| 1. |
Koji Tamura, Takaaki Fujimoto, Toru Shimizu, Kinuko Nagayoshi, Yusuke Mizuuchi, Koji Shindo, Kenoki Ohuchid, Masafumi Nakamura, Risk factors and clinical significance of subcutaneous emphysema after robot-assisted laparoscopic rectal surgery: a single-center experience, Journal of Robotic Surgery, 10.1007/s11701-023-01802-9, 18, 42, 2024.04, Subcutaneous emphysema (SE) is a complication of laparoscopic surgery, potentially resulting in severe respiratory failure. No reports to date have focused on SE during robot-assisted (RA) rectal surgery. We aimed to reveal the risk factors and clinical significance of SE after RA/laparoscopic rectal surgery. We retrospectively reviewed 221 consecutive patients who underwent RA/laparoscopic rectal surgery. The occurrence of SE was evaluated on postoperative radiographs. Laparoscopic surgery was performed in 120 patients and RA in 101. SE developed in 55 (24.9%) patients. Logistic regression analysis identified RA surgery (odds ratio [OR]: 4.89, 95% confidence interval [CI] 2.13-11.22, p Keywords: Postoperative complication; Rectal cancer; Robot-assisted surgery; Subcutaneous emphysema. |
| 2. |
Koji Tamura, Takashi Ueki, Hiromichi Nakayama, Yusuke Watanabe, Masafumi Sada, Kinuko Nagayoshi, Yusuke Mizuuchi, Kenoki Ohuchida, Hitoshi Ichimiya, Masafumi Nakamura, Preoperative prediction of malignancy and surgical treatment strategy in appendiceal tumors: multicenter review of 51 consecutive cases, Langenbecks Arch Surg , 10.1007/s00423-023-02807-6, 408, 1, 2023.04. |
| 3. |
Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kenoki Ohuchida, Kohei Nakata, Toru Nakano, Masafumi Nakamura, Relationship between prognostic impact of N3 lymph node metastasis at the root of the feeding artery and location of colon cancer, Langenbecks Arch Surg, 10.1007/s00423-023-02778-8, 408, 1, 31, 2023.04, Purpose: To determine whether N3 nodal involvement predicts outcomes and whether its prognostic implications vary with tumor location in patients with Stage III colon cancer (CC).
Methods: We defined N3 as lymph node metastases near the bases of the major feeding arteries. We retrospectively examined recurrence rates and patterns by tumor location and sites of lymph node metastases in 57 patients with N3 CC who had undergone curative resections between January 2000 and March 2019. Survival analysis was performed to compare the prognoses of patients with and without N3 lymph node metastasis.
Results: Most N3 patients had large tumors (T ? 3); five had T2 disease. Recurrence occurred quickly in one patient with T2N3M0 disease. Multivariate survival analysis demonstrated that N3 lymph node metastasis is an independent predictor of poor prognosis in Stage III CC patients (P
Conclusion: N3 is a robust prognostic marker in CC patients. Recurrence risk varies by tumor location. N3 right-sided CCs with lymph node metastasis at the base of the superior mesenteric artery have poorer prognoses than do N3 left-sided CCs.
Keywords: Feeding artery; Inferior mesenteric artery; N3 colon cancer; Superior mesenteric artery; Tumor sidedness.. |
| 4. |
kohei Nakata, Toshiya Abe, Noboru Ideno, So Nakamura, Naoki Ikenaga, Kinuko Nagayoshi, Yusuke Mizuuchi, Taiki Moriyama, Kenoki Ohuchida, Masafumi Nakamura, A left-sided approach for wide mobilization of the pancreas with complete dissection of the Treitz ligament(with video), Surgical Endoscopy, 10.1007/s00464-023-10065-2, 37, 6, 4982-4989, 2023.04. |
| 5. |
Kinuko Nagayoshi, Yusuke Mizuuchi, Koji Tamura, Masafumi Sada, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura, Combination of robotic and transperineal techniques for total pelvic exenteration followed by a posterior-anterior approach to the supralevator space - a video vignette, Colorectal Dis, 10.1111/codi.16765, 25, 11, 2282-2283, 2023.04. |
| 6. |
Kohei Nakata, Toshiya Abe, Noboru Ideno, So Nakamura, Naoki Ikenaga, Kinuko Nagayoshi, Yusuke Mizuuchi, Taiki Moriyama, Kenoki Ohuchida, Masafumi Nakamura, Minimally invasive distal pancreatectomy for pancreatic cancer: cranial-to-caudal approach with identification of Gerota's fascia (with video), Surg Endosc, 10.1007/s00464-023-10438-7, 37, 11, 8901-8909, 2023.04, Background: Although radical antegrade modular pancreatosplenectomy for pancreatic ductal adenocarcinoma (PDAC) has become the gold standard procedure in open distal pancreatectomy, there has been no gold standardized procedure for PDAC in minimally invasive distal pancreatectomy (MIDP). In this study, we analyzed our novel cranial-to-caudal approach (CC approach) for patients undergoing MIDP and provide a video clip illustrating the details of the CC approach.
