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Progression of remnant gastric cancer is associated with duration of follow-up following distal gastrectomy

World Journal of Gastroenterology 2012年第22期18卷 2832-2836页

作者： Shuhei Komatsu Daisuke Ichikawa Kazuma Okamoto Daito Ikoma Masahiro Tsujiura Yukihisa Nishimura Yasutoshi Murayama Atsushi Shiozaki Hisashi Ikoma Yoshiaki Kuriu masayoshi nakanishi Hitoshi Fujiwara Toshiya Ochiai Yukihito Kokuba Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine 465 Kajii-cho Kawaramachihirokoji Kamigyo-ku Kyoto 602-8566 Japan

AIM： TO re-evaluate the recent clinicopathological fea- tures of remnant gastric cancer （RGC） and to develop desirable surveillance ***： Between 1997 and 2008, 1149 patients underwent gastrectomy for gastric cancer at the Department of Digestive Surgery, Kyoto Prefectural Uni- versity of Medicine, Japan. Of these, 33 patients un- derwent gastrectomy with lymphadenectomy for RGC. Regarding the initial gastric disease, there were 19 patients with benign disease and 14 patients with gas- tric cancer. The hospital records of these patients were reviewed retrospectively. RESULTS： Concerning the initial gastric disease, the RGC group following gastric cancer had a shorter in- terval [P 〈 0.05; gastric cancer vs benign disease： 12 （2-22） vs 30 （4-51） years] and were more frequently reconstructed by Billroth- I procedure than those fol- lowing benign lesions （P 〈 0.001）. Regarding recon- struction, RGC following Billroth-]_l reconstruction showed a longer interval between surgical procedures [P 〈 0.001; Billroth-11 vs Billroth- I ： 32 （5-51） vs 12 （2-36） years] and tumors were more frequently associated with benign disease （P 〈 0.001） than those following Billroth- I reconstruction. In tumor location of RGC, after Billroth- I reconstruction, RGC occurred more fre- quently near the suture line and remnant gastric wall. After Billroth- 1I reconstruction, RGC occurred more fre- quently at the anastomotic site. The duration of follow- up was significantly associated with the stage of RGC （P 〈 0.05）. Patients diagnosed with early stage RGC such as stage Ⅰ-Ⅱ tended to have been followed up almost every second year. CONCLUSION： Meticulous follow-up examination and early detection of RGC might lead to a better prognosis. Based on the initial gastric disease and the procedure of reconstruction, an appropriate follow-up interval and programs might enable early detection of RGC.

关键词： Remnant gastric cancer Surveillance Fol-low-up Reconstruction Distal gastrectomy

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Surgical treatment of hepatocellular carcinoma with severe intratumoral arterioportal shunt

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World Journal of Gastroenterology 2010年第25期16卷 3211-3214页

作者： Hiromichi Ishii Teruhisa Sonoyama Shingo Nakashima Hiroyuki Nagata Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma masayoshi nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Toshiya Ochiai Yukihito Kokuba Chohei Sakakura Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine Kyoto 602-8566 Japan

We report a case of hepatocellular carcinoma (HCC) that caused a severe arterioportal shunt (APS). A 49-year-old man was admitted to hospital due to esophagogastric variceal hemorrhage and HCC, and underwent endoscopic variceal ligation (EVL) and endoscopic injection sclerotherapy (EIS). He was then referred to our hospital. Abdominal computed tomography revealed a lowdensity lesion in the posterior segment of the liver and an intratumoral APS, which caused portal hypertension. Although the patient underwent EVL, EIS, Hassab’s operation, and transcatheter arterial embolization for APS, he vomited blood due to rupture of esophagogastric varices. Right hepatectomy was performed for the treatment of HCC and APS, although the indocyanine green retention value at 15 min after intravenous injection was poor (30%). The patient’s postoperative course was uneventful. Eventually, APS disappeared and the esophagogastric varices improved.

关键词： Arterioportal shunt Hepatocellular carcinoma Esophagogastric varices

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Early thrombomodulin-α administration outcome for acute disseminated intravascular coagulopathy in gastrointestinal surgery

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World Journal of Gastroenterology 2017年第5期23卷 891-898页

作者： Hirotaka Konishi Kazuma Okamoto Katsutoshi Shoda Tomohiro Arita Toshiyuki Kosuga Ryo Morimura Shuhei Komatsu Yasutoshi Murayama Atsushi Shiozaki Yoshiaki Kuriu Hisashi Ikoma masayoshi nakanishi Daisuke Ichikawa Hitoshi Fujiwara Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKajii-choKyoto city 6028566Japan

