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Precision surgical approach with lymph-node dissection in early gastric cancer

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World Journal of Gastroenterology 2019年第14期25卷 1640-1652页

作者： shinichi kinami Naohiko Nakamura Yasuto Tomita Takashi Miyata Hideto Fujita Nobuhiko Ueda Takeo Kosaka Department of Surgical Oncology Kanazawa Medical University

The gravest prognostic factor in early gastric cancer is lymph-node metastasis,with an incidence of about 10% overall. About two-thirds of early gastric cancer patients can be diagnosed as node-negative prior to treatment based on clinicpathological data. Thus, the tumor can be resected by endoscopic submucosal dissection. In the remaining third, surgical resection is necessary because of the possibility of nodal metastasis. Nevertheless, almost all patients can be cured by gastrectomy with D1+ lymph-node dissection. Laparoscopic or robotic gastrectomy has become widespread in East Asia because perioperative and oncological safety are similar to open surgery. However, after D1+ gastrectomy,functional symptoms may still result. Physicians must strive to minimize postgastrectomy symptoms and optimize long-term quality of life after this operation.Depending on the location and size of the primary lesion, preservation of the pylorus or cardia should be considered. In addition, the extent of lymph-node dissection can be individualized, and significant gastric-volume preservation can be achieved if sentinel node biopsy is used to distinguish node-negative patients.Though the surgical treatment for early gastric cancer may be less radical than in the past, the operative method itself seems to be still in transition.

关键词： Stomach neoplasms surgery Gastrectomy methods Recovery of function Sentinel lymph node surgery Gastric cancer

Diagnostic ability of multi-detector spiral computed tomography for pathological lymph node metastasis of advanced gastric cancer

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World Journal of Gastrointestinal Oncology 2020年第4期12卷 435-446页

作者： Zhi-Yong Jiang shinichi kinami Naohiko Nakamura Takashi Miyata Hideto Fujita Hiroyuki Takamura Nobuhiko Ueda Takeo Kosaka Department of Surgical Oncology Kanazawa Medical University1-1 DaigakuUchinada-machiKahoku-gunIshikawa 920-0293Japan

BACKGROUND The reliability of preoperative nodal diagnosis of advanced gastric cancer by multi-detector spiral computed tomography(MDCT)is still unclear.AIM To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic patterns.METHODS A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this study.The nodal sizes measured on computed tomography(CT)images were compared with the pathology results.A receiver-operating characteristic curve was constructed,from which the critical value(CV)was calculated by using the data of the first 69 patients retrospectively.By using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive patients.This enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node mapping.The intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and diffuse.RESULTS Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no metastasis.The number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,respectively.The CV obtained from the receiver-operating characteristic was 7.6 mm for the long axis.The sensitivity was 91.4%and the specificity was 47.3%in the prospective phase.The large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these forms.CONCLUSION The ability of MDCT to contribute to a nodal diagnosis of advanced gastric cancer was examined prospectively with precise size data from node mapping,using a CV of 7.6 mm for the long axis that was calculated from the retrospectively collected data.The sensitivity was as high as 91%,and would be improved when referring to the enhanced patterns.However,its specificity was as l

关键词： Advanced gastric cancer Lymph node metastasis Multi-detector spiral computed tomography Pathological diagnosis

Life prognosis of sentinel node navigation surgery for early-stage gastric cancer:Outcome of lymphatic basin dissection

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World Journal of Gastroenterology 2021年第46期27卷 8010-8030页

作者： shinichi kinami Naohiko Nakamura Tomoharu Miyashita Hidekazu Kitakata Sachio Fushida Takashi Fujimura Yasuo Iida Noriyuki Inaki Toru Ito Hiroyuki Takamura Department of Surgical Oncology Kanazawa Medical UniversityKahoku 920-0293IshikawaJapan Department of Gastroenterological Endoscopy Kanazawa Medical UniversityKahoku 920-0293IshikawaJapan Department of Gastrointestinal Surgery Kanazawa UniversityKanazawa 920-8641IshikawaJapan Department of Surgery Toyama City HospitalToyama 939-8511ToyamaJapan Department of Mathematics Division of General EducationKanazawa Medical UniversityKahoku 920-0293IshikawaJapan

