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World Journal of Gastroenterology 2012年第29期18卷 3787-3789页

作者： kazuhiro hanazaki Department of Surgery Kochi Medical SchoolKochi UniversityKohasuOkochoNankoku-CityKochi 783-8505Japan

It is well known that perioperative hyperglycemia is the main cause of infectious complications after *** improve perioperative glycemic control,we wish to highlight and comment on an interesting paper published recently by the Annals of Surgery entitled:"Early postoperative hyperglycemia is associated with postoperative complications after pancreatoduodenectomy(PD)" by Eshuis et *** authors concluded that early postoperative glucose levels more than 140 mg/dL was significantly associated with complications after *** we recommend that perioperative tight glycemic control(TGC) is an effective method to prevent postoperative complications including surgical site infection after distal,proximal,and total pancreatic resection,we support strongly this conclusion drawn in this ***,if early postoperative glucose control in patients undergoing PD was administrated by conventional method such as sliding scale approach as described in this article,it is difficult to maintain ***,we introduce a novel perioperative glycemic control using an artificial endocrine pancreas against pancreatogenic diabetes after pancreatic resection including PD.

关键词： Tight glycemic control Pancreatic resection Surgical site infection Artificial endocrine pancreas

Mucin phenotype of gastric cancer and clinicopathology of gastric-type differentiated adenocarcinoma

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World Journal of Gastroenterology 2010年第37期16卷 4634-4639页

作者： Tsutomu Namikawa kazuhiro hanazaki Department of Surgery Kochi Medical School

Differentiated adenocarcinoma of the stomach is classified into gastric or intestinal phenotypes based on mucus expression. Recent advances in mucin histochemistry and immunohistochemistry have highlighted the importance of such a distinction, and it is important clinically to distinguish between gastricand intestinal-type differentiated adenocarcinoma. However, a clinical and pathological diagnosis of this type is often difficult in early gastric cancer because of histological similarities between a hyperplastic epithelium and lowgrade atypia. Furthermore, determining tumor margins is often difficult, even with extensive preoperative examination. It is therefore critical to consider these diagnostic difficulties and different biological behaviors with high malignant potential when treating patients with gastric-type differentiated adenocarcinoma.

关键词： Differentiated adenocarcinoma Gastric cancer Gastric phenotype Mucin core protein Mucous phenotype

Surgical outcome of adenosquamous carcinoma of the pancreas

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World Journal of Gastroenterology 2008年第44期14卷 6765-6770页

作者： Takehiro Okabayashi kazuhiro hanazaki Department of Surgery Kochi Medical SchoolKohasu-OkochoNankoku-CityKochi 783-8505Japan

Adenosquamous carcinoma is rare,accounting for 3%-4% of all pancreatic carcinoma cases. These tumors are characterized by the presence of variable proportions of mucin-producing glandular elements and squamous components,the latter of which should account for at least 30% of the tumor tissue. Recently,several reports have described cases of adenosquamous carcinoma of the pancreas. However,as the number of patients who undergo resection at a single institute is limited,large studies describing the clinicopathological features,therapeutic management,and surgical outcome for adenosquamous carcinoma of the pancreas are lacking. We performed a literature review of English articles retrieved from Medline using the keywords 'pancreas' and 'adenosquamous carcinoma'. Additional articles were obtained from references within the papers identif ied by the Medline search. Our subsequent review of the literature revealed that optimal adjuvant chemotherapy and/or radiotherapy regimens for adenosquamous carcinoma of the pancreas have not been established,and that curative surgical resection offers the only chance for long-term survival. Unfortunately,the prognosis of the 39 patients who underwent pancreatic resection for adenosquamous carcinoma was very poor,with a 3-year overall survival rate of 14.0% and a median survival time of 6.8 mo. Since the postoperative prognosis of adenosquamous carcinoma of the pancreas is currently worse than that of pancreatic adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques should be investigated as they may prove indispensible to the improvement of surgical outcomes.

