Clinical nutrition (Edinburgh, Scotland) 12/2011; 31(3):330-6. · 3.27 Impact Factor -
Article: Outcome of surgical resection for recurrent pulmonary metastasis from colorectal carcinoma.
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ABSTRACT: The outcomes after repeat pulmonary resection for colorectal cancer (CRC) and the factors associated with the prognosis of these patients remain uncharacterized. Data on 156 patients who underwent curative resection of pulmonary metastasis from CRC were reviewed. Repeat pulmonary resection was performed in 25 patients; the present study examined the outcomes and factors associated with prognosis after repeat pulmonary resection. The 5-year survival rate after the first pulmonary resection was 56.2%. A multivariate analysis identified a histological type other than well-differentiated adenocarcinoma, a high prethoracotomy serum carcinoembryonic antigen (CEA) level, and the presence of hilar or mediastinal lymph node metastasis as poor prognostic factors for the first pulmonary resection. The 5-year survival rate after repeat pulmonary resection was 42.1%. Hilar or mediastinal lymph node metastasis at the time of the repeat resection was significantly associated with poor survival. Repeat pulmonary resection for metastatic CRC provides satisfactory outcomes. Hilar or mediastinal lymph node involvement is consistently associated with a poor prognosis after the first and repeat pulmonary resections.American journal of surgery 08/2011; 202(4):419-26. · 2.36 Impact Factor -
Article: Multicenter phase I/II study of docetaxel, cisplatin and fluorouracil combination chemotherapy in patients with advanced or recurrent squamous cell carcinoma of the esophagus.
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ABSTRACT: Esophageal squamous cell carcinoma (ESCC) is refractory to current therapeutic regimens and more effective therapies are imperative. To this end, we conducted a multicenter phase I/II trial of docetaxel, cisplatin, and fluorouracil (DCF) combination chemotherapy for ESCC. The study subjects were 46 patients with advanced or recurrent ESCC. Treatment included docetaxel at 60, 70, and 75 mg/m(2), cisplatin at 70 mg/m(2) on day 1, and daily fluorouracil at 700 mg/m(2) on days 1 through 5. The recommended dose of docetaxel was determined in phase I, while the response rate (RR) and progression-free survival rates were analyzed in phase II. The recommended dose was determined to be 70 mg/m(2) in phase I. In phase II, the RR was 72.5%. Interim analysis showed median and 1-year progression-free survival of 14 months and 55.6%, respectively. Grade 3/4 toxicities of leukopenia and neutropenia occurred in 72.5 and 90% of patients, respectively. No treatment-related death was recorded. Surgical resection was subsequently performed in 20 patients after chemotherapy, and curative resection was achieved in 19. DCF was tolerable and effective for advanced and recurrent ESCC. Such findings might encourage a change in the treatment strategy for ESCC.Oncology 07/2011; 80(5-6):307-13. · 2.27 Impact Factor -
Article: [A case of lung metastasis from colon cancer controlled effectively by the stereotactic radiotherapy].
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ABSTRACT: A 73-year-old man underwent a sigmoid colon resection and an insertion of a hepatic arterial infusion catheter for multiple liver metastases from sigmoid colon cancer. After the hepatectomy, the patient was detected a lung metastasis and was scheduled to undergo mFOLFOX6 chemotherapy. The tumor lesion was reduced once in size, but it has grown again after the chemotherapy. So, we underwent a stereotactic radiotherapy (60 Gy/10 Fr). The tumor lesion became a scar and the patient was doing well without any recurrence at 21 months after undergoing stereotactic radiotherapy. Lung resection has a better result than other treatments for a lung metastasis caused from colon cancer, but there are some cases with no indication of the operation due to a complication. Stereotactic radiotherapy can be an effective treatment for lung metastasis from colon cancer with no indication of the operation.Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2551-3. -
Article: Laparoscopic detection of sentinel node in gastric cancer surgery by indocyanine green fluorescence imaging.