AIMTo investigate the efficacy of thrombomodulin (TM)-α for treatment of disseminated intravascular coagulopathy (DIC) in the field of gastrointestinal ***-six peri-operative DIC patients in the field of gastrointestinal surgery who were treated with TM-α were retrospectively investigated. The relationships between patient demographics and the efficacy of TM-α were examined. Analysis of survival at 28 d was also performed on some parameters by means of the Kaplan-Meier method. Relationships between the initiation of TM-α and patient demographics were also *** formation or bacteremia was the most frequent cause of DIC (33%), followed by digestive tract perforation (31%). Twenty-six patients developed DIC after surgery, frequently within 1 wk (81%). TM-α was most often administered within 1 d of the DIC diagnosis (72%) and was continued for more than 3 d (64%). Although bleeding tendency was observed in 7 patients (19%), a hemostatic procedure was not needed. DIC scores, systemic inflammatory response syndrome (SIRS) scores, quick-sequential organ failure assessment (qSOFA) scores, platelet counts, and prothrombin time ratios significantly improved after 1 wk (P < 0.05, for all). The overall survival rate at 28 d was 71%. The duration of TM-α administration (≥ 4 , ≤ 6) and improvements in DIC-associated scores (DIC, SIRS and qSOFA) at 1 wk were significantly better prognostic factors for 28-d survival (P < 0.05, for all). TM-α was administered significantly earlier to patients with severe clinical symptoms, such as high qSOFA scores, sepsis, shock or high lactate values (P < 0.05, for all).CONCLUSIONEarly administration of TM-α and improvements in each parameter were essential for treatment of DIC. The diagnosis of patients with mild symptoms requires further study.

关键词： Quick-sequential organ failure assessment Thrombomodulin-α Gastrointestinal surgery Systemic inflammatory response syndrome Acute disseminated intravascular coagulopathy

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Laparoscopic transhiatal approach for resection of an adenocarcinoma in long-segment Barrett's esophagus

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World Journal of Gastroenterology 2015年第29期21卷 8974-8980页

作者： Atsushi Shiozaki Hitoshi Fujiwara Hirotaka Konishi Osamu Kinoshita Toshiyuki Kosuga Ryo Morimura Yasutoshi Murayama Shuhei Komatsu Yoshiaki Kuriu Hisashi Ikoma masayoshi nakanishi Daisuke Ichikawa Kazuma Okamoto Chouhei Sakakura Eigo Otsuji Division of Digestive Surgery Department of Surgery Kyoto Prefectural University of Medicine

Barrett's esophagus(BE) is a precursor of esophageal adenocarcinoma and is associated with gastroesophageal reflux disease, which is often preceded by a hiatal hernia. We describe a case of esophageal adenocarcinoma arising in long-segment BE(LSBE) associated with a hiatal hernia that was successfully treated with a laparoscopic transhiatal approach(LTHA) without thoracotomy. The patient was a 42-year-old male who had previously undergone laryngectomy and tracheal separation to avoid repeated aspiration pneumonitis. An ulcerative lesion was found in a hiatal hernia by endoscopy and superficial esophageal cancer was also detected in the lower thoracic esophagus. The histopathological diagnosis of biopsy samples from both lesions was adenocarcinoma. There were difficulties with the thoracic approach because the patient had severe kyphosis and muscular contractures from cerebral palsy. Therefore, we performed subtotal esophagectomy by LTHA without thoracotomy. Using hand-assisted laparoscopic surgery, the esophageal hiatus was divided and carbon dioxide was introduced into the mediastinum. A hernial sac was identified on the cranial side of the right crus of the diaphragm and carefully separated from the surrounding tissues. Abruption of the thoracic esophagus was performed up to the level of thearch of the azygos vein via LTHA. A cervical incision was made in the left side of the permanent tracheal stoma, the cervical esophagus was divided, and gastric tube reconstruction was performed via a posterior mediastinal route. The operative time was 175 min, and there was 61 m L of intra-operative bleeding. A histopathological examination revealed superficial adenocarcinoma in LSBE. Our surgical procedure provided a good surgical view and can be safely applied to patients with a hiatal hernia and kyphosis.

关键词： Laparoscopic transhiatal approach Barrett'sesophageal carcinoma Hiatal hernia

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Optimal duration of the early and late recurrence of hepatocellular carcinoma after hepatectomy

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World Journal of Gastroenterology 2015年第4期21卷 1207-1215页

作者： Yusuke Yamamoto Hisashi Ikoma Ryo Morimura Hirotaka Konishi Yasutoshi Murayama Shuhei Komatsu Atsushi Shiozaki Yoshiaki Kuriu Takeshi Kubota masayoshi nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Chouhei Sakakura Toshiya Ochiai Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan Department of Surgery North Medical CenterKyoto Prefectural University of MedicineKyoto 6028566Japan

AIM: To determine the best cut-off value between the early and late recurrence periods after the initial recurrence of hepatocellular carcinoma(HCC).METHODS: The clinical records of 404 patients who underwent macroscopic curative hepatectomy for HCC between 1980 and 2010 were retrospectively examined. We divided the 252 patients experienced a recurrence of HCC into two groups, the early and late recurrence groups using the "minimum P-value" approach. Factors for early recurrence were investigated using all 404 patients, and factors related to late recurrence were investigated in the patients who were confirmed to be recurrence free at the end of the early recurrence ***: For the 252 patients who experienced a recurrence, the optimal cut-off value for differentiating early and late recurrence based on the overall survival after initial recurrence was 17 mo(5-year overall survival after initial recurrence: 15.4% vs 36.3%, P = 0.000018). Cox proportional hazard analysis identified early recurrence(P = 0.003) as one of the independent prognostic factors associated with overall survival after initial recurrence. A logistic regression model showed that an alpha-fetoprotein level > 100 ng/m L(P < 0.001), multiple HCC(P < 0.001), serosal invasion(P = 0.031), and microvascular invasion(P = 0.012) were independent factors associated with early recurrence, whereas the only independent factor related to late recurrence was liver cirrhosis(P = 0.002).CONCLUSION: Seventeen months after hepatectomy is a useful cut-off value between early and late recurrence of HCC based on the prognosis and different etiologies.