Methods: Ninety-four patients who underwent MIDP with splenectomy between 2016 and 2021 were included in this study. The CC approach was performed in 23 (24.5%) of the 94 patients. The concept of the CC approach is easy identification of Gerota's fascia from the cranial side of the pancreas and secure tumor removal (R0 resection) wrapped by Gerota's fascia. The short- and long-term outcomes were compared between the CC and non-CC approaches.
Results: The median operation time and blood loss were similar between the two groups. The ratios of grade ≥ B postoperative pancreatic fistula and Clavien-Dindo grade ≥ III complications were also comparable. All patients in the CC approach group achieved R0 resection, and the R0 ratio was similar in the two groups (p = 0.345). The 2-year survival rate in CC and non-CC approach groups was 87.5% and 83.6%, respectively (p = 0.903).
Conclusions: The details of the CC approach for MIDP were demonstrated based on an anatomical point of view. This approach has the potential to become a standardized approach for left-sided PDAC.
Keywords: Approach; Distal pancreatectomy; Minimally invasive pancreatectomy.. |
| 7. |
Yusuke Mizuuchi, Kinuko Nagayoshi, Masafumi Nakamura, Hiroki Ikeuchi, Motoi Uchino, Kitaro Futami, Kinya Okamoto, Tsunekazu Mizushima, Hisashi Nagahara, Kazuhiro Watanabe, Koji Okabayashi, Kazutaka Yamada, Hiroki Ohge, Shinji Tanaka, Yoshiki Okita, Yu Sato, Hideki Ueno, Atsuo Maemoto, Michio Itabashi, Hideaki Kimura, Koya Hida, Yusuke Kinugasa, Kenichi Takahashi, Fumikazu Koyama, Tsunekazu Hanai, Kiyoshi Maeda, Toshihiro Noake, Yoshifumi Shimada, Takayuki Yamamoto, Junya Arakaki, Keiji Mastuda, Junji Okuda, Eiji Sunami, Yoshito Akagi, Kenji Kastumata, Kay Uehara, Takeshi Yamada, Shin Sasaki, Soichiro Ishihara, Yoichi Ajioka, Kenichi Sugihara; Study Group for Inflammatory Bowel Disease-Associated Intestinal Cancers of the Japanese Society for Cancer of the Colon and Rectum, Prognostic impact of tumour location in stage II/III ulcerative colitis-associated colon cancer: subgroup analysis of a nationwide multicentre retrospective study in Japan, Br J Surg, 10.3393/ac.2022.00122.0017., 38, 5, 353-361, 2023.04. |
| 8. |
Kinuko Nagayoshi, Yusuke Mizuuchi, Jinghui Zhang, Kyoko Hisano, Koji Tamura, Masafumi Sada, Kohei Nakata, Kenoki Ohuchida, Masafumi Nakamura, Strong impact of sarcopenic state defined by skeletal muscle mass index on postoperative complication of Crohn's disease patients, Surgery Open Science, 10.1016/j.sopen.2023.07.022, 6, 15, 54-59, 2023.04, Background: Malnutrition impacts the clinical course of Crohn's disease; however, there is little evidence of its influence on perioperative adverse events. We assessed whether nutritional indicators are associated with postoperative complications in surgical treatment of Crohn's disease.
Methods: 137 patients with Crohn's disease who underwent surgical treatment between January 2011 and December 2020 were included. Skeletal muscle index was calculated by a single CT slice. We analyzed the risk factors for adverse events.
Results: 37 % of patients had postoperative complications. Adverse events occurred more frequently in patients with high serum C-reactive protein, low serum albumin, prognostic nutritional index Conclusions: Skeletal muscle index is the most useful nutritional predictor of postoperative complications in Crohn's disease patients among other nutritional indices. We believe that these patients are at high risk of postoperative complications and need appropriate nutritional support in the perioperative period.