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ABSTRACT: Indocyanine green (ICG) fluorescence imaging is a promising technique for detection of sentinel node (SN) as it avoids unnecessary resection. However, the ICG fluorescence imaging system cannot be used in laparoscopic surgery because of technological difficulties. A prototype laparoscopic detection system comprising an electron multiplier charge-coupled device (EM-CCD) as the detector and a xenon lamp as the light source was developed. The CCD camera head was attached to the end of a specially designed laparoscope that could transmit ICG fluorescence. The system allows visualization of both color and fluorescence images. Laparoscopic surgery in ten patients with gastric cancer included SN biopsy using ICG dye, ICG fluorescence images using our system, and laparoscopy-assisted gastrectomy (LAG) with lymphadenectomy. SNs were sliced into 2-mm sections for histological examination and imprint cytology. Immediately after intraoperative ICG injection by endoscopy, the laparoscopic ICG fluorescence imaging system allowed easy visualization of the lymphatic vessels draining from the primary gastric tumor toward the lymph nodes and traced the moving injected dye, whereas lymph vessels and nodes were hardly recognized by ICG green color through a standard laparoscope. Surgeons could confirm the removed lymph nodes stained with ICG by fluorescent imaging. SNs were successfully detected in all patients. Three patients had suspicious metastases in the SNs; two patients had lymph node metastases only in the SNs. Our newly developed laparoscopic ICG fluorescence imaging system is promising in the detection of SNs in laparoscopic gastric cancer surgery. The preliminary results suggest an easier and shorter learning curve of dye-guided SN biopsy in laparoscopic gastric surgery.Surgical Endoscopy 10/2010; 25(5):1672-6. · 4.01 Impact Factor -
Article: CEA-antigen and SCC-antigen mRNA expression in peripheral blood predict hematogenous recurrence after resection in patients with esophageal cancer.
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ABSTRACT: Although several studies have suggested an association between circulating tumor cells (CTC) and prognosis after esophageal cancer surgery, large-scale studies are lacking. The aim of this study was to prospectively examine the correlation between CTC and outcome in a large number of patients who underwent esophagectomy. A cohort of 244 patients with squamous cell carcinoma of the esophagus who underwent curative surgery between 2002 and 2007 were prospectively analyzed for CTC before surgery and after the thoracic procedure. Reverse transcription-polymerase chain reaction for CEA and SCC antigen mRNA was used to detect cancer cells in the peripheral blood. CTC was defined as positive when at least 1 tumor marker mRNA was detected. CTC was positive in 34 patients (13.9%) before surgery and in 41 patients (16.8%) after the thoracic procedure. Multivariate analysis identified tumor depth (hazard ratio [HR], 0.439; 95% confidence interval [95% CI], 0.268-0.722; P = 0.0012), lymph node metastasis (HR, 2.467; 95% CI, 1.436-4.237; P = 0.0011), venous invasion (HR, 1.802; 95% CI, 1.082-3.002; P = 0.0236), and CTC status after the thoracic procedure (HR, 1.647; 95% CI, 1.032-2.629; P = 0.0365) as independent prognostic factors of disease-free survival. The rates of hematogenous (P = 0.0222) and local (P = 0.0464) recurrences were significantly higher in patients with CTC(+) after the thoracic procedure than those with CTC(-) after the thoracic procedure. Responders to neoadjuvant chemotherapy showed less lymphatic invasion and a decreased positive CTC rate after the thoracic procedure than nonresponders. CTC status after the thoracic procedure is a useful predictor for hematogenous and local recurrences in patients with esophageal cancer.Annals of Surgical Oncology 10/2010; 17(10):2779-86. · 4.17 Impact Factor -
Article: Successful embolization assisted by covered stents for a pseudoaneurysm following pancreatic surgery.
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ABSTRACT: Delayed intra-abdominal hemorrhage after pancreatic surgery is a potentially lethal complication. Transarterial coil embolization and/or the placing of an endovascular stent are minimally invasive and effective procedures. An artery that is extensively eroded and rendered friable due to operative skeletonization or postoperative inflammation sometimes contributes to delayed intra-abdominal hemorrhage or rebleeding after coil embolization. This report presents a case of successful management of postoperative hemorrhage in a-74-year-old Japanese male. He experienced bleeding from a pseudoaneurysm of the brittle hepatic artery following total pancreatectomy. Initially the pseudoaneurysm was successfully treated with covered coronary stent-grafts, but rebleeding occurred 1 mo later due to the brittleness of the artery. Rebleeding was definitively managed by the complete packing of the stent by coil embolization. He remains stable at 18 mo following the final embolization. A stent graft can be used for protecting a brittle artery to avoid injury by coil embolization.World journal of gastrointestinal surgery. 09/2010; 2(9):295-8. -
Article: Talaporfin-mediated photodynamic therapy for peritoneal metastasis of gastric cancer in an in vivo mouse model: drug distribution and efficacy studies.
