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Is rectal cancer prone to metastasize to lymph nodes than colon cancer?

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World Journal of Gastroenterology 2011年第29期17卷 3465-3466页

作者： Takashi Akiyoshi Toshiaki watanabe masashi Ueno Tetsuichiro Muto Gastroenterological Center Department of Gastroenterological SurgeryCancer Institute HospitalJapanese Foundation for Cancer ResearchTokyo 135-8550Japan Department of Surgery Teikyo University School of MedicineTokyo 173-8605Japan

The biology of colorectal cancer differs according to its location within the large intestine.A report published in a previous issue of World Journal of Gastroenterology (November 2010) evaluated the importance of tumor location as a risk factor for lymph node metastasis in colorectal cancer,and showed that rectal cancer is prone to metastasize to lymph nodes as compared with colon ***,in order to conclude that the tumor location is independently associated with the occurrence of lymph node metastasis,it is necessary to consider a selection bias or other patientand tumorrelated factors carefully.

关键词： Rectum Colon Lymph node Metastasis Cancer

Long-term efficacy of endoscopic coagulation for different types of gastric vascular ectasia

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World Journal of Gastroenterology 2013年第18期19卷 2799-2805页

作者： Yukinori Imai Yoshie Mizuno Kiyoko Yoshino Kazuhiro watanabe Kayoko Sugawara Daisuke Motoya masashi Oka Satoshi Mochida Department of Gastroenterology and Hepatology Faculty of Medicine Saitama Medical University Saitama 350-0495 Japan

AIM: To examine the long-term therapeutic efficacies of endoscopic cauterization for gastric vascular ectasia, according to the type of lesion. METHODS: Thirty-eight patients with hemorrhagic gastric vascular ectasia (VE) were treated by endoscopic cauterization: 13 by heater probe coagulationand 25 by argon plasma coagulation. Depending on the number of lesions, 14 and 24 patients were classified into localized VE (≤ 10; LVE) and extensive VE (> 10; EVE), respectively. The patients were followedup by repeated endoscopic examinations after the therapy, and the incidences of VE recurrence and rebleeding from the lesions were evaluated. RESULTS: Although the VE lesions disappeared initially in all the patients after the therapy, the recurrence of VE developed in 25 patients (66%) over a mid-term observation period of 32 mo, and re-bleeding occurred in 15 patients (39%). The recurrence of VE was found in all patients with EVE, with re-bleeding occurring in 14 patients (58%). In contrast, only 1 patient (7%) with LVE showed recurrence of the lesions and complicating hemorrhage. Both the cumulative recurrence-free rates and cumulative re-bleeding-free rates were significantly lower in the EVE group than in the LVE group (P < 0.001 and P < 0.001, respectively). Moreover, the cumulative re-bleeding-free rate in the EVE group was 47.6% at 1 year and 25.4% at 2 years in patients with chronic renal failure, which were significantly lower than the rates in the patients without chronic renal failure (83.3% and 74.1%, respectively) (P < 0.05). CONCLUSION: The recurrence of VE and re-bleeding from the lesions was more frequent in the patients with EVE, especially in those with complicating renal failure.

关键词： Gastric vascular ectasia Heater probe coagulation Argon plasma coagulation Renal failure Recurrence

Long-term outcomes and prognostic factors of patients with obstructive colorectal cancer: A multicenter retrospective cohort study

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World Journal of Gastroenterology 2016年第22期22卷 5237-5245页

作者： Ishibe Atsushi Ota Mitsuyoshi Yamaguchi Kazuya Kaida Syuhei Kamiya Noriyuki Momiyama masashi watanabe Akira Sekizawa Kentaro Kamimukai Nobuyuki Sugimasa Natsuko watanabe Jun Ichikawa Yasushi Kunisaki Chikara Endo Itaru Department of Gastroenterological Surgery Graduate School of Medicine Yokohama City University Fukuura Kanazawa-ku Yokohama 236-0004 Japan Department of Surgery Gastroenterological Center Yokohama City University Urafune Minami-ku Yokohama 232-0024 Japan Department of Surgery Yokohama City Hospital Okazawa Hodogaya-ku Yokohama 240-8555 Japan Department of Surgery Yokosuka Kyosai Hospital Maigahamadori Yokosuka 238-8558 Japan Department of Surgery Ito Municipal Hospital Ito 414-0055 Japan Department of Surgery Fujisawa City Hospital Fujisawa 251-8550 Japan Department of Surgery Yokosuka City Hospital Nagasaka Yokosuka 240-0195 Japan Department of Surgery Yokohama Hodogaya Central Hospital Kamadai Hodogaya-ku Yokohama 240-8585 Japan Department of Surgery Saiseikai Yokohamashi Nanbu Hospital Kounandai Kounan-ku Yokohama 234-0054 Japan Department of Oncology Graduate School of Medicine Yokohama City University Yokohama 236-0004 Japan

