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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 *** 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 *** 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

Decreased accumulation of ultrasound contrast in the liver of nonalcoholic steatohepatitis rat model

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World Journal of Gastroenterology 2011年第37期17卷 4191-4198页

作者： Yuki miyata takeo Miyahara Fuminori Moriyasu Department of Gastroenterology and Hepatology Tokyo Medical University

AIM:To investigate the diagnosis of nonalcoholic steatohepatitis(NASH) using contrast ultrasonography in the NASH rat ***:The liver in methionine choline-deficient diet(MCDD) rats,a NASH model constructed by feeding an MCDD,was examined by contrast ultrasonography at weeks 2,4,8,12 and 16,with late phase images of contrast ultrasonography(Kupffer imaging) in which contrast enhancement was achieved by incorporation of a contrast agent by Kupffer cells(KCs),and images were compared to those in rats taking a regular ***:Decrease in contrast enhancement was observed first in MCDD rats at week *** were counted based on immunohistochemistry,but their numbers were not reduced and it was assumed that attenuation of contrast enhancement was attributable to reduced phagocytic activity of the ***:It is suggested that clinical application of contrast ultrasonography may be valuable for noninvasive diagnosis of NASH.

关键词： Nonalcoholic steatohepatitis Leptin Kupffer cell Methionine choline-deficient diet Contrast ultrasound

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 *** To examine the diagnostic ability of MDCT more precisely by using data on intranodal pathological metastatic *** A total of 108 patients with advanced gastric cancer who underwent MDCT and curative gastrectomy at Kanazawa Medical University Hospital were enrolled in this *** 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 *** using the CV,sensitivity and specificity were calculated with prospectively collected data from 39 consecutive *** enabled a more precise one-to-one correspondence of lymph nodes between CT and pathological examination by using the size data of lymph node *** intranodal pathological metastatic patterns were classified into the following four types:Small nodular,peripheral,large nodular,and *** Although all the cases were clinically suspected as having metastasis,81 had lymph node metastasis and 27 had no *** number of dissected,detected on CT,and metastatic nodes were,4241,897,and 801,*** CV obtained from the receiver-operating characteristic was 7.6 mm for the long *** sensitivity was 91.4%and the specificity was 47.3%in the prospective *** large nodular and diffuse metastases were easy to diagnose becausemetastatic nodes with a large axis often exhibit these *** 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 *** sensitivity was as high as 91%,and would be improved when referring to the en

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

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 ***, 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 *** To investigate the usefulness of the fat-dissociation method for harvesting dissected lymph nodes of gastric cancer *** 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 *** 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 *** 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