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ABSTRACT: Photodynamic therapy (PDT) is a potential treatment for the peritoneal dissemination of gastric cancer, because its cytotoxicity is limited to superficial lesions. We examined the accumulation of talaporfin in peritoneal metastatic nodules and determined the optimal laser condition for these nodules. We also evaluated the pathological response after therapy. We created a peritoneal metastasis model in nude mice using the MKN-45 EGFP cell line. We evaluated the accumulation of talaporfin in peritoneal metastatic nodules and normal organs by spectrophotometric analysis 2-8 h after i.p. talaporfin. To determine optimal PDT conditions, we treated metastatic nodules and the small intestine using multiple laser doses (2, 5, and 10 J/cm2, respectively). Accumulation of talaporfin was detected in metastatic nodules in higher intensities than in the small intestine. The fluorescent intensity of the peritoneal metastatic nodules gradually decreased dependent on the time interval between the laser treatment and talaporfin administration. Fluorescent intensity in the small intestine decreased more than in the metastatic nodules. The pathological response rates by dose were 52.5% at 2 J/cm2, 43.2% at 5 J/cm2, and 64.4% at 10 J/cm2, respectively, when the laser treatment was used 2 h after talaporfin administration, whereas at 4 h, they were 20.8, 25.5, and 26.2%, respectively. Finally, the recommended treatment conditions were considered to be a 2 J/cm2 laser dose and a 4-h interval in terms of toxicity. Talaporfin-mediated PDT may be an effective treatment modality for patients with advanced gastric adenocarcinoma and metastatic peritoneal nodules.International Journal of Oncology 02/2010; 36(2):313-20. · 2.40 Impact Factor -
Article: Second primary cancer in patients with colorectal cancer after a curative resection.
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ABSTRACT: Colorectal cancer (CRC) patients have an increased risk of developing other malignancies. Understanding the characteristics of the second primary cancer is important to establish an effective surveillance program. This study investigated 301 CRC patients to assess the risk factors for postoperative primary cancers arising from organs distinct from the colorectal area (extracolorectal cancers). The observed/expected ratio (O/E ratio) was calculated using the Osaka Cancer Registry, to determine the rate of increase in extracolorectal cancers. The frequency of postoperative extracolorectal cancers was 12.6%. A logistic regression analysis showed only age to be an independent risk factor for postoperative extracolorectal cancer development. The O/E ratio of overall postoperative extracolorectal cancer was significantly higher than one (O/E ratio 2.6, p < 0.01). In each organ, the frequency of lung and gastric cancers were significantly higher than one, with O/E ratios of 3.2 and 2.7 (p < 0.01 and p < 0.05, respectively). The frequency of postoperative extracolorectal cancers in CRC patients was significantly higher than that in the normal population, especially for lung and gastric cancers. Clinicians should carefully follow patients for a possible recurrence of CRC and educate CRC patients with regard to the high risk of a second primary cancer.Digestive surgery 11/2009; 26(5):400-5. · 1.37 Impact Factor -
Article: Feasibility of a lateral region sentinel node biopsy of lower rectal cancer guided by indocyanine green using a near-infrared camera system.
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ABSTRACT: A lateral pelvic lymph node dissection (LPLD) for lower rectal cancer may be beneficial for a limited number of patients. If sentinel node (SN) navigation surgery could be applied to lower rectal cancer, then unnecessary LPLDs could be avoided. The aim of this study was to investigate the feasibility of lateral region SN biopsy by means of indocyanine green (ICG) visualized with a near-infrared camera system (Photodynamic Eye, PDE). This study investigated the existence of a lateral region SN in 25 patients with lower rectal cancer. ICG was injected around the tumor, and the lateral pelvic region was observed with PDE. With PDE, the lymph nodes and lymph vessels that received ICG appeared as shining fluorescent spots and streams in the fluorescence image. This allowed the detection of not only tumor-negative SNs but also tumor-positive SNs as shining spots. The lateral SNs were detected in 6 of 6 T1 and T2 diseases and 17 of 19 T3 diseases. The lateral SNs were successfully identified in 23 (92%) of the 25 patients. The mean number of lateral SNs per patients was 2.1. Of the 23 patients, 6 patients underwent LPLD. Of the 3 patients who had a tumor-negative SN, all dissected lateral non-SNs were negative in all 3 cases. We could detect the lateral SNs, not only in T1 and T2 disease, but also in T3 disease. Although this is only a preliminary study, the detection of lateral SNs in lower rectal cancer by means of the ICG fluorescence imaging system is considered to be a promising technique that may be used for determining the indications for performing LPLD.Annals of Surgical Oncology 09/2009; 17(1):144-51. · 4.17 Impact Factor -
Article: Accumulation of excess visceral fat is a risk factor for pancreatic fistula formation after total gastrectomy.
