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Tetsuro Maruyama,
Masaya Uesato,
Yasunori Akutsu,
Isamu Hoshino,
Yoshihide Semba,
Nobuyoshi Takeshita,
Naoki Akanuma,
Yuka Isozaki,
Daisuke Horibe,
Mikito Mori, Tsuguaki Kono,
Kiyohiko Shuto,
Hisahiro Matsubara
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ABSTRACT: An epiphrenic diverticulum is a pulsion pseudodiverticulum of the distal esophagus that is frequently associated with esophageal motility disorders. Therefore, a simple diverticulectomy leads to a poor outcome. High-resolution impedance manometry (HRIM), introduced recently, enables easier evaluation of both esophageal pressure and bolus transit dynamics. We report the case of a 40-year-old female diagnosed with an epiphrenic diverticulum with hypertensive lower esophageal sphincter pressure by use of HRIM. She underwent a laparoscopic transhiatal diverticulectomy with a long myotomy and Dor’s fundoplication and was discharged with no complications. Four weeks after the operation, HRIM was performed again, and showed no accumulation of water in the esophagus and improvement of bolus transit. We herein report the usefulness of HRIM for evaluation of esophageal motility disorders for patients with an epiphrenic diverticulum.
Esophagus 04/2013; · 0.66 Impact Factor
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ABSTRACT: Purpose: S-1 is widely used for various cancers. It may be useful for esophageal squamous cell carcinoma (ESCC); however, there are insufficient data. The purpose is to provide results of an analysis of S-1 monotherapy for unresectable and recurrent ESCC. Patients and Methods: Twenty patients with histologically proven ESCC who were previously treated with other chemo(radio)therapies were treated with S-1 alone as second- or third-line chemotherapy. Results: A complete response (CR) was observed in 1 case (5%). A partial response (PR), stable disease (SD), and progressive disease (PD) were seen in 4 (20.0%), 7 (35.0%), and 8 (40.0%) cases, respectively. Two cases (10%) of anemia, 1 case (5%) of leukopenia, 3 cases (15%) of fatigue, and 3 cases (15%) of diarrhea were observed as grade 3 toxicity; however, there were no cases of grade 4 toxicity. The 1-year progression-free survival (PFS) rate was 10.0%, and the median PFS was 100 days. The 1-year overall survival (OS) was 30.5%, and the median OS was 330 days. The 1-year PFS rate in CR/PR/SD and PD was 16.7 and 0%, and the median survival time was 120 and 40 days. Conclusion: S-1 is a promising new drug which can be used as a second- or third-line chemotherapy for ESCC.
Oncology 04/2013; 84(5):305-310. · 2.27 Impact Factor
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ABSTRACT: A 65-year-old man with dysphagia and hoarseness was admitted to our hospital. The upper gastrointestinal examinations revealed a tumor in the lower esophagus while the biopsy specimens revealed squamous cell carcinoma. The clinical diagnosis was esophageal cancer(Lt, type 2, cT3N4M0, cStage IVa). The patient underwent neoadjuvant-chemotherapy(5-fluorouracil/cisplatin). After one course, computed tomography(CT)showed rapid growth of the tumor and lymph nodes, resulting in a progressive disease. It was considered unresectable because of the direct invasion of the No. 1 lymph node to the liver. Then, three courses of docetaxel were administered as second-line chemotherapy, and CT revealed the markedly reduced size of the tumor and lymph nodes, resulting in a partial response. The tumor was now thought to be resectable. Subtotal esophagectomy could be performed and the postoperative course was uneventful. Histopathological findings showed no evidence of malignancy at the primary tumor(grade 3), although there were residual atypical keratinocytes in some lymph nodes. The patient is doing well without any signs of recurrence 21 months after the surgery.
Gan to kagaku ryoho. Cancer & chemotherapy 02/2013; 40(2):233-5.
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Gaku Ohira,
Kiyohiko Shuto, Tsuguaki Kono,
Takayuki Tohma,
Hisashi Gunji,
Kazuo Narushima,
Shunsuke Imanishi,
Takeshi Fujishiro,
Tohru Tochigi,
Toshiharu Hanaoka,
Hideaki Miyauchi,
Naoyuki Hanari,
Hisahiro Matsubara,
Noriyuki Yanagawa
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ABSTRACT: To clarify the usefulness of arterial phase scans in contrast computed tomography (CT) imaging of strangulation ileus in order to make an early diagnosis.