关键词： Adenosquamous carcinoma of the pancreas Pancreatectomy Surgical outcome Survival afterpancreatic resection

Clinical analysis of primary anaplastic carcinoma of the small intestine

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World Journal of Gastroenterology 2009年第5期15卷 526-530页

作者： Tsutomu Namikawa kazuhiro hanazaki Department of Surgery Kochi Medical School Kohasu-Okocho Nankoku-City Kochi 783-8505 Japan

Primary anaplastic carcinoma is a rare variant of small intestinal cancer. Most reports of primary anaplastic carcinoma of the small intestine are isolated case reports, therefore the clinicopathological features, therapeutic management, and surgical outcome of this tumor type remain unclear. This review analyzes the available clinical characteristics of primary anaplastic carcinoma of the small intestine and investigates key differences from differentiated adenocarcinoma of the small intestine. A Medline search was performed using the keywords ＇small intestine＇ and ＇anaplastic carcinoma＇ or ＇undifferentiated carcinoma＇. Additional articles were obtained from references within the papers identified by the Medline search. The literature revealed a poor prognosis for patients who underwent surgical resection for anaplastic carcinoma of the small intestine, which gave a 3-year overall survival rate of 10.8% and a median survival time of 5.0 mo. The literature suggests that anaplastic carcinoma~ is markedly more aggressive than differentiated adenocarcinoma of the small intestine. Surgical resection with the aim of complete tumor removal provides the only beneficial therapeutic option for patients with anaplastic carcinoma of the small intestine, because chemotherapy and radiation therapy have no significant effect on the rate of survival. However, despite complete tumor resection, most patients with anaplastic carcinoma of the small intestine are at great risk of disease recurrence. Multicenter clinical trials are expected to provide additional therapeutic strategies and establish the efficacy of multimodality adjuvant therapy. This report also highlights the importance of a systematic diagnostic approach for anaplastic carcinoma of the small intestine.

关键词： Anaplastic carcinoma Small intestinalcancer Small intestinal tumor Operation Prognosis

Clinicopathological features of early gastric cancer with duodenal invasion

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World Journal of Gastroenterology 2009年第19期15卷 2309-2313页

作者： Tsutomu Namikawa kazuhiro hanazaki Department of Surgery Kochi Medical SchoolKohasu-OkochoNankoku-CityKochi 783-8505Japan

The incidence of early gastric cancer （EGC） with duodenal invasion is extremely low, although advanced gastric cancer that arises in the antrum occasionally invades the duodenum. We investigated the clinicopathological features of EGC with duodenal invasion and provided strategies for clinical management.A Medline search was performed using the keyword early gastric cancer＂ and ＂duodenal invasion＇： Additional articles were obtained from references within the papers identified by the Medline search. We revealed that EGC with duodenal invasion was of the superficial spreading type of tumor. Tumors 〉 60 mm in size invaded the duodenum more extensively, and the distance of duodenal invasion from the pyloric ring was further in the elevated type than in the depressed type of *** was no significant difference between the length of duodenal invasion and the histological type of the tumor. Gastric cancer located adjacent to the pyloric ring, even if cancer invasion was confined to the mucosa or submucosa, was more likely to invade the *** present study reveals that the elevated type of EGC is associated with more extensive duodenal invasion when the tumor size is 〉 60 ram, thus highlighting the importance of identification of duodenal invasion in these cases. We also reveal that sufficient duodenal resection with a cancer-free distal surgical margin should be performed in cases of duodenal invasion.

关键词： Duodenal invasion Early gastric cancer Gastrectomy Superficial spreading type Tumordifferentiation

Relationship between perioperative glycemic control and postoperative infections

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World Journal of Gastroenterology 2009年第33期15卷 4122-4125页

作者： kazuhiro hanazaki Hiromichi Maeda Takehiro Okabayashi Department of Surgery Kochi Medical SchoolKochi University

Perioperative hyperglycemia in critically ill surgery patients increases the risk of postoperative infection (POI), which is a common, and often costly, surgical complication. Hyperglycemia is associated with abnormalities in leukocyte function, including granulocyte adherence, impaired phagocytosis, delayed chemotaxis, and depressed bactericidal capacity. These leukocyte deficiencies are the cause ofinfection and improve with tight glycemic control, which leads to fewer POIs in critically ill surgical patients. Tight glycemic control, such as intensive insulin therapy, has a risk of hypoglycemia. In addition, the optimal targeted blood glucose range to reduce POI remains unknown. Since 2006, we have investigated tight perioperative blood glucose control using a closed-loop artificial endocrine pancreas system, to reduce POI and to avoid hypoglycemia. In this Topic Highlight, we review the relationship between perioperative glycemic control and POI, including the use of the artificial pancreas.

