Shuji Takiguchi

Osaka City University, Ōsaka, Ōsaka, Japan

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Publications (273)730.87 Total impact

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    ABSTRACT: The optimal extent of lymphadenectomy in patients with esophageal cancer is controversial. This study aimed to examine the therapeutic value of lymph node (LN) dissection for each LN station in patients with esophageal squamous cell carcinoma (ESCC) who receive neoadjuvant chemotherapy. In 304 patients with ESCC who underwent neoadjuvant chemotherapy, Efficacy Index (EI) was calculated by multiplying the incidence of metastasis by the 3-year survival rate of patients with positive nodes for each LN station. Prognosis was better in responders to neoadjuvant chemotherapy than non-responders (3-year survival; 66.3% vs 48.1%, P = 0.0035). The total number of resected LNs did not affect survival although the number of positive LNs did. The number of resected LNs did not correlate with the number of metastatic LNs. Cardiac LN and recurrent nerve LN showed high EI, irrespective of tumor location. EI for each LN station did not vary according to the response to neoadjuvant therapy. The present study showed that therapeutic value of each LN was not affected by preoperative chemotherapy. The location of resected LNs rather than the total number of resected LNs may be more important to maximize the survival benefit of lymphadenectomy. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Jul 2015 · Journal of Surgical Oncology
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    ABSTRACT: A significant problem to be solved for patients after liver transplantation (LT) is malnutrition with anorexia in the early posttransplant period. We hypothesized that this problem was due to the change in ghrelin metabolism during LT. The aim of this study was to examine the balance of acyl ghrelin (AG) and desacyl ghrelin and the dependence of the regulation mechanism on hepatic-related enzymes in patients during LT. AG, desacyl ghrelin, and acyl/total ghrelin (A/T) concentrations in blood samples were measured in 15 patients with liver failure (LF), 15 patients after LT, and 10 controls. The correlations between the participants' ghrelin profiles and hepatic function-related data, including liver enzymes, were evaluated. In vitro assays using synthetic AG for assessment of deacylation activity in serum were performed. AG and A/T ratio were significantly higher in the LF patients than the patients after LT and controls (AG: 25.9 ± 12.6 versus 16.4 ± 12.6 and 9.8 ± 7.6 fmol/mL, P < 0.05; A/T ratio: 17.4 ± 4.1 versus 12.2 ± 5.5 and 11.8% ± 5.9%, P < 0.05). The serum cholinesterase level was inversely correlated with AG and A/T ratio (P < 0.01). In vitro assays showed that deacylation activity was significantly lower in patients with LF than controls (10.5% versus 42.4%, 90 min; P < 0.01). Degradation of AG was partially suppressed by a cholinesterase inhibitor. Deacylation activity was lower in LF patients, which could cause elevation of AG levels. Serum cholinesterase may be responsible for deacylation in humans. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Jun 2015 · Journal of Surgical Research
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    ABSTRACT: There is increasing evidence that the expression of microRNA (miRNA) in cancer is associated with chemosensitivity, but the mechanism of miRNA-induced chemoresistance has not been fully elucidated. The aim of this study was to examine the role of extracellular miRNA in the response to chemotherapy in esophageal cancer. First, serum expression of miRNAs selected by miRNA array was measured by quantitative RT-PCR in 68 patients with esophageal cancer who received cisplatin based chemotherapy to examine the relationship between miRNA expression and response to chemotherapy. The serum expression levels of 18 miRNAs were different between responders and non-responders by miRNA array. Of these, high expression levels of miR-27a/b correlated with poor response to chemotherapy in patients with esophageal cancer. Next, in vitro assays were conducted to investigate the mechanism of miRNA-induced chemoresistance. Although transfection of miR-27a/b to cancer cells had no significant impact on chemosensitivity, esophageal cancer cells cultured in supernatant of miR-27a/b-transfected normal fibroblast showed reduced chemosensitivity to cisplatin, compared to cancer cells cultured in supernatant of normal fibroblast. MiR-27a/b-transfected normal fibroblast showed α-SMA expression, a marker of cancer-associated fibroblasts, and increased production of TGF-β. Chemosensitivity recovered after administration of neutralizing antibody of TGF-β to the supernatant transfer experiments. Our results indicated that miR-27a/b is involved in resistance to chemotherapy in esophageal cancer, through miR-27a/b induced transformation of normal fibroblast into cancer-associated fibroblasts. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.