A comparative examination was carried out with respect to the CT value of the intestinal tract wall in each scanning phase, the CT value of the content in the intestinal tract, and the CT value of ascites fluid in the portal vein phase for a group in which ischemia was observed (Group I) and a group in which ischemia was not observed (Group N) based on the pathological findings or intra-surgical findings. Moreover, a comparative examination was carried out in Group I subjects for each scanning phase with respect to average differences in the CT values of the intestinal tract wall where ischemia was suspected and in the intestinal tract wall in non-ischemic areas.
There were 15 subjects in Group I and 30 subjects in Group N. The CT value of the intestinal tract wall was 41.8 ± 11.2 Hounsfield Unit (HU) in Group I and 69.6 ± 18.4 HU in Group N in the arterial phase, with the CT value of the ischemic bowel wall being significantly lower in Group I. In the portal vein phase, the CT value of the ischemic bowel wall was 60.6 ± 14.6 HU in Group I and 80.7 ± 17.7 HU in Group N, with the CT value of the ischemic bowel wall being significantly lower in Group I; however, no significant differences were observed in the equilibrium phase. The CT value of the solution in the intestine was 18.6 ± 9.5 HU in Group I and 10.4 ± 5.1 HU in Group N, being significantly higher in Group I. No significant differences were observed in the CT value of the accumulation of ascites fluid. The average difference in the CT values between the ischemic bowel wall and the non-ischemic bowel wall for each subject in Group I was 33.7 ± 20.1 HU in the arterial phase, being significantly larger compared to the other two phases.
This is a retrospective study using a small number of subjects; however, it suggests that there is a possibility that CT scanning in the arterial phase is useful for the early diagnosis of strangulation ileus.
World journal of radiology. 11/2012; 4(11):450-4.
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Yasunori Akutsu,
Masaya Uesato,
Kiyohiko Shuto, Tsuguaki Kono,
Isamu Hoshino,
Daisuke Horibe,
Testutaro Sazuka,
Nobuyoshi Takeshita,
Tetsuro Maruyama,
Yuka Isozaki,
Naoki Akanuma,
Hisahiro Matsubara
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ABSTRACT: OBJECTIVES:: T1 esophageal squamous cell carcinoma (ESCC) has a low, but still present, risk of lymph node (LN) metastasis. Endoscopic mucosal resection (EMR) or endoscopic submucosal dissection (ESD) is often applied for T1 ESCC. To achieve successful treatment by EMR/ESD, the risk of LN metastases, LN recurrence, and hematological recurrence need to be better understood. The aim of this study was to determine the precise risk for metastasis in T1 ESCC. METHODS:: We divided 295 patients with T1 ESCC who underwent surgery and/or ESD/EMR into 6 categories (m1, m2, m3, sm1, sm2, and sm3). Their risks of LN metastasis, LN recurrence, hematological recurrence, and the outcome were determined. RESULTS:: The rates of LN metastasis and LN recurrence were 0% in m1 and m2, 9% in m3, 16% in sm1, 35% in sm2, and 62% in sm3 cases. The incidence of hematological recurrence was 0% in m1, m2, m3, and sm1 cases; 9% in sm2 cases; and 13% in sm3 cases. The overall risk of metastasis was 9% in m3, 16% in sm1, 38% in sm2, and 64% in sm3 patients. The 5-year disease-specific survival rates were 100% in m1, m2, and m3; 90.9% in sm1; 78.8% in sm2; and 68.6% in sm3 patients. Statistically, both lymphatic and venous invasion were selected as predictive markers for metastasis. In m3 patients, positivity for either of these had an odds ratio for metastasis of 7.333 (P = 0.093). CONCLUSIONS:: Our study provides a precise assessment of the comprehensive risk of metastasis and feasible predictive markers for T1 ESCC.