关键词： Glycemic control Surgical site infection Artificial pancreas Insulin therapy Glucose toxicity

Surgical outcome of carcinosarcoma of the gall bladder:A review

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World Journal of Gastroenterology 2009年第39期15卷 4877-4882页

作者： Takehiro Okabayashi Zhao-Li Sun Robert A Montgomery kazuhiro hanazaki Department of Surgery Kochi Medical School Kohasu-Okocho Nankoku- City Kochi 783-8505 Japan Department of Surgery Johns Hopkins University School of Medicine 720 Rutland Ave. Ross 771 Baltimore MD 21205 Japan

Carcinosarcoma,which comprises less than one percent of all gall bladder neoplasms,is characterized by the presence of variable proportions of carcinomatous and sarcomatous ***,several reports have described patients suffering from carcinosarcoma of the gall ***,there are no large studies regarding the clinicopathologic features,therapeutic management,and surgical outcome of this disease because the number of patients who undergo resection of gall bladder carcinosarcoma at a single institution is limited.A Medline search was performed using the keywords 'gall bladder' and 'carcinosarcoma'.Additional articles were obtained from references within the papers identified by the Medline *** adjuvant chemotherapy and/or radiotherapy protocols for carcinosarcoma of the gall bladder have not been *** surgical resection offers the only chance for long-term survival from this *** outcome of 36 patients who underwent surgical resection for carcinosarcoma of the gall bladder was poor;the 3-year overall survival rate was only 31.0% and the median survival time was 7.0 *** the postoperative prognosis of carcinosarcoma of the gall bladder is worse than that of adenocarcinoma,new adjuvant chemotherapies and/or radiation techniques are essential for improvement of surgical outcome.

关键词： Gall bladder Carcinosarcoma Spindle cell carcinoma Surgery Outcome

Clinical applications of 5-aminolevulinic acid-mediated fluorescence for gastric cancer

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World Journal of Gastroenterology 2015年第29期21卷 8769-8775页

作者： Tsutomu Namikawa Tomoaki Yatabe Keiji Inoue Taro Shuin kazuhiro hanazaki Department of Surgery Kochi Medical School Nankoku Department of Anesthesiology Kochi Medical School Nankoku Department of Urology Kochi Medical School Nankoku

5-aminolevulinic acid(ALA) is a naturally occurring amino acid that is a protoporphyrin IX(Pp IX) precursor and a next-generation photosensitive substance. After exogenous administration of ALA, Pp IX specifically accumulates in cancer cells owing to the impaired metabolism of ALA to Pp IX in mitochondria, which results in a red fluorescence following irradiation with blue light and the formation of singlet oxygen. Fluorescence navigation by photodynamic diagnosis(PDD) using ALA provides good visualization and detection of gastric cancer lesions and is a potentially valuable diagnostic tool for gastric cancer for evaluating both the surgical resection margins and extension of the lesion. Furthermore, PDD using ALA might be used to detect peritoneal metastases during preoperative staging laparoscopy, where it could provide useful information for the selection of a therapeutic approach. Another promising application for this modality is in the evaluation of lymph node metastases. Photodynamic therapy(PDT) using ALA to cause selective damage based on the accumulation of a photosensitizer in malignant tissue is expected to be a non-invasive endoscopic treatment for superficial early gastric cancer. ALA has the potential to be used not only as a diagnostic agent but also as a therapeutic drug, resulting in a new strategy for cancer diagnosis and therapy. Here, we review the current use of PDD and PDT in gastric cancer and evaluate its future potential beyond conventional modalities combined with a light energy upconverter, a light-emitting diode and nearinfrared rays as light sources.