    Preview · Article · May 2015 · Carcinogenesis
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    ABSTRACT: Ghrelin is mainly secreted from the stomach and plays a role in appetite, weight gain, and the promotion of a positive energy balance. The levels of ghrelin decrease immediately after gastrectomy. We herein investigated the effect of the administration of synthetic ghrelin to treat postoperative severe weight loss in a prospective, one-arm clinical trial to develop new strategies for weight gain. Ten patients (four distal gastrectomy and six total gastrectomy) received ghrelin treatment. Eligibility criteria included patients who underwent gastrectomy more than 1 year previously and 15 % body weight loss from the preoperative weight or a body mass index under 19. Synthetic human ghrelin (3 μg/kg) was administered to the patients twice a day for 1 week. Oral intake of calories, appetite [evaluated using the visual analog scale (VAS)], and body weight before and during administration of ghrelin were compared. There was a significant difference in the oral food intake before and during treatment (before treatment: 1236 ± 409 kcal vs. during treatment: 1398 ± 365 kcal, p = 0.039), and the VAS for appetite significantly improved with each day of ghrelin administration (p < 0.05). Significant amounts of body weight were gained (39.5 ± 6.8 vs. 40.1 ± 6.9, p = 0.037). The administration of synthetic ghrelin improved the food intake and was effective for treating appetite loss and body weight loss. Synthetic ghrelin may be a promising new therapy for severe body weight loss following gastrectomy.
    No preview · Article · May 2015 · Surgery Today
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    ABSTRACT: We conducted this retrospective cohort study to evaluate which preoperative comorbidities and their combinations are most strongly associated with postoperative complications after gastrectomy. We collected data on 214 consecutive patients who underwent gastrectomy for gastric cancer. Preoperative comorbidities were placed into one of ten categories: cardiac, pulmonary, liver, renal, central nervous system, hypertension, diabetes, endocrine/metabolic, vascular, and immune/hematological. The relationship between the number of comorbidities and the incidence of postoperative complications was evaluated. Among 120 patients (56.1 %) with comorbidities, 48 had a single comorbidity and 72 had multiple (≥2) comorbidities. The incidence of postoperative complications was 45.8 % (33/72) for patients with multiple comorbidities and 23.9 % (34/142) for those with 0 or 1 comorbidity (P = 0.001). Among the ten types of comorbidities, only pulmonary (P = 0.019) and vascular diseases (P = 0.007) were significantly associated with the occurrence of postoperative complications. Patients with multiple comorbidities had a significantly higher incidence of postoperative complications after gastrectomy. Among the comorbidities studied, pulmonary and vascular diseases had the strongest association with postoperative complications.
    No preview · Article · Apr 2015 · Surgery Today
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    ABSTRACT: As a step to large-scale clinical trials, we conducted a small-scale exploratory study to clarify whether the secondary lumen of the double-lumen (DL) peripherally inserted central catheters (PICCs) could perform as well as the secondary lumen of the DL centrally inserted central catheters (CICCs), with an acceptable complication rate in the perioperative surgery period. Forty thoracic esophageal cancer patients requiring central venous catheterization during the perioperative period were assigned to the DL-PICC (4.5-French, 60-cm) group or the DL-CICC (16-gauge, 30-cm) group, with 1:1 randomization. The primary endpoint was the completion rate of continuous catecholamine infusion via the secondary lumen during the observation period. Thirty-two cases (14 cases in the PICC group and 18 cases in the CICC group) were analyzed. Continuous catecholamine infusion via the secondary lumen was completed in all 32 cases. No major complications related to PICC/CICC placement/maintenance were noted in the groups during the median observation period of 6 days. The secondary lumen of the DL-PICCs performed as well as the secondary lumen of the DL-CICCs with acceptable safety during the relatively short perioperative period of these thoracic esophageal cancer patients (UMIN Clinical Trial Registry UMIN000008131).
    No preview · Article · Apr 2015 · The journal of vascular access
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    ABSTRACT: The optimal analgesia following laparoscopic distal gastrectomy (LDG) has not been determined; moreover, it has been unclear whether epidural anesthesia has benefits for laparoscopic surgery. In this study, we evaluated the effectiveness of epidural analgesia after LDG. This retrospective study included 84 patients who underwent LDG for gastric cancer. Patients received either combined thoracic epidural and general anesthesia (Epidural group, n = 34) or general anesthesia alone (No epidural group, n = 50). We recorded data on the patients, surgery, postoperative outcomes and anesthesia-related complications. In the Epidural group, the first day of flatus was significantly earlier (2.21 vs. 2.44 days, p = 0.045) and the number of additional doses of analgesics was significantly lower (2.85 vs. 4.86 doses, p = 0.007) than in the No epidural group. Postoperative urinary retention occurred at a significantly higher rate in the Epidural group (n = 7; 20.6 %) than in the No epidural group (p < 0.001). Epidural anesthesia may reduce the need for additional analgesics after LDG, but increases the risk of urinary retention.