BACKGROUND Lymphatic basin dissection is a sentinel node biopsy method that is specific for gastric cancer.In this method,the dyed lymphatic system is dissected en bloc,and sentinel nodes are identified at the back table(ex vivo).Even with lymphatic basin dissection,blood flow to the residual stomach can be preserved,and functionpreserving curative gastrectomy can be performed.The oncological safety of function-preserving curative gastrectomy combined with lymphatic basin dissection has not yet been fully investigated.We hypothesized that the oncological safety of sentinel node navigation surgery(SNNS)is not inferior to that of the guidelines.AIM To investigate the life prognosis of SNNS for gastric cancer in comparison with guidelines surgery.METHODS This was a retrospective cohort study.Patients were selected from gastric cancer patients who underwent sentinel node biopsy from April 1999 to March 2016.Patients from April 1999 to August 2008 were from the Department of Surgery II,Kanazawa University Hospital,and patients from August 2009 to March 2016 were from the Department of Surgical Oncology,Kanazawa Medical University Hospital.Patients who were diagnosed with gastric cancer,which was preoperatively diagnosed as superficial type(type 0),5 cm or less in length,clinical T1-2 and node negative,and underwent various gastrectomies guided by sentinel node navigation were retrospectively collected.The overall survival(OS)and relapsefree survival(RFS)of these patients(SNNS group)were investigated.Patients with gastric cancer of the same stage and who underwent guidelines gastrectomy with standard nodal dissection were also selected as the control group.RESULTS A total of 239 patients in the SNNS group and 423 patients in the control group were included.Pathological nodal metastasis was observed in 10.5%and 10.4%of the SNNS and control groups,respectively.The diagnostic abilities of sentinel node biopsy were 84%and 98.6%for sensitivity and accuracy,respectively.In the SNNS group,81.6%of patients underwent modified g

关键词： Early gastric cancer Sentinel node biopsy Function preserving surgery Lymph node dissection Gastrectomy Lymphatic basin dissection

Defecation disorders are crucial sequelae that impairs the quality of life of patients after conventional gastrectomy

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World Journal of Gastrointestinal Surgery 2021年第11期13卷 1484-1496页

作者： Koji Nakada Masami Ikeda Masazumi Takahashi shinichi kinami Masashi Yoshida Yoshikazu Uenosono Masanori Terashima Atsushi Oshio Yasuhiro Kodera University School of Medicine Tokyo 105-8461Japan Department of Surgery Asama General HospitalSaku 385-0022Japan Division of Gastroenterological Surgery Yokohama Municipal Citizen’s HospitalYokohama 240-8555Japan Department of Surgical Oncology Kanazawa Medical SchoolKanazawa 920-0293Japan Department of Surgery International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Digestive Surgery Imamura General HospitalKagoshima 890-0064Japan Division of Gastric Surgery Shizuoka Cancer CenterShizuoka 411-8777Japan Faculty of Letters Arts and SciencesWaseda UniversityTokyo 169-8050Japan Department of Gastroenterological Surgery Nagoya University Graduate School of MedicineNagoya 466-8550Japan