AIM: To investigate the long-term oncologic outcomes and prognostic factors in patients with obstructive colorectal cancer(CRC) at multiple Japanese ***: We identified 362 patients diagnosed with obstructive colorectal cancer from January 1, 2002 to December 31, 2012 in Yokohama Clinical Oncology Group's department of gastroenterological surgery. Among them, 234 patients with stage Ⅱ/Ⅲ disease who had undergone surgical resection of their primary lesions were analyzed, retrospectively. We report the long-term outcomes, the risk factors for recurrence, and the prognostic ***: The five-year disease free survival and cancer-specific survival were 50.6% and 80.3%, respectively. A multivariate analysis showed the ASAPS(HR = 2.23, P = 0.026), serum Albumin ≤ 4.0 g/d L(HR = 2.96, P = 0.007), T4 tumor(HR = 2.73, P = 0.002) and R1 resection(HR = 6.56, P = 0.02) to be independent risk factors for recurrence. Furthermore, poorly differentiated cancers(HR = 6.28, P = 0.009), a T4 tumor(HR = 3.46, P = 0.011) and R1 resection(HR = 6.16, P = 0.006) were independent prognostic factors in patients with obstructive ***: The outcomes of patients with obstructive CRC was poor. T4 tumor and R1 resection were found to be independent prognostic factors for both recurrence and survival in patients with obstructive CRC.

关键词： Obstructive colorectal cancer Prognostic factor Survival

Different natural courses of chronic hepatitis B with genotypes B and C after the fourth decade of life

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World Journal of Gastroenterology 2007年第34期13卷 4560-4565页

作者： Tatsuji Maeshiro Shingo Arakaki Takako watanabe Hajime Aoyama Joji Shiroma Tsuyoshi Yamashiro Tetsuo Hirata Akira Hokama Fukunori Kinjo Tomofumi Nakayoshi Tomokuni Nakayoshi masashi Mizokami Jiro Fujita Hiroshi Sakugawa Control and Prevention of Infectious Disease (First Department of Internal Medicine) Department of Medicine and Therapeutics Faculty of Medicine University of the Ryukyus Okinawa Japan Department of Blood transfusion medicine Ryukyu University Hospital Okinawa Japan Department of Endoscopy Ryukyu University Hospital Okinawa Japan Department of Internal Medicine Tomishiro Central Hospital Okinawa Japan Department of Internal Medicine Heart Life Hospital Okinawa Japan Clinical Molecular Informative Medicine Nagoya City University Graduate School of Medical Science Nagoya Japan

MIM： To investigate the different impact of genotypes E and C on the development of liver cirrhosis （LC） among different age groups of patients with chronic hepatitis （CH-B）.METHODS： We examined the outcome of 121 patients with CH-B, divided by age and genotype. Univariate analyses were used to compare different groups. The Cox proportional hazard model was employed to evaluate factors affecting the development of LC.RESULTS： In patients 〈 30 years old, there were no significant predictors for development of LC. However, in patients ≥ 30 years old, genotype C was the only significant predictor. In the genotype C group, 8 of 12 patients who progressed to LC were 30-49 years old at initial diagnosis of chronic hepatitis （7 patients were positive for HBeAg）. In the genotype B group, 4 of 8 patients who developed LC were ≥50 years old at initial diagnosis and were HBeAg-negative.CONCLUSION： The rate of development of LC was comparable in patients infected with genotypes B and C when CH-B occurred at 〈 30 years old. However, CH-B patients infected with genotype C showed poor prognosis if they were 30-49 years old and were positive for HBeAg. Age-specific natural course of CH-B should be considered when patients with CH-B are treated with antiviral drugs.