    No preview · Article · Apr 2015 · Surgery Today
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    ABSTRACT: Right non-recurrent inferior laryngeal nerve is a rare nerve anomaly that communicates the right vagal nerve trunk to the laryngeal nerve directly in the neck, and is usually accompanied by an aberrant right subclavian artery. We report a case of thoracic esophagectomy with intraoperative neuromonitoring undertaken in a patient with these abnormalities. This case report concerns a 66-year-old man with thoracic esophageal carcinoma who was referred to our hospital. An aberrant right subclavian artery that gave us a prediction of a right non-recurrent inferior laryngeal nerve was detected preoperatively using computed tomography, and identified visually with intraoperative neuromonitoring. Identification of this nerve anomaly during cervical lymph node dissection was considered important to avoid unexpected neural injuries. For a successful esophagectomy with lymph node dissection in patients with this anomaly, intraoperative neuromonitoring for the non-recurrent inferior laryngeal nerve may provide a useful contribution to surgical safety.
    No preview · Article · Apr 2015 · Esophagus
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    ABSTRACT: Conducting clinical trials to establish evidence of the benefits of adjuvant treatment for resectable esophagogastric junction (EGJ) cancer is difficult because it is a very rare disease compared with gastric or esophageal cancer. In the West, where esophageal cancer occurs more frequently than gastric cancer, a phase III trial (the CROSS trial) demonstrated the efficacy of preoperative chemoradiotherapy using carboplatin plus paclitaxel for patients with esophageal or EGJ cancer. Thus, this preoperative regimen is considered to be the standard adjuvant treatment for resectable EGJ cancer in the West. On the other hand, the Western evidence is not widely accepted in Asia because there are many differences in surgical techniques, particularly in the field of lymph node dissection, between the West and Asia. The standard adjuvant treatment for resectable EGJ cancer in Asia is postoperative chemotherapy using S-1 alone or capecitabine plus oxaliplatin based on the results of two large-scale phase III trials in gastric cancer conducted in East Asia. The incidence of EGJ cancer has recently increased in Japan, and nationwide studies to develop more effective adjuvant treatment for resectable EGJ cancer should be conducted in the near future.
    No preview · Article · Apr 2015 · Nippon Geka Gakkai zasshi
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    ABSTRACT: S-1, cisplatin, and docetaxel (DCS) constitute an effective regimen for gastric cancer. We conducted a retrospective cohort study of systemic DCS and a prospective phase I trial of intraperitoneal DCS in the preoperative setting for marginally resectable gastric cancer. Under the systemic regimen, patients received cisplatin (60 mg/m(2)) plus docetaxel (40 mg/m(2)) intravenously on day 1 and S-1 (80 mg/m(2)) on days 1-14, of a 28-day cycle. With the intraperitoneal regimen, the schedule for S-1 and cisplatin was the same. Dose escalation for docetaxel started at 30 mg/m(2) (level 1). Between August 2010 and July 2013, 26 consecutive patients were treated with the systemic regimen. Grade 3-4 neutropenia occurred in 81% but the toxicity profile was very tolerable. The response rate based on the Response Evaluation Criteria in Solid Tumors (RECIST) was 89%. Between April 2012 and April 2014, 5 patients with linitis plastica, large ulcero-invasive type tumors, positive washing cytology or peritoneal metastasis were enrolled in the phase I trial of the intraper itoneal regimen. Grade 3-4 elevations in aspartate/ alanine aminotransferase (AST/ALT) occurred in the first 2 patients. The next 3 patients, who received docetaxel (20 mg/m(2)) on days 1 and 15 (level 0), had no dose-limiting toxicity. Four patients, including 3 with peritoneal metastasis and/or positive cytology before treatment, underwent R0 resection after intraperitoneal chemotherapy. Our studies revealed the efficacy of the systemic regimen and the safety of the intraperitoneal regimen. Further investigation of these two types of preoperative DCS chemotherapy is warranted. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    No preview · Article · Apr 2015 · Anticancer research
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    ABSTRACT: Pyruvate kinase M2 (PKM2) is a key glycolytic enzyme that regulates the Warburg effect and is necessary for tumor growth. However, its role in chemoresistance has not been fully elucidated. PKM2 expression was examined by immunohistochemistry in 205 tissue samples from thoracic esophageal squamous cell carcinoma patients who had undergone curative surgery (100 patients with surgery alone and 105 patients with preoperative chemotherapy). The relationship between PKM2 expression and clinicopathological factors, including chemotherapy response was examined. In vitro assays were performed to determine the mechanism of PKM2-related chemoresistance, using esophageal squamous cell carcinoma cell lines. PKM2 expression significantly correlated with tumor cell differentiation, tumor depth, and tumor stage. Strong PKM2 expression significantly correlated with decreased survival rates and poor response to chemotherapy. In vitro assays showed that PKM2 inhibition significantly decreased cisplatin resistance and increased apoptosis. In siPKM2-transfected cells, pyruvate kinase activity paradoxically increased, followed by increased intracellular reactive oxygen species levels. The ratio of NADPH/NADP, which is an indicator of glucose influx into pentose phosphate pathway (PPP), significantly decreased in siPKM2-transfected cells upon cisplatin treatment compared with control cells. PKM2 expression is associated with esophageal squamous cell carcinoma chemoresistance. PKM2 inhibition can restore cisplatin sensitivity by inactivating PPP.