关键词： Early recurrence Late recurrence Hepatocellular ca

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Post-hepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis

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World Journal of Gastroenterology 2015年第1期21卷 246-253页

作者： Yusuke Yamamoto Hisashi Ikoma Ryo Morimura Katsutoshi Shoda Hirotaka Konishi Yasutoshi Murayama Shuhei Komatsu Atsushi Shiozaki Yoshiaki Kuriu Takeshi Kubota masayoshi nakanishi Daisuke Ichikawa Hitoshi Fujiwara Kazuma Okamoto Chouhei Sakakura Toshiya Ochiai Eigo Otsuji Division of Digestive Surgery Department of SurgeryKyoto Prefectural University of MedicineKyoto 6028566Japan Department of Surgery North Medical Center Kyoto Prefectural University of MedicineKyoto 6028566Japan

AIM: To analyze hepatocellular carcinoma(HCC) patients with portal vein tumor thrombosis(PVTT) using the tumor-node-metastasis(TNM) staging ***: We retrospectively analyzed 372 patients with HCC who underwent hepatectomy between 1980 and *** studied the outcomes of HCC patients with PVTT to evaluate the American Joint Committee on Cancer TNM staging system(7th edition) for stratifying and predicting the prognosis of a large cohort of HCC patients after hepatectomy in a *** vein invasion(vp) 1 was defined as an invasion or tumor thrombus distal to the second branch of the portal vein,vp2 as an invasion or tumor thrombus in the second branch of the portal vein,vp3 as an invasion or tumor thrombus in the first branch of the portal vein,and vp4 as an invasion or tumor thrombus in the portal trunk or extending to a branch on the contralateral ***: The cumulative 5-year overall survival(5yr OS) and 5-year disease-free survival(5yr DFS) rates of the 372 patients were 58.3% and 31.3%,*** 5yr DFS and 5yr OS of vp3-4 patients(n = 10) were 20.0%,and 30.0%,respectively,which was comparable with the corresponding survival rates of vp1-2 patients(P = 0.466 and 0.586,respectively).In the subgroup analysis of patients with macroscopic PVTT(vp2-4),the OS of the patients who underwent preoperative transarterial chemoembolization was comparable to that of patients who did not(P = 0.747).There was a significant difference in the DFS between patients with stage Ⅰ HCC and those with stage Ⅱ HCC(5yr DFS 39.2% vs 23.1%,P 100 mg/dL was independently associated with ***: Hepatectomy for vp3-4 HCC results in a survival rate similar to hepatectomy for *** stratified the stage Ⅱ-Ⅲ HCC patients according to prognosis.

关键词： Hepatocellular carcinoma Hepatectomy Portal vein t

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A case of severe acalculous cholecystitis associated with sorafenib treatment for advanced hepatocellular carcinoma

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World Journal of Gastrointestinal Oncology 2012年第5期4卷 115-118页

作者： Yosuke Aihara Hitoshi Yoshiji Masaharu Yamazaki Yasuhide Ikenaka Ryuichi Noguchi Chie Morioka Kosuke Kaji Haruki Tastumi Keisuke nakanishi Maiko Nakamura Junichi Yamao Masahisa Toyohara Akira Mitoro masayoshi Sawai Motoyuki Yoshida Masao Fujimoto Masahito Uemura Hiroshi Fukui Third Department of Internal Medicine Nara Medical UniversityNara 634-8522Japan

Sorafenib,a multikinase inhibitor,is the first and only drug,which improves significantly the overall survival in patients with advanced hepatocellular carcinoma(HCC).However,many patients experience diverse side effects,some of them severe and *** date,acute acalculous cholecystitis has not been documented in association with a HCC patient treated with ***,we report the case of a 43-yearold woman with hepatitis C virus-related advanced *** received sorafenib,and later complained ofa sudden onset of severe right hypocondrial pain with rebound tenderness and muscle *** examination showed mild elevation of transaminases,biliary enzymes,bilirubin,inflammation markers,and a marked peripheral *** computed tomography(CT) revealed a swollen gallbladder with exudate associated with severe inflammation without stones or ***,sorafenib treatment was stopped immediately,and steroid-pulse therapy was *** therapy drastically improved all clinical manifestations along with normalization of CT findings,eosinophilia,and liver *** summary,we herein report a rare case of acute severe acalculous cholecystitis associated with sorafenib in the patient with advanced HCC.

关键词： Hepatocelluar carcinoma Sorafenib Acalculous cholecystitis

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