关键词： Hepatitis B, chronic Hepatitis B virus Hepatitis B e antigen Genotypes Molecular epidemiology

Risk factors for local recurrence and appropriate surveillance interval after endoscopic resection

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World Journal of Gastroenterology 2019年第12期25卷 1502-1512页

作者： Yoriaki Komeda Tomohiro watanabe Toshiharu Sakurai masashi Kono Kazuki Okamoto Tomoyuki Nagai Mamoru Takenaka Satoru Hagiwara Shigenaga Matsui Naoshi Nishida Naoko Tsuji Hiroshi Kashida Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine

BACKGROUND Risk factors for local recurrence after polypectomy, endoscopic mucosal resection(EMR), and endoscopic submucosal dissection(ESD) have not been ***, the appropriate interval for endoscopic surveillance of colorectal tumors at high-risk of local recurrence has not been *** To clarify the clinicopathological characteristics of recurrent lesions after endoscopic colorectal tumor resection and determine the appropriate *** Three hundred and sixty patients(1412 colorectal tumors) who underwent polypectomy, EMR, or ESD and received endoscopic surveillance subsequently for more than one year to detect local recurrence were enrolled in this study. The clinicopathological factors associated with local recurrence were determined via univariate and multivariate *** Local recurrence was observed in 31 of 360(8.6%) patients [31 of 1412(2.2%)lesions] after colorectal tumor resection. Piecemeal resection, tumor size of more than 2 cm, and the presence of villous components were associated with colorectal tumor recurrence after endoscopic resection. Of these three factors, the piecemeal resection procedure was identified as an independent risk factor for recurrence. Colorectal tumors resected into more than five pieces were associated with a high risk of recurrence since the average period from resection torecurrence in these cases was approximately 3 mo. The period to recurrence in cases resected into more than 5 pieces was much shorter than that in those resected into less than 4 pieces(3.8 ± 1.9 mo vs 7.9 ± 5.0 mo, P < 0.05).CONCLUSION Local recurrence of endoscopically treated colorectal tumors depends upon the outcome of first endoscopic procedure. Piecemeal resection was the only significant risk factor associated with local recurrence after endoscopic resection.

关键词： Local recurrence Colorectal tumor Endoscopic surveillance Piecemeal resection Risk factors

Impact of discontinuing non-steroidal antiinflammatory drugs on long-term recurrence in colonic diverticular bleeding

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World Journal of Gastroenterology 2015年第4期21卷 1292-1298页

作者： Naoyoshi Nagata Ryota Niikura Tomonori Aoki Takuro Shimbo Katsunori Sekine Hidetaka Okubo Kazuhiro watanabe Toshiyuki Sakurai Chizu Yokoi Junichi Akiyama Mikio Yanase masashi Mizokami Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and MedicineTokyo 162-8655Japan Department of Clinical Research and Informatics National Center for Global Health and MedicineTokyo 162-8655Japan Department of Gastroenterology and Hepatology National Center for Global Health and MedicineKohnodai HospitalChiba 272-8516Japan

AIM: To determine the effect of discontinuing nonsteroidal antiinflammatory drugs(NSAIDs) on recurrence in long-term follow-up patients with colonic diverticular bleeding(CDB).METHODS: A cohort of 132 patients hospitalized for CDB examined by colonoscopy was prospectively enrolled. Comorbidities, lifestyle, and medications(NSAIDs, low-dose aspirin, antiplatelet agents, anticoagulants, acetaminophen, and corticosteroids) were assessed. After discharge, patients were requested to visit the hospital on scheduled days during the followup period. The Kaplan-Meier method was used to estimate ***: Median follow-up was 15 mo. The probability of recurrence at 1, 6, 12, and 24 mo was 3.1%, 19%, 27%, and 38%, respectively. Of the 41 NSAID users on admission, 26(63%) discontinued NSAID use at discharge. Many of the patients who could discontinue NSAIDs were intermittent users, and could be switched to alternative therapies, such as acetaminophen or an antiinflammatory analgesic plaster. The probability of recurrence at 12 mo was 9.4% in discontinuing NSAID users compared with 77% in continuing users(P 70 years, right-sided diverticula, history of hypertension, and hemodialysis. No patients developed cerebrocardiovascular events during ***: There is a substantial recurrence rate after discharge among patients hospitalized for diverticular bleeding. Discontinuation of NSAIDs is an effective preventive measure against recurrence. This study provides new information on risk reduction strategies for diverticular bleeding.