    No preview · Article · Mar 2015 · Annals of Surgical Oncology
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    ABSTRACT: Managing postoperative pain is important to ensure a good quality of life and fast recovery after surgery. We examined the feasibility of peroral management for the postoperative pain after laparoscopic-assisted distal gastrectomy (LADG). Between June 2012 and September 2013, we enrolled 34 patients prospectively to receive peroral tramadol/acetaminophen combination tablets, celecoxib and prochlorperazine maleate after LADG through postoperative day 3 (ORAL group). The postoperative pain was assessed using a visual analogue scale. Postoperative outcomes related to the analgesic methods were compared with those of patients who used epidural anesthesia between January 2010 and December 2011 (EPI group). The ORAL group pain scale scores on postoperative days 1-3 were 3.96, 3.06 and 2.40, respectively. The frequency of additional analgesic use in the ORAL group was significantly lower than in the EPI group (P = 0.006). The rate of urethral catheter reinsertion was 20.6 % in the EPI group (P = 0.054). A multivariate analysis revealed that only epidural anesthesia was a significant risk factor for the need for additional medication four times or more for breakthrough pain (P = 0.048). Postoperative pain management using oral analgesics after LADG is feasible and safe, and is an ideal pain treatment associated with few adverse events while providing pain relief not inferior to epidural anesthesia.
    No preview · Article · Mar 2015 · Surgery Today
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    ABSTRACT: Cancer tissue is maintained by relatively small populations of cancer stem cells (CSCs), which are involved in chemotherapy resistance, recurrence and metastasis. As tumor tissues are comprised of various cells, studies of human clinical samples are important for the characterization of CSCs. In the present study, an expression profiling study was performed in which an anti-cell surface marker antibody-based array platform, a flow cytometry-based cell separation technique and a tumorigenicity analysis in immunodeficient animals were utilized. These approaches revealed that the markers cluster of differentiation (CD)44 and CD26 facilitated the fractionation of surgically resected human gastric cancer (GC) cells into the following subset populations with distinct tumorigenic potentials: Highly tumorigenic CD26(+)CD44(+) cells (6/6 mice formed tumors), moderately tumorigenic CD26(+)CD44(-) cells (5/6 mice formed tumors), and weakly or non-tumorigenic CD26(-)CD44(-) cells (2/6 mice formed tumors). Furthermore, exposure to 5-fluorouracil significantly increased the proportion of CD26(+) cells in vitro. The present study demonstrated that the combined expression of CD26 and CD44 presents a potential marker of human GC stem cells.
    Preview · Article · Mar 2015 · Oncology letters
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    ABSTRACT: Gastric cancer represents a great challenge for health care providers and requires a multidisciplinary approach in which surgery plays the main role. Minimally invasive surgery has been progressively developed, first with the advent of laparoscopy and more recently with the spread of robotic surgery, but a number of issues are currently being investigate, including the limitations in performing effective extended lymph node dissections and, in this context, the real advantages of using robotic systems, the possible role for advanced Gastric Cancer, the reproducibility of completely intracorporeal techniques and the oncological results achievable during follow-up. Searches of MEDLINE, Embase and Cochrane Central Register of Controlled Trials were performed to identify articles published until April 2014 which reported outcomes of surgical treatment for gastric cancer and that used minimally invasive surgical technology. Articles that deal with endoscopic technology were excluded. A total of 362 articles were evaluated. After the review process, data in 115 articles were analyzed. A multicenter study with a large number of patients is now needed to further investigate the safety and efficacy as well as long-term outcomes of robotic surgery, traditional laparoscopy and the open approach. Copyright © 2015. Published by Elsevier Ltd.