BACKGROUND Defecation disorders are obscure sequelae that occurs after gastrectomy,and its implication on daily lives of patients have not been sufficiently investigated.AIM To examine the features of defecation disorders after gastrectomy and to explore its implication on daily lives of patients in a large cohort using the Postgast rectomy Syndrome Assessment Scale(PGSAS)-45.METHODS We conducted a nationwide multi-institutional study using PGSAS-45 to examine the prevalence of postgastrectomy syndrome and its impact on daily lives of patients after various types of gastrectomy.Data were obtained from 2368 eligible patients at 52 institutions in Japan.Of these,1777 patients who underwent total gastrectomy(TG;n=393)or distal gastrectomy(DG;n=1384)were examined.The severity of defecation disorder symptoms,such as diarrhea and constipation,and their correlation with other postgastrectomy symptoms were examined.The importance of defecation disorder symptoms on the living states and quality of life(QOL)of postgastrectomy patients,and those clinical factors that affect the severity of defecation disorder symptoms were evaluated using multiple regression analysis.RESULTS Among seven symptom subscales of PGSAS-45,the ranking of diarrhea was 4th in TG and 2nd in DG.The ranking of constipation was 5th in TG and 1st in DG.The symptoms that correlated well with diarrhea were dumping and indigestion in both TG and DG;while those with constipation were abdominal pain and mealrelated distress in TG,and were meal-related distress and indigestion in DG.Among five main outcome measures(MOMs)of living status domain,constipation significantly impaired four MOMs,while diarrhea had no effect in TG.Both diarrhea and constipation impaired most of five MOMs in DG.Among six MOMs of QOL domain,diarrhea impaired one MOM,whereas constipation impaired all six MOMs in TG.Both diarrhea and constipation equally impaired all MOMs in DG.Male sex,younger age,division of the celiac branch of vagus nerve,and TG,independently worsened diarrhea,while f

关键词： Postgastrectomy syndrome Defecation disorders Quality of life Patientreported outcome measures Gastrectomy

Background factors influencing postgastrectomy syndromes after various types of gastrectomy

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World Journal of Clinical Cases 2018年第16期6卷 1111-1120页

作者： shinichi kinami Masazumi Takahashi Takashi Urushihara Masami Ikeda Masashi Yoshida Yoshikazu Uenosono Atsushi Oshio Yoshimi Suzukamo Masanori Terashima Yasuhiro Kodera Koji Nakada Department of Surgical Oncology Kanazawa Medical University Division of Gastroenterological Surgery Yokohama Municipal Citizen’s Hospital Department of Gastroenterological Breast and Transplant Surgery Hiroshima Prefectural Hospital Department of Surgery Asama General Hospital Department of Surgery International University of Health and Welfare Hospital Department of Surgery Imamura General Hospital Faculty of Letters Arts and Sciences Waseda University Department of Physical Medicine and Rehabilitation Tohoku University Graduate School of Medicine Division of Gastric Surgery Shizuoka Cancer Center Department of Gastroenterological Surgery Nagoya University Graduate School of Medicine Department of Laboratory Medicine The Jikei University Daisan Hospital

BACKGROUND Postgastrectomy syndromes(PGS) after curative gastrectomy for gastric cancer are influenced by not only gastrectomy type but also by background factors. Recently, a nationwide PGS study was performed using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45) questionnaire.AIM To determine the influence of each background factor on PGS for each gastrectomy type using PGS assessment study(PGSAS) data as an additional analysis. METHODS The data of 2368 patients were obtained from the PGSAS. This included patients undergoing distal gastrectomy(DG) with Billroth I reconstruction, DG with Roux-en-Y reconstruction, total gastrectomy with Roux-en-Y, proximal gastrectomy, pylorus-preserving gastrectomy(PPG), and local resection. Multiple regression analysis was performed to explore the independent effects of each background factor on the main outcome measures(MOMs) of PGSAS-45 for each gastrectomy type. The background factors included postoperative period, age, sex, surgical approach(laparoscopic or open), and the status of the celiac branch of the vagal nerve.RESULTS The MOMs of DG and PPG were highly affected by background factors, whereas those of total gastrectomy with Roux-en-Y, proximal gastrectomy, and local resection were not. Worse PGS were found in females, whereas a longer postoperative period alleviated some of the MOMs. For DG and PPG, a laparoscopic approach and preservation of the celiac branch improved several MOMs.CONCLUSION Various background factors affected PGS, and their influence varied with the type of gastrectomy performed. Laparoscopic surgery and celiac branch preservation can improve PGS in patients undergoing DG and PPG.