Keywords: Crohn's disease; Nutritional status; Postoperative complications; Sarcopenia; Skeletal muscle mass index.. |
| 9. |
Sho Okuda, Kenoki Ohuchida, Koji Shindo, Taiki Moriyama, Jun Kawata, Koji Tamura, Masafumi Sada, Kinuko Nagayoshi, Yusuke Mizuuchi, Naoki Ikenaga, Kohei Nakata, Yoshinao Oda, Masafumi Nakamura, Clinical impact of remnant lymphatic invasion on the recurrence of esophageal squamous cell carcinoma after esophagectomy with neoadjuvant chemotherapy, Oncol Lett, 10.3892/ol.2022.13457, 24, 4, 337, 2022.04, For stage II and III esophageal squamous cell carcinoma (ESCC), neoadjuvant chemotherapy (NAC) followed by esophagectomy is recommended in the Japanese guidelines for the diagnosis and treatment of esophageal cancer. However, recurrence of ESCC is common regardless of the NAC regimen and surgical method, and NAC demonstrates limited efficacy against recurrence. Therefore, the present study was conducted to identify risk factors of recurrence of ESCC with surgery after NAC. The outcomes of 51 patients who underwent esophagectomy for ESCC after NAC from 2010 to 2017 at Kyushu University Hospital were retrospectively analyzed. A total of 52 patients with ESCC without NAC followed by esophagectomy from 2001 to 2017 were selected for comparison. Among patients who underwent NAC followed by surgery, only lymphatic invasion (LY; hazard ratio, 2.761; 95% CI, 1.86-6.43, P=0.018) was an independent factor significantly associated with 3-year recurrence-free survival in the multivariate analysis. In patients with pathologic lymph node metastasis (pN) and no LY after NAC, there was significantly less recurrence compared with patients with pN and LY (P=0.0085), whereas in patients without LY after NAC, the presence of pN was not significantly associated with recurrence (P=0.2401). There were significantly fewer LY (+) patients in the NAC (+) group (P=0.0158) compared with those in the NAC (-) group. The presence of LY was an independent risk factor for recurrence of ESCC after esophagectomy following NAC. Overall, adjuvant treatment after surgery may be required in cases with remnant LY after NAC.
Keywords: esophageal squamous cell carcinoma; lymphatic invasion; neoadjuvant chemotherapy; recurrence factor.. |
| 10. |
Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Koji Tamura, Kinuko Nagayoshi, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kohei Nakata, Kenoki Ohuchida, Toru Nakano, Masafumi Nakamura, Cross-sectional area of psoas muscle as a predictive marker of anastomotic failure in male rectal cancer patients: Japanese single institutional retrospective observational study, Annals of Coloproctology, 10.3393/ac.2022.00122.0017, 38, 5, 353-361, 2022.04. |
| 11. |
Saori Hayashi, Makoto Kubo, Sawako Matsuzaki, Masaya Kai, Takafumi Morisaki, Mai Yamada, Kazuhisa Kaneshiro, Yuka Takao, Akiko Shimazaki, Kinuko Nagayoshi, Yusuke Mizuuchi, Masafumi Nakamura, Significance of the Multi-gene Panel myRisk in Japan, Anticancer Research , org/10.21873/anticanres.15907, 42, 8, 4097-4102, 2022.04. |
| 12. |
Kinuko Nagayoshi, Shuntaro Nagai, Kyoko Hisano, Yusuke Mizuuchi, Hayato Fujita, Masafumi Nakamura, Atrophic change of the abdominal rectus muscle significantly influences the onset of parastomal hernias beyond existing risk factors after end colostomy, Hernia, 10.1007/s10029-020-02192-9, 25, 1, 141-148, 2021.04. |
| 13. |
Yoshihiko Sadakari, Kyoko Hisano, Masafumi Sada, Yusuke Mizuuchi, Kinuko Nagayoshi, Hayato Fujita, Shuntaro Nagai, Tatsuya Manabe, Takashi Ueki, Masafumi Nakamura, Long-term effects of laparoscopic lateral pelvic lymph node dissection on urinary retention in rectal cancer, Surgical Endoscopy, 10.1007/s00464-021-08364-7, 36, 2, 999-1007, 2021.04, Abstract
Background: The addition of lateral pelvic lymph node dissection (LPLND) in rectal cancer surgery has been reported to increase the incidence of post-operative urinary retention. Here, we assessed the predictive factors and long-term outcomes of urinary retention following laparoscopic LPLND (L-LPLND) with total mesorectal excision (TME) for advanced lower rectal cancer.
Methods: This retrospective single-institutional study reviewed post-operative urinary retention in 71 patients with lower rectal cancer who underwent L-LPLND with TME. Patients with preoperative urinary dysfunction or who underwent unilateral LPLND were excluded. Detailed information regarding patient clinicopathologic characteristics, post-void residual urine volume, and the presence or absence of urinary retention over time was collected from clinical and histopathologic reports and telephone surveys. Urinary retention was defined as residual urine > 100 mL and the need for further treatment.
Results: Post-operative urinary retention was observed in 25/71 patients (35.2%). Multivariate analysis revealed that blood loss ≥ 400 mL [odds ratio (OR) 4.52; 95% confidence interval (CI) 1.24-16.43; p = 0.018] and inferior vesical artery (IVA) resection (OR 8.28; 95% CI 2.46-27.81; p Conclusion: We identified the predictive factors of urinary retention following L-LPLND with TME, including increased blood loss (≥ 400 mL) and IVA resection. Urinary retention associated with unilateral IVA resection improved relatively quickly. L-LPLND with unilateral IVA resection is a feasible and safe procedure to improve oncological curability. However, if oncological curability is guaranteed, bilateral IVA resection should be avoided to prevent irreversible urinary retention.