    Full-text · Article · Mar 2015 · International Journal of Surgery (London, England)
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    ABSTRACT: Background and objectiveTumor-associated macrophages (TAMs) are well known to have distinct roles in tumor progression and metastasis. However, the role of TAMs in chemoresistance has not been fully investigated. The aim of this study is to examine whether TAMs, especially M2 macrophages, are associated with the tumor response to chemotherapy with esophageal cancers.Methods Using 210 tissues from patients with esophageal cancer who underwent surgery, we calculated the number of intratumoral CD68+ macrophages, CD163+ macrophages, and CD8+ lymphocytes using immunohistochemistry. CD68 and CD163 were used as markers for whole macrophages and M2 macrophages, respectively.ResultsInfiltration of CD68+ macrophages and CD163+ macrophages was significantly associated with tumor depth, lymphatic invasion, and venous invasion. High infiltration of CD68+ macrophages and CD163+ macrophages was significantly associated with poor prognosis for patients undergoing neoadjuvant chemotherapy. Regarding the response to chemotherapy, high infiltration of CD68+ and CD163+ macrophages had a significant association with poor response to chemotherapy, both clinically and pathologically (P < 0.001, P < 0.001). Multivariate analysis showed that infiltration of CD163+ macrophages was an independent prognostic factor in patients undergoing neoadjuvant chemotherapy.Conclusions Infiltration of TAMs, especially M2 macrophages, is associated with a poor response to chemotherapy and poor prognosis of patients with esophageal cancer. J. Surg. Oncol. © 2015 Wiley Periodicals, Inc.
    No preview · Article · Mar 2015 · Journal of Surgical Oncology
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    ABSTRACT: Bursectomy, a traditional operative procedure to remove the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has been performed for serosa-positive gastric cancer in Japan and Eastern Asia. We conducted a multicenter, randomized, controlled trial to demonstrate the noninferiority of the omission of bursectomy. Between July 2002 and January 2007, 210 patients with cT2-3 gastric adenocarcinoma were randomized intraoperatively to D2 gastrectomy with or without bursectomy. The primary endpoint was overall survival (OS). We provide the results of the final analysis of the complete 5-year follow-up data. After the median follow-up of 80 months, 5-year OS was 77.5% for the bursectomy group and 71.3% for the nonbursectomy group (2-sided P = .16 for superiority; 1-sided P = .99 for noninferiority). The hazard ratio for death in the nonbursectomy group was 1.40 (95% CI, 0.87-2.25). The 5-year recurrence-free survivals were 73.7% and 66.6% in the bursectomy and nonbursectomy groups, respectively (2-sided P = .33 for superiority; 1-sided P = .99 for noninferiority). Cox multivariate analysis revealed that bursectomy was an independent prognostic factor of good OS (P = .033). Subgroup analysis showed a trend toward improved survival after bursectomy for tumors in the middle or lower third of the stomach and for pathologically serosa-positive tumors. The final analysis could not demonstrate the noninferiority of the omission of bursectomy. Bursectomy should not be abandoned as a futile procedure. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Feb 2015 · Surgery
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    ABSTRACT: This is a case report of chylothorax after esophagectomy for esophageal cancer cured by intranodal lymphangiography in the groin. A 62-year-old man was admitted to our Hospital with dysphagia. The diagnosis was made of advanced esophageal cancer (T3N1M0, stage IIIA). After neoadjuvant chemotherapy, radical surgery was performed. On postoperative day (POD) 9, left pleural effusion drainage increased sharply and changed to a milky white color, leading to a diagnosis of chylothorax. Although chylothorax was managed with conservative treatment, there was an inadequate response to it. On POD 15, lymphangiography was performed. Inguinal nodes were directly accessed under ultrasound guidance and lipiodol was injected into nodes. After the lymphangiography, the left pleural effusion drainage immediately decreased. On POD 40, the patient was discharged. To the best of our knowledge, this is the first report of a chylothorax after esophagectomy for esophageal cancer to be cured by ultrasound-guided intranodal lymphangiography in the groin. Copyright© 2015 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.
    No preview · Article · Feb 2015 · Anticancer research
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    ABSTRACT: Purpose: This study aimed to assess the efficacy of daikenchuto (DKT), a commonly prescribed, traditional Japanese herbal medicine, on postoperative intestinal dysfunction after gastric cancer surgery. Methods: Patients with gastric cancer scheduled for a total gastrectomy were randomly assigned before surgery to receive either no treatment (n = 40; control group) or DKT (7.5 g/day, t.i.d.) for 3 months (n = 41) postoperatively. We examined gastrointestinal motility, stool attributes, the quantity of bowel gas, the quality of life, and the incidence of postoperative ileus. Results: During the hospital stay, significant differences were observed between the DKT group and controls in the number of stools per day (1.1 ± 0.6 vs 0.8 ± 0.4, respectively; P = 0.037) and stool consistencies (Bristol scale ratings were 3.7 ± 0.8 vs 3.1 ± 0.8, respectively; P = 0.041). The DKT group showed significant reductions in gas volume scores, calculated from abdominal radiographs, at 7 days, 1 month, and 3 months after surgery. The groups did not show significant differences in quality of life scores (based on the Gastrointestinal Symptom Rating Scale) or in the incidence of postoperative ileus. Conclusion: DKT improved bowel movements, stool properties, and bowel gas. These results suggested that DKT promoted early postoperative bowel functions after total gastrectomy.
    No preview · Article · Jan 2015 · Journal of Gastrointestinal Surgery
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    ABSTRACT: Purpose Patients with resectable thoracic esophageal squamous cell cancer (TESCC) and positron emission tomography (PET)-positive lymph nodes (PET-N positive) are likely to have ≥3 pathological lymph node metastases (pLNMs) and show a higher rate of postoperative recurrence despite curative resection than PET-N-negative TESCC patients. We examined the prognostic significance of 18F-fluorodeoxyglucose uptake into lymph node metastases after neoadjuvant chemotherapy (NAC) for PET-N positive TESCC and aimed to propose the optimal NAC response criteria for these patients. Methods Fifty-one patients with PET-N positive TESCC underwent two courses of NAC followed by surgery. Metabolic responses of primary tumors and LNs were prospectively evaluated and associations with clinicopathological data and patient survival assessed by univariate and multivariate analyses. Results After NAC, 21 patients were post-treatment (post-) PET-N positive and 30 post-PET-N negative. A significantly (p
    No preview · Article · Dec 2014 · Annals of Surgical Oncology
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    ABSTRACT: Whether thorough mediastinal dissection is indicated in patients with Siewert type II adenocarcinoma of the esophagogastric junction (EGJ) remains controversial. We conducted a multicenter study to find a preoperative indicator of mediastinal node metastasis. We retrospectively collected data on 315 patients with pT2-T4 Siewert type II tumors who underwent R0 or R1 resection. The rates of metastasis or recurrence were investigated for the upper, middle, and lower mediastinal lymph nodes. Multivariate logistic analysis was used to identify significant indicators of metastasis or recurrence in the mediastinal nodes. The overall rates of metastasis or recurrence in the upper, middle, and lower mediastinal lymph nodes were 4%, 7%, and 11%, respectively. Rates were significantly higher when the distance from the EGJ to the proximal edge of primary tumor was >3 cm for the upper and middle mediastinal nodes and >2 cm for the lower mediastinal nodes. Multivariate analysis revealed that this distance was the only factor significantly associated with metastasis or recurrence in any mediastinal region. The 5-year overall survival rate in the 12 patients with metastasis in the upper or middle mediastinal lymph nodes was 17%. The distance from the EGJ to the proximal edge of primary tumor may be a significant indicator of metastasis or recurrence in the mediastinal lymph nodes in patients with Siewert type II tumors. Thorough mediastinal lymph node dissection via a transthoracic approach may provide a therapeutic benefit when the distance is >3 cm. Copyright © 2015 Elsevier Inc. All rights reserved.
    No preview · Article · Dec 2014 · Surgery

Publication Stats

3k Citations
730.87 Total Impact Points

Institutions

  • 2004-2015
    • Osaka City University
      • Department of Gastroenterological Surgery
      Ōsaka, Ōsaka, Japan
  • 1999-2015
    • Osaka University
      • • Division of Gastroenterological Surgery
      • • Graduate School of Medicine
      • • School of Medicine
      Suika, Ōsaka, Japan
    • Niigata Teishin Hospital
      Niahi-niigata, Niigata, Japan
  • 2013
    • Osaka Police Hospital
      Ōsaka, Ōsaka, Japan