关键词： Postgastrectomy syndrome Gastrectomy Gastric cancer Postgastrectomy Syndrome Assessment Scale-45

Quality of life after total vs distal gastrectomy with Rouxen-Y reconstruction: Use of the Postgastrectomy Syndrome Assessment Scale-45

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World Journal of Gastroenterology 2017年第11期23卷 2068-2076页

作者： Masazumi Takahashi Masanori Terashima Hiroshi Kawahira Eishi Nagai Yoshikazu Uenosono shinichi kinami Yasuhiro Nagata Masashi Yoshida Keishiro Aoyagi Yasuhiro Kodera Koji Nakada Division of Gastroenterological Surgery Yokohama Municipal Citizen’s Hospital Division of Gastric Surgery Shizuoka Cancer Center Center for Frontier Medical Engineering Chiba University Department of Surgery and Science Graduate school of medicine Kyushu University Department of Digestive Surgery Kagoshima University Graduate School of Medicine Department of Surgical Oncology Kanazawa Medical School Center for Comprehensive Community Care Education Graduate School of Biomedical Sciences Nagasaki University Department of Surgery International University of Health and Welfare Hospital Department of Surgery Kurume University School of Medicine Department of Gastroenterological Surgery Nagoya University Graduate School of Medicine Department of Laboratory Medicine The Jikei University School of Medicine

AIM To investigate the detrimental impact of loss of reservoir capacity by comparing total gastrectomy(TGRY) and distal gastrectomy with the same Rouxen-Y(DGRY) reconstruction. The study was conducted using an integrated questionnaire, the Postgastrectomy Syndrome Assessment Scale(PGSAS)-45, recently developed by the Japan Postgastrectomy Syndrome Working Party.METHODS The PGSAS-45 comprises 8 items from the Short Form-8, 15 from the Gastrointestinal Symptom Rating Scale, and 22 newly selected items. Uni-and multivariate analysis was performed on 868 questionnaires completed by patients who underwent either TGRY(n = 393) or DGRY(n = 475) for stage I gastric cancer(52 institutions). Multivariate analysis weighed of six explanatory variables, including the type of gastrectomy(TGRY/DGRY), interval after surgery, age, gender, surgical approach(laparoscopic/open), and whether the celiac branch of the vagus nerve was preserved/divided on the quality of life(QOL).RESULTS The patients who underwent TGRY experienced the poorer QOL compared to DGRY in the 15 of 19 main outcome measures of PGSAS-45. Moreover, multiple regression analysis indicated that the type of gastrectomy, TGRY, most strongly and broadly impaired the postoperative QOL among six explanatory variables. CONCLUSION The results of the present study suggested that TGRY had a certain detrimental impact on the postoperative QOL, and the loss of reservoir capacity could be a major cause.

关键词： Postgastrectomy syndrome Quality of life Gastric cancer Gastrectomy Patient-reported outcome

Efficacy of the fat-dissociation method for nodal harvesting in gastric cancer

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World Journal of Gastrointestinal Surgery 2020年第6期12卷 277-286页

作者： shinichi kinami Toshio Ohnishi Naohiko Nakamura Zhi Yong Jiang Takashi Miyata Hideto Fujita Hiroyuki Takamura Nobuhiko Ueda Takeo Kosaka Department of Surgical Oncology Kanazawa Medical UniversityKahoku-gunIshikawa920-0293Japan

BACKGROUND There is an increased need for accurate staging for gastric cancer treatment.Consequently, it is necessary to carefully examine all dissected lymph nodes for precise staging. Recently, the fat-dissociation method has been developed as a quick and accurate method for harvesting dissected lymph nodes of colorectal cancer cases.AIM To investigate the usefulness of the fat-dissociation method for harvesting dissected lymph nodes of gastric cancer cases.METHODS Fifty-six resected specimens from gastric cancer patients who underwent standard curative gastrectomy and lymph node dissection at our hospital were used. Group 2 lymph nodes were separated from each specimen, and the remaining adipose tissue containing the group 1 lymph nodes was used. Some resected specimens were subjected to the fat-dissociation method. One vial of Imofully~? was dissolved in 50 m L of saline and injected into the tissue. The tissue was incubated for 1 h and the dissolved fat was removed. Subsequently, the nodes were identified, picked up with scissors, and mapped. The number of nodes in each lymphatic compartment and duration of lymph node harvest and mapping were compared.RESULTS The fat-dissociation method was used for 24 samples, while the conventional dissection method was used for 32 samples. The total number of harvested lymph nodes was 45.9 in the fat dissociation group and 44.3 in the control group, and there was no significant difference between the two groups. There were also no significant differences in the number of lymph nodes between the two groups based on a comparison of the lymphatic compartments. However, the total median duration of the fat-dissociation method was 38.2 min, reflecting a reduced duration of approximately 60 min compared to the control group.CONCLUSION Based on our results, the fat-dissociation method is effective in shortening the duration of lymph node harvest in gastric cancer surgery.