Annals of surgery 10/2012; · 7.90 Impact Factor
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ABSTRACT: It is known that cisplatin induces the excretion of zinc from the urine and thereby reduces its serum concentration. However, the fluctuation of these trace elements during or after cisplatin-based chemotherapy has not been evaluated. To answer this question, we performed a clinical study in esophageal cancer patients undergoing cisplatin-based chemotherapy. Eighteen patients with esophageal cancer who were not able to swallow food or water orally due to complete stenosis of the esophagus were evaluated. The patients were divided into a control group [total parenteral nutrition (TPN) alone for 28 days, ten cases] and an intervention group (TPN with additional trace elements for 28 days, eight cases). The serum concentrations of zinc, iron, copper, manganese, triiodothyronin (T3), and thyroxin (T4), as alternative indicators of iodine, were measured on days 0, 14, and 28 of treatment, and statistically analyzed on day 28. In the control group, the serum concentration of copper was significantly decreased from 135.4 (day 0) to 122.1 μg/ml (day 14), and finally to 110.6 μg/ml (day 28, p = 0.015). The concentration of manganese was also significantly decreased from 1.34 (day 0) to 1.17 μg/ml (day 14) and finally to 1.20 (day 28, p = 0.049). The levels of zinc, iron, T3, and T4 were not significantly changed. In the intervention group, the supplementation with trace elements successfully prevented these decreases in their concentrations. TPN with supplementary trace elements is preferable and recommended for patients who are undergoing chemotherapy in order to maintain the patients' nutrient homeostasis.
Biological trace element research 10/2012; · 1.92 Impact Factor
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Naoki Akanuma,
Isamu Hoshino,
Yasunori Akutsu,
Kiyohiko Shuto,
Toru Shiratori, Tsuguaki Kono,
Masaya Uesato,
Asami Sato,
Yuka Isozaki,
Tetsuro Maruyama,
Nobuyoshi Takeshita,
Hisahiro Matsubara
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ABSTRACT: Adenocarcinoma arising from heterotopic gastric mucosa (HGM) is exceedingly rare. This report presents the case of a 57-year-old male who presented with the chief complaint of dysphagia. Endoscopy and computed tomography revealed a locally advanced tumor of the cervical esophagus and swollen mediastinal lymph nodes. He underwent chemoradiotherapy followed by esophagectomy with three-field lymph node dissection. The resected tumor was a circumferentially scarred lesion located 1.5 cm from the proximal margin. The tumor was identified to be a well-differentiated adenocarcinoma arising from HGM with invasion to the muscularis propria. Postoperative chemoradiotherapy was performed because positive surgical margins were observed in the resected tissue. The patient has remained alive for more than 4 years after surgery, without any evidence of recurrence.
Surgery Today 06/2012; · 1.22 Impact Factor
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ABSTRACT: Background/Aims: There are few second-line regimens available for esophageal cancer. The use of fractionated docetaxel and nedaplatin as second-line chemotherapy was examined in this study. Methodology: Eligibility criteria were follows: histologically-proven squamous cell carcinoma, surgically unresectable disease, failure to respond to chemotherapy with -FU and cisplatin and no more than 2 prior chemotherapy regimens. A total of 12 patients were enrolled in this study. To reduce toxicities, fractionated docetaxel (50mg/m2 in day 1 and 8 ) and nedaplatin (50mg/m2 in day 1) were administered as second-line chemotherapy. Results: Stable disease (SD) was observed in 4 cases (33%) and the disease control rate was 33%. Regarding toxicities, leukopenia was the most frequently observed (8 cases, 67%); however, there were no cases of grade 4 non-hematological toxicity. The 1-year overall survival was 26.7% and the median survival time was 7.8 months (95% CI=3.328-12.272 months). The 1-year progression-free survival was 0% and the median progression-free time was 2.0 months (95% CI=1.319-2.681). Conclusions: Combination chemotherapy using fractionated docetaxel and nedaplatin is safe and effective and appears to be a feasible regimen to use as second-line chemotherapy for FP-resistant advanced esophageal squamous cell carcinoma.
Hepato-gastroenterology 02/2012; 59(119). · 0.66 Impact Factor
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ABSTRACT: The correlation between the number of pathologic metastatic LNs in patients with esophageal squamous cell carcinoma (ESCC) after neoadjuvant chemoradiotherapy (NACRT) and surgical outcome has rarely been reported. We evaluated the correlation between the number of pathologic metastatic lymph nodes (LNs) and the surgical outcome in ESCC after NACRT.