关键词： Non-steroidal anti-inflammatories Drug withdrawal

Hot snare polypectomy vs endoscopic mucosal resection using bipolar snare for intermediate size colorectal lesions:Propensity score matching

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World Journal of Gastroenterology 2023年第23期29卷 3668-3677页

作者： Nobuhisa Minakata Tatsuro Murano masashi Wakabayashi Maasa Sasabe Takashi watanabe Tomohiro Mitsui Hiroki Yamashita Atsushi Inaba Hironori Sunakawa Keiichiro Nakajo Tomohiro Kadota Kensuke Shinmura Hiroaki Ikematsu Tomonori Yano Department of Gastroenterology and Endoscopy National Cancer Center Hospital EastKashiwa 2778577ChibaJapan Department of Biostatistics Division Center for Research Administration and SupportNational Cancer CenterKashiwa 2778577ChibaJapan

BACKGROUND Endoscopic resection(ER)with bipolar snare,in which the electric current only passes through the tissue between the device’s two electrodes,is a prominent method used to prevent perforation due to electricity *** using bipolar snare with or without submucosal injection enabled safe resection of colorectal lesions measuring 10-15 mm in an ex vivo porcine *** with bipolar snare is expected to have good treatment outcomes in 10-15 mm colorectal lesions,with high safety even without submucosal ***,no clinical reports have compared treatment outcomes with and without submucosal *** To compare the treatment outcomes of bipolar polypectomy with hot snare polypectomy(HSP)to those with endoscopic mucosal resection(EMR).METHODS In this single-centre retrospective study,we enrolled 10-15 mm nonpedunculated colorectal lesions(565 Lesions in 463 patients)diagnosed as type 2A based on the Japan Narrow-band Imaging Expert Team classification,resected by either HSP or EMR between January 2018 and June 2021 at the National Cancer Center Hospital *** were divided into HSP and EMR groups,and propensity score matching was *** the matched cohort,en bloc and R0 resection rates and adverse events were compared between the two *** Of the 565 lesions in 463 patients,117 lesions each in the HSP and EMR groups were selected after propensity score *** the original cohort,there was a significant difference in antithrombotic drug use(P<0.05),lesion size(P<0.01),location(P<0.01),and macroscopic type(P<0.05)between the HSP and EMR *** the matched cohort,the en bloc resection rates were comparable between both groups[93.2%(109/117)vs 92.3%(108/117),P=0.81],and there was no significant difference in the R0 resection rate[77.8%(91/117)vs 80.3%(94/117),P=0.64].The incidence of delayed bleeding was similar in both groups[1.7%(2/117)].Perforation occurred in the EMR group[0.9%(1/117)]but not in the HSP ***

关键词： Adenoma Cohort studies Colonoscopy Colorectal cancer Endoscopic mucosal resection Treatment outcome

Risk factors for adverse in-hospital outcomes in acute colonic diverticular hemorrhage

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World Journal of Gastroenterology 2015年第37期21卷 10697-10703页

作者： Naoyoshi Nagata Ryota Niikura Tomonori Aoki Shiori Moriyasu Toshiyuki Sakurai Takuro Shimbo Katsunori Sekine Hidetaka Okubo Kazuhiro watanabe Chizu Yokoi Junichi Akiyama Mikio Yanase masashi Mizokami Kazuma Fujimoto Naomi Uemura Department of Gastroenterology and Hepatology National Center for Global Health and Medicine Department of Clinical Research and Informatics National Center for Global Health and Medicine Department of Gastroenterology and Hepatology National Center for Global Health and Medicine Kohnodai Hospital Kohnodai Department of Internal Medicine and Gastrointestinal Endoscopy Saga Medical School