关键词： Gastric cancer Lymph node dissection Staging Lymph node mapping Fatdissociationmethod Efficacy

Factors affecting the quality of life of patients after gastrectomy as assessed using the newly developed PGSAS-45 scale: A nationwide multi-institutional study

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World Journal of Gastroenterology 2016年第40期22卷 8978-8990页

作者： Koji Nakada Masazumi Takahashi Masami Ikeda shinichi kinami Masashi Yoshida Yoshikazu Uenosono Yoshiyuki Kawashima Sayumi Nakao Atsushi Oshio Yoshimi Suzukamo Masanori Terashima Yasuhiro Kodera Department of Laboratory Medicine Daisan Hospital Jikei University School of MedicineTokyo 201-8601Japan Division of Gastroenterological Surgery Yokohama Municipal Citizen’s HospitalYokohama 240-8555Japan Department of Surgery Asama General HospitalSaku 085-0022Japan Department of Surgical Oncology Kanazawa Medical SchoolKanazawa 920-0293Japan Department of Surgery International University of Health and Welfare HospitalTochigi 329-2763Japan Department of Digestive Surgery Breast and Thyroid SurgeryKagoshima University Graduate School of MedicineKagoshima 890-8620Japan Division of Gastroenterological Surgery Saitama Cancer CenterSaitanna 362-0806Japan Department of Surgery 2 Tokyo Women’s Medical UniversityTokyo 162-8666Japan Faculty of Letters Arts and SciencesWaseda UniversityTokyo 169-8050Japan Department of Physical Medicine and Rehabilitation Tohoku University Graduate School of MedicineSendai 980-8575Japan Division of Gastric Surgery Shizuoka Cancer CenterShizuoka 411-8777Japan Department of Gastroenterological Surgery Nagoya University Graduate School of MedicineNagaya 466-8550Japan

AIM To identify certain clinical factors other than the type of gastrectomy which affect the postoperative quality of life(QOL) of patients after gastrectomy.METHODS The postgastrectomy syndrome assessment scale(PGSAS)-45 was designed to assess the severity of symptoms, the living status and the QOL of gastrectomized patients. It consists of 45 items, of which 22 are original items while 23 were retrieved from the SF-8 and Gastrointestinal Symptoms Rating Scale questionnaires with permission. A nationwide surveillance study to validate PGSAS was conducted and 2368 gastric cancer patients who underwent various types of gastrectomy at 52 medical institutions were enrolled. Of these, 1777 patients who underwent total gastrectomy(TG) reconstructed with Roux-Y(n = 393), distal gastrectomy(DG) reconstructed with Billroth-I(n = 909), or DG reconstructed with Roux-Y(n = 475) were evaluated in the current study. The influence of the type of gastrectomy and other clinical factors such as age, sex, duration after surgery, the symptom severity, the degree of weight loss, dietary intake, and the ability for working on the postoperative QOL(i.e., dissatisfaction for daily life subscale, physical component summary and mental component summary of the SF-8) were examined by multiple regression analysis(MRA). In addition, importance of various symptoms such as esophageal reflux, abdominal pain, meal-related distress, indigestion, diarrhea, constipation and dumping on the postoperative living status and QOL were also appraised by MRA.RESULTS The postoperative QOL were significantly deteriorated in patients who underwent TG compared to those after DG. However, the extent of gastrectomy was not an influential factor on patients' QOL when adjusted by the MRA. Among various clinical factors, the symptom severity, ability for working, and necessity for additional meals were the most influential factorsto the postoperative QOL. As for the individual symptoms, meal-related distress, dumping, abdominal pain, and esophageal reflux significa