Eighty-eight patients with ESCC who underwent NACRT followed by surgery were evaluated. The clinical response of NACRT was evaluated and surgical specimens of the primary tumor and resected LNs were analyzed clinicopathologically.
Fewer pathologic metastatic LNs was associated with better survival. According to the number of metastatic LNs, the difference in the median survival was the largest between the groups when patients were divided into those with 2 and 3 metastatic LNs (χ(2) : 13.694, P < 0.001). With regard to clinical factors, the initial N status prior to treatment had the most significant impact on survival by a univariate analysis (P = 0.064), and the number of pathologic metastatic LNs was a risk factor for poor survival, with a hazard ratio of 5.128 (95% C.I.: 1.438-18.285, P = 0.012) by a multivariate analysis.
Of the various factors, the number of pathologic metastatic LNs was the strongest indicator to predict the patients' survival.
Journal of Surgical Oncology 12/2011; 105(8):756-60. · 2.10 Impact Factor
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ABSTRACT: A 71-year-old man presented with chief complains of hoarseness and dysphagia. He was diagnosed to have an advanced esophageal adenocarcinoma in the middle thoracic esophagus for which chemoradiation therapy was started. Partial response was observed and he was referred to our hospital thereafter. After detailed examination, he underwent a subtotal esophagectomy followed by two-field lymphadenectomy in May 2001. Histopathological examination revealed a complete response. Ten months later, hematological examination showed a high serum CEA level and CT scan disclosed mediastinal lymph node recurrences. He received a course of systemic chemotherapy so called FP therapy and five months later, a course of combination chemotherapy with 700 mg/m2 5-FU on days 1-5 and 70 mg/m2 nedaplatin on day 1 was administered. Because the high serum CEA level sustained afterward, FDG-PET was undertaken in March 2003. The right adrenal gland showed an intense abnormal FDG uptake and CT scan detected a low density mass in the area. Since no metastases could be identified in other sites, right adrenalectomy was performed. Pathological finding was poorly-differentiated tubular adenocarcinoma. Five years and eleven months after adrenalectomy, he died of pneumonia with no signs of recurrence. Surgical resection may contribute to improving the prognosis of solitary adrenal metastasis of esophageal cancer without the other noncurative factors.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2406-8.
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Kiyohiko Shuto,
Gaku Ohira, Tsuguaki Kono,
Toshiyuki Natsume,
Takayuki Tohma,
Asami Sato,
Takumi Ota,
Hiroshige Saito,
Yasunori Akutsu,
Masaya Uesato,
Hisahiro Matsubara,
Shinichi Okazumi,
Takehito Kaiho
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ABSTRACT: The prognosis of esophageal liver metastasis remains poor because of the high incidence of synchronous metastasis in other area and insufficient response to systemic chemotherapy. We assessed loco-regional anticancer potential of intra-arterial 5-FU chemotherapy for esophageal liver metastasis aimed at combination with systemic chemotherapy, radiotherapy and ablation therapy as a multidisciplinary treatment. Six patients of esophageal cancer with liver metastasis and without extra-hepatic metastasis were enrolled. Intra-aortic chemotherapy consisted of 5-FU (250 mg/body) in a one-shot infusion or a continuous infusion for 7 days with 2-week intervals until failure. The responses of liver metastasis were 2 cases of CR, 3 of PR and 1 of SD. The response rate and the local control rate were 83% and 100%, respectively. The maximum time to progression was 53 months. Grade 3/4 toxicity was not observed. Two cases had catheter failure and the treatment was interrupted. Liver metastases were controlled well until death in all cases except one. Low-dose intra-aortic 5-FU chemotherapy provided a good regional response and a combination with systemic chemotherapy may prolong survival for the patients of liver metastasis of esophageal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2409-11.