关键词： Fluorescence imaging 5-aminolevulinic acid Photodynamic diagnosis Photodynamic therapy Gastric cancer

Perioperative intensive insulin therapy using artificial endocrine pancreas in patients undergoing pancreatectomy

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World Journal of Gastroenterology 2009年第33期15卷 4111-4115页

作者： Hiromichi Maeda Takehiro Okabayashi Tomoaki Yatabe Koichi Yamashita kazuhiro hanazaki Department of Surgery Kochi Medical SchoolKochi University Department of Anesthesiology and Critical Care Medicine Kochi Medical SchoolKochi University

Perioperative glycemic control is important for reducing postoperative infectious complications. However, clinical trials have shown that efforts to maintain normoglycemia in intensive care unit patients result in deviation of glucose levels from the optimal range, and frequent attacks of hypoglycemia. Tight glycemic control is even more challenging in those undergoing pancreatic resection. Removal of lesions and surrounding normal pancreatic tissue often cause hormone deficiencies that lead to the destruction of glucose homeostasis, which is termed pancreatogenic diabetes. Pancreatogenic diabetes is characterized by the occurrence of hyperglycemia and iatrogenic severe hypoglycemia, which adversely effects patient recovery. Postoperatively, a variety of factors including surgical stress, inflammatory cytokines, sympathomimetic drug therapy, and aggressive nutritional support can also affect glycemic control. This review discusses the endocrine aspects of pancreatic resection and highlights postoperative glycemic control using a closed-loop system or artificial pancreas. In previous experiments, we have demonstrated the reliability of the artificial pancreas in dogs with total pancreatectomy, and its postoperative clinical use has been shown to be effectiveand safe, without the occurrence of hypoglycemic episodes, even in patients after total pancreatectomy. Considering the increasing requirement for tight perioperative glycemic control and the recognized risk of hypoglycemia, we propose the use of an artificial endocrine pancreas that is able to monitor continuously blood glucose concentrations with proven accuracy, and administer automatically substances to return blood glucose concentration to the optimal narrow range.

关键词： Blood glucose Diabetes mellitus Hyperglycemia Pancreas Artificial Pancreatectomy

Perioperative insulin therapy using a closed-loop artificial endocrine pancreas after hepatic resection

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World Journal of Gastroenterology 2009年第33期15卷 4116-4121页

作者： Takehiro Okabayashi Hiromichi Maeda Zhao-Li Sun Robert A Montgomery Isao Nishimori kazuhiro hanazaki Department of Surgery Kochi Medical School Kohasu- Okocho Nankoku-City Kochi 783-8505 Japan Department of Surgery Johns Hopkins University School of Medicine 720 Rutland Ave. Ross 771E Baltimore MD 21205 United States Department of Gastroenterology and Hepatology at Kochi Medical School Kohasu-Okocho Nankoku- City Kochi 783-8505 Japan

Postoperative hyperglycemia is common in critically ill patients, even in those without a prior history of diabetes mellitus. It is well known that hyperglycemia induced by surgical stress often results in dysregulation of liver metabolism and immune function, impairing postoperative recovery. Current evidence suggests that maintaining normoglycemia postoperatively improves surgical outcome and reduces the mortality and morbidity of critically ill patients. On the basis of these observations, several large randomized controlled studies were designed to evaluate the benefit of postoperative tight glycemic control with intensive insulin therapy. However, intensive insulin therapy carries the risk of hypoglycemia, which is linked to serious neurological events. Recently, we demonstrated that perioperative tight glycemic control in surgical patients could be achieved safely using a closed-loop glycemic control system and that this decreased both the incidence of infection at the site of the surgical incision, without the appearance of hypoglycemia, and actual hospital costs. Here, we review the benefits and requirements of perioperative intensive insulin therapy using a dosed-loop artificial endocrine pancreas system in hepatectomized patients. This novel intensive insulin therapy is safe and effectively improves surgical outcome after hepatic resection.

关键词： Artificial pancreas Hepatic resection Hyperglycemia Intensive insulin therapy Surgical site infection