Keywords: Inferior vesical artery; Laparoscopy; Lateral pelvic lymph node dissection; Long-term effects; Rectal cancer; Urinary retention.. |
| 14. |
Yusuke Mizuuchi, Yoshitaka Tanabe, Masafumi Sada, Yoshiki Kitaura, Shuntaro Nagai, Yusuke Watanabe, Sadafumi Tamiya, Kinuko Nagayoshi, Kenoki Ohuchida, Toru Nakano, Masafumi Nakamura, Predictive factors associated with relapse of stage II/III colon cancer treated with peroral anti-cancer agents in the adjuvant setting, Mol Clin Oncol, 10.3892/mco.2021.2284., 14, 6, 122, 2021.04. |
| 15. |
Kinuko Nagayoshi, Shuntaro Nagai, Karen P. Zaguirre, Kyoko Hisano, Masafumi Sada, Yusuke Mizuuchi, Masafumi Nakamura, Securing the surgical field for mobilization of right?sided colon cancer using the duodenum?first multidirectional approach in laparoscopic surgery, Techniques in Coloproctology, 10.1007/s10151-021-02444-5, 25, 7, 865-874, 2021.04. |
| 16. |
Koba R, Fujita H, Nishibori M, Saeki K, Nagayoshi K, Sadakari Y, Nagai S, Sekizawa O, Nitta K, Manabe T, Ueki T, Ishida T, Oda Y, Nakamura M, Quantitative evaluation of the intratumoral distribution of platinum in oxaliplatin-treated rectal cancer: In situ visualization of platinum via synchrotron radiation X-ray fluorescence spectrometry, Int J Cancer, 10.1002/ijc.32592, 146, 9, 2498-2509, 2020.04, Oxaliplatin, a platinum-based drug, is a key chemotherapeutic agent for colorectal cancer (CRC), but drug resistance and toxic effects have been major limitations of its use. Synchrotron radiation X-ray fluorescence spectrometry (SR-XRF) is a rapid, non-destructive technique for monitoring the distribution of metals and trace elements in cells or tissue samples. We applied SR-XRF to visualize the distribution of platinum and other elements in 30 rectal cancer specimens resected from patients who received oxaliplatin-based preoperative chemotherapy and quantified platinum concentration in the tumor epithelium and stroma, respectively, using calibration curves. The platinum concentration in rectal cancer tissue ranged 2.85�11.44 ppm, and the detection limit of platinum was 1.848 ppm. In the tumor epithelium, the platinum concentration was significantly higher in areas of degeneration caused by chemotherapy than in non-degenerated area (p < 0.001). Co
nversely, in the tumor stroma, the platinum concentration was significantly higher in patients with limited therapeutic responses than in those with strong therapeutic responses (p < 0.001). Furthermore, multivariate analysis illustrated that higher platinum concentration in the tumor stroma was an independent predictive factor of limited histologic response (Odds Ratio; 19.99, 95% confidence interval; 2.04�196.37, p = 0.013). This is the first study to visualize and quantify the distribution of platinum in human cancer tissues using SR-XRF. These results suggest that SR-XRF analysis may contribute to predicting the therapeutic effect of oxaliplatin-based chemotherapy by quantifying the distribution of platinum.. |
| 17. |
Sadakari Y, Nagai S, Velasquez VV, Nagayoshi K, Fujita H, Ohuchida K, Manabe T, Ohtsuka T, Nakamura M, Application of ultrasonography to high-tie and low-tie vascular ligation of the inferior mesenteric artery in laparoscopic colorectal cancer surgery: technical notes., Surg Endosc, 10.1007/s00464-018-6302-1, 33, 1, 309-314, 2018.04, Abstract
BACKGROUND:
Two ligation techniques can be applied in laparoscopy for left-sided colorectal cancer: (1) high-tie (HT), transection at the level of the inferior mesenteric artery (IMA); and (2) low-tie (LT), transection below the IMA, at the level of superior rectal artery (SRA), preserving the left colic artery (LCA). However, even with preoperative images, it can still be a challenge to identify these structures due to intraoperative individual conditions. In this study, we assess the use intraoperative ultrasonography (IOUS) to aid us in identifying the IMA and its branches to the SRA, LCA, and sigmoid artery.
METHODS:
We performed IOUS in 18 patients diagnosed with left-sided colorectal cancer. Preoperatively, a three-dimensional computed tomography (3D-CT) angiography was