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Kazunori Otsuki,
Kyosan Yoshikawa,
Takashi Kenmochi,
Kenichi Saigo,
Michihiro Maruyama,
Naotake Akutsu,
Chikara Iwashita,
Taihei Ito, Tsuguaki Kono,
Shinichi Okazumi,
Takehide Asano
Pancreas 04/2010; 39(3):418-9. · 2.39 Impact Factor
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Kiyohiko Shuto,
Hiroshige Saito,
Gaku Ohira,
Toshiyuki Natsume, Tsuguaki Kono,
Takayuki Tohma,
Asami Sato,
Takumi Ota,
Yasunori Akutsu,
Tomoyoshi Aoyagi,
Hisahiro Matsubara
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ABSTRACT: We evaluated the power of DWIBS in patients with postoperative lymph node recurrence of esophageal cancer and compared with FDG-PET findings. Forty-seven suspected lesions by MDCT were enrolled. No significant difference between DWIBS and PET was observed in sensitivity (95% vs 97%), PPV (83% vs 90%) and overall accuracy rate (81% vs 87%). The ADCs (x10(-3) mm2/s) of recurrent nodes, primary cancer and normal esophagus were 1.124, 1.058 and 2.079, respectively. ADCs of recurrent nodes were significantly lower than those of normal esophagus (p<0.0001). The cut-off ADC line of 1.5 revealed 100% overall accuracy for separating the recurrent lesion from normal esophagus. Noninvasive DWIBS may become a valid modality to discriminate nodal recurrence of esophageal cancer by no means inferior to PET.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2009; 36(12):2468-70.
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Tsuguaki Kono,
Shinichi Okazumi,
Ryoyu Mochizuki,
Kazunori Ootsuki,
Kouichi Shinotou,
Hiroshi Matsuzaki,
Toshiyuki Natsume,
Takashi Kenmochi,
Toshio Nakagohri,
Takehide Asano,
Takenori Ochiai
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ABSTRACT: In recent years, it has become increasingly necessary to evaluate pancreatic function after pancreatectomy, but few precise methods are available.
To evaluate different surgical techniques for pancreatectomy in terms of the preservation of pancreatic function by (11)C-methionine positron emission tomography (PET), which determines amino acid metabolism in the pancreas.
The study included 33 pancreatectomy cases: 5 of distal pancreatectomy, 5 of pancreaticoduodenectomy, 10 of pylorus-preserving pancreaticoduodenectomy, 7 of duodenum-preserving pancreatic head resection, and 6 of inferior pancreatic head resection. The method was as follows. Approximately 370 MBq (11)C-methionine was intravenously injected. Cross-sectional imaging of the pancreas was performed by PET after 30 minutes. The images obtained were used to determine the radioactivity concentration in the pancreas. By adjustment of the radioactivity concentration for body weight and dosage, the differential absorption ratio could be determined to indicate the level of accumulation in the pancreas. Each surgical method used was evaluated on the basis of the differential absorption ratio. Postoperative total pancreatic accumulation was divided by preoperative level to calculate the total preserved pancreatic function rate (TPPFR), and postoperative local pancreatic accumulation was divided by preoperative level to calculate the local preserved pancreatic function rate (LPPFR). These rates were then compared for the individual techniques used.
The results indicated that TPPFR and LPPFR were 61.2 +/- 20.0% and 114.6 +/- 29.4% for distal pancreatectomy (n = 5), 31.8 +/- 20.0% and 58.7 +/- 30.0% for pancreaticoduodenectomy (n = 5), 21.6 +/- 14.7% and 58.4 +/- 29.8% for pylorus-preserving pancreaticoduodenectomy (n = 10), 47.9 +/- 35.5% and 67.7 +/- 30.6% for duodenum-preserving pancreatic head resection (n = 7), and 48.1 +/- 29.5% and 83.9 +/- 30.5% for inferior pancreatic head resection (n = 6). TPPFR was highest in distal pancreatectomy cases. Among the pancreatic head resections, TPPFR was quite high for both inferior pancreatic head resection and duodenum-preserving pancreatic head resection. In contrast, TPPFR for pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy was quite low. LPPFR was highest for distal pancreatectomy and only slightly lower for inferior pancreatic head resection. In contrast, LPPFR was markedly lower for pancreaticoduodenectomy and pylorus-preserving pancreaticoduodenectomy.
In conclusion, this method using (11)C-methionine PET is clearly useful for the evaluation of pancreatic function after pancreatectomy.
Pancreas 08/2002; 25(1):20-5. · 2.39 Impact Factor