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ABSTRACT: The effect of obesity on gastrectomy in patients with gastric cancer is controversial. The degree of abdominal fat increases the technical difficulty of abdominal surgery. This study examined the effect of visceral fat on total gastrectomy and risk factors associated with the formation of pancreatic fistula. Between February 2001 and April 2007, 191 patients with gastric cancer underwent total gastrectomy. The visceral fat area (VFA) was calculated from computed tomography (CT) scans taken at the level of the umbilicus using FatScan Software. Patients were divided into high- (> or =100 cm(2), n = 52) and low-VFA groups (<100 cm(2), n = 139), and also into high- (> or =25 kg/m(2), n = 47) and low-BMI groups (<25 kg/m(2), n = 144). Blood loss and incidence of pancreatic fistula were significantly higher in the high- than low-VFA group. However, only blood loss was significantly different between the high- and low-BMI groups. VFA, blood loss, and splenectomy were identified as significant risk factors for pancreatic fistula formation on univariate analysis, and multivariate logistic regression analysis of these factors identified VFA (p = 0.0001) and splenectomy (p = 0.0014) as significant predictors of pancreatic fistula. VFA is a better indicator for pancreatic fistula formation after total gastrectomy than is BMI. Lymph node dissection must be performed carefully, especially in patients with visceral fat accumulation during total gastrectomy with splenectomy.Annals of Surgical Oncology 03/2009; 16(6):1520-5. · 4.17 Impact Factor -
Article: Doubling time of carcinoembryonic antigen is a significant prognostic factor after the surgical resection of locally recurrent rectal cancer.
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ABSTRACT: Patients undergoing a curative rectal cancer resection have a risk of developing locoregional recurrence. A curative resection for local recurrence is the option of improvement in prognosis. However, a curative resection is sometimes too invasive and should be considered in selected patients. A total of 43 patients with locally recurrent rectal cancer who had been treated by operation between 1989 and 2007 were retrospectively reviewed and the factors, including doubling time of carcinoembryonic antigen (CEA-dt), were analyzed. The 5-year overall survival rate after the operation for local recurrence was 50.8%. Gender, presence of distant metastasis, tumor size, CEA-dt and curability were found to be significant prognostic factors. A multivariate analysis demonstrated the presence of distant metastasis, CEA-dt and tumor size to be significant prognostic factors for overall survival. The 5-year overall survival rates of patients with a CEA-dt > or =150 days and a tumor size <5 cm were 76.9%. The tumor size and CEA-dt were useful prognostic factors that were recognizable before surgery. Patients with locally recurrent rectal cancer with a CEA-dt > or =150 days and a recurrent tumor size <5 cm are considered to be good candidates for surgery.Digestive surgery 10/2008; 25(4):319-24. · 1.37 Impact Factor -
Article: [A case of refractory inguinal lymphorrhea cured by lipiodol lymphangiography].
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ABSTRACT: We report a case of inguinal lymphorrhea cured by Lipiodol lymphangiography. The patient was a 80-year-old female who underwent an abdomino-perineal resection with lateral pelvic lymph node dissection and inguinal lymph node extraction for anal canal cancer. Histologically, the tumor was a poorly differentiated adenocarcinoma and considered to be stage IV (a2, n3 (+), P0, H3, M (-), cur C) in the Japanese classification of colorectal cancer. We recognized a lot of lymph node metastases in dissected lateral pelvic lymph node and inguinal lymph node. By hepatic arterial infusion using 5-FU (1250 mg/body weekly), the liver metastases had a complete response after 15 courses. She noticed a left inguinal lymph node swelling and an elevation of serum CEA level (79.5 ng/mL) was observed. There was no evidence of recurrence except left inguinal lymph nodes. She underwent a left inguinal lymph node dissection. Serous discharge from a surgical site persisted despite of conservative therapy such as compression. She received lymphangiography using 8 mL of Lipiodol from left dorsum of foot. We found three lymph ducts heading to left groin and observed a lot of Lipiodol leakage from ducts. We determined not only the site of leakage but we also confirmed a gradual decrease and a complete stop of lypmphorrhea in 7 days after lymphangiography. Slight lymph edema of left lower extremity appeared but gradually relieved. Lymphangiography using Lipiodol helps determine the site of leakage and may be an effective therapeutic modality for treating refractory lymphorrhea.Gan to kagaku ryoho. Cancer & chemotherapy 12/2007; 34(12):2162-4.
Top co-authors
Top Journals
Institutions
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2012
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Osaka City University
- Department of Gastroenterological Surgery
Ōsaka-shi, Osaka-fu, Japan
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2005–2012
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Osaka Medical Center for Cancer and Cardiovascular Diseases
Ōsaka-shi, Osaka-fu, Japan
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2011
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Osaka University
- Gastroenterological Surgery
Ōsaka-shi, Osaka-fu, Japan
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