关键词： Postgastrectomy 症候群生活的质量病人 -- 报导结果效果尺寸 Gastrectomy

Comparison of effects of six main gastrectomy procedures on patients’ quality of life assessed by Postgastrectomy Syndrome Assessment Scale-45

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World Journal of Gastrointestinal Surgery 2021年第5期13卷 461-475页

作者： Koji Nakada Yoshiyuki Kawashima shinichi kinami Ryoji Fukushima Hiroshi Yabusaki Akiyoshi Seshimo Naoki Hiki Keisuke Koeda Mikihiro Kano Yoshikazu Uenosono Atsushi Oshio Yasuhiro Kodera Department of Laboratory Medicine The Jikei University School of MedicineTokyo 105-8461Japan Department of Gastroenterological Surgery Saitama Cancer CenterSaitama 362-0806Japan Department of Surgical Oncology Kanazawa Medical UniversityKahoku-gun 920-0293IshikawaJapan Department of Surgery Teikyo University School of MedicineTokyo 173-8605Japan Department of Surgery Niigata Cancer Center HospitalNiigata 951-8566Japan Department of Gastrointestinal and Pediatric Surgery Tokyo Medical UniversityTokyo 160-0023Japan Department of Upper Gastrointestinal Surgery Kitasato University School of MedicineKanagawa 252-0374Japan Department of Medical Safety Science Iwate Medical UniversityIwate 028-3695Japan Department of Surgery Hiroshima City Asa Citizens HospitalHiroshima 731-0293Japan Department of Digestive Surgery Imamura General HospitalKagoshima 890-0064Japan Faculty of Letters Arts and SciencesWaseda UniversityTokyo 162-8644Japan Department of Gastroenterological Surgery Nagoya University Graduate School of MedicineNagoya 466-8550Japan

BACKGROUND The effects of various gastrectomy procedures on the patient’s quality of life(QOL)are not well understood.Thus,this nationwide multi-institutional crosssectional study using the Postgastrectomy Syndrome Assessment Scale-45(PGSAS-45),a well-established questionnaire designed to clarify the severity and characteristics of the postgastrectomy syndrome,was conducted.AIM To compare the effects of six main gastrectomy procedures on the postoperative QOL.METHODS Eligible questionnaires retrieved from 2368 patients who underwent either of six gastrectomy procedures[total gastrectomy with Roux-en-Y reconstruction(TGRY;n=393),proximal gastrectomy(PG;n=193),distal gastrectomy with Roux-en-Y reconstruction(DGRY;n=475),distal gastrectomy with Billroth-I reconstruction(DGBI;n=909),pylorus-preserving gastrectomy(PPG;n=313),and local resection of the stomach(LR;n=85)]were analyzed.Among the 19 main outcome measures of PGSAS-45,the severity and characteristics of postgastrectomy syndrome were compared for the aforementioned six gastrectomy procedures using analysis of means.RESULTS TGRY and PG significantly impaired the QOL of postoperative patients.Postoperative QOL was excellent in LR(cardia and pylorus were preserved with minimal resection).In procedures removing the distal stomach,diarrhea subscale(SS)and dumping SS were less frequent in PPG than in DGBI and DGRY.However,there was no difference in the postoperative QOL between DGBI and DGRY.The most noticeable adverse effects caused by gastrectomy were mealrelated distress SS,dissatisfaction at the meal,and weight loss,with significant differences among the surgical procedures.CONCLUSION Postoperative QOL greatly differed among six gastrectomy procedures.The severity and characteristics of postgastrectomy syndrome should be considered to select gastrectomy procedures,overcome surgical shortcomings,and enhance postoperative care.

关键词： Gastrectomy Quality of life Postgastrectomy syndromes Patient reported outcome measures