AIM: To investigate the factors associated with transfusion, further bleeding, and prolonged length of ***: In total, 153 patients emergently hospitalized for diverticular bleeding who were examined by colonoscopy were prospectively enrolled. Patients in whom the bleeding source was identified received endoscopic treatment such as clipping or endoscopic ligation. After spontaneous cessation of bleeding withconservative treatment or hemostasis with endoscopic treatment, all patients were started on a liquid food diet and gradually progressed to a solid diet over 3d, and were discharged. At enrollment, we assessed smoking, alcohol, medications [non-steroidal antiinflammatory drugs(NSAIDs)], low-dose aspirin, and other antiplatelets, warfarin, acetaminophen, and oral corticosteroids), and co-morbidities [hypertension,diabetes mellitus, dyslipidemia, cerebro-cardiovascular disease, chronic liver disease, and chronic kidney disease(CKD)]. The in-hospital outcomes were need for transfusion, further bleeding after spontaneous cessation of hemorrhage, and length of hospital *** odds ratio(OR) for transfusion need, further bleeding, and prolonged length of stay were estimated by logistic regression ***: No patients required angiographic embolization or surgery. Stigmata of bleeding occurred in 18% of patients(27/153) and was treated by endoscopic procedures. During hospitalization, 40patients(26%) received a median of 6 units of packed red blood cells. Multivariate analysis revealed that female sex(OR = 2.5, P = 0.02), warfarin use(OR= 9.3, P 70years(OR = 2.1, P = 0.04) and NSAID use(OR = 2.7,P = 0.03) were

关键词： In-hospital adverse clinical outcomes Antithrombot

Removal of diminutive colorectal polyps: A prospective randomized clinical trial between cold snare polypectomy and hot forceps biopsy

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World Journal of Gastroenterology 2017年第2期23卷 328-335页

作者： Yoriaki Komeda Hiroshi Kashida Toshiharu Sakurai George Tribonias Kazuki Okamoto masashi Kono Mitsunari Yamada Teppei Adachi Hiromasa Mine Tomoyuki Nagai Yutaka Asakuma Satoru Hagiwara Shigenaga Matsui Tomohiro watanabe Masayuki Kitano Takaaki Chikugo Yasutaka Chiba Masatoshi Kudo Department of Gastroenterology and Hepatology Kindai University Faculty of Medicine Department of Pathology Kindai University Faculty of Medicine Clinical Research Center Kindai University Hospital

AIMTo compare the efficacy and safety of cold snare polypectomy (CSP) and hot forceps biopsy (HFB) for diminutive colorectal *** prospective, randomized single-center clinical trial included consecutive patients ≥ 20 years of age with diminutive colorectal polyps 3-5 mm from December 2014 to October 2015. The primary outcome measures were en-bloc resection (endoscopic evaluation) and complete resection rates (pathological evaluation). The secondary outcome measures were the immediate bleeding or immediate perforation rate after polypectomy, delayed bleeding or delayed perforation rate after polypectomy, use of clipping for bleeding or perforation, and polyp retrieval rate. Prophylactic clipping after polyp removal wasn’t routinely *** hundred eight patients were randomized into the CSP (102), HFB (106) and 283 polyps were evaluated (CSP: 148, HFB: 135). The en-bloc resection rate was significantly higher with CSP than with HFB [99.3% (147/148) vs 80.0% (108/135), P < 0.0001]. The complete resection rate was significantly higher with CSP than with HFB [80.4% (119/148) vs 47.4% (64/135), P < 0.0001]. The immediate bleeding rate was similar between the groups [8.6% (13/148) vs 8.1% (11/135), P = 1.000], and endoscopic hemostasis with hemoclips was successful in all cases. No cases of perforation or delayed bleeding occurred. The rate of severe tissue injury to the pathological specimen was higher HFB than CSP [52.6% (71/135) vs 1.3% (2/148), P < 0.0001]. Polyp retrieval failure was encountered CSP (7), HFB (2).CONCLUSIONCSP is more effective than HFB for resecting diminutive polyps. Further long-term follow-up study is required.

关键词： Cold snare polypectomy Colonoscopy Polypectomy Colorectal diminutive polyps Hot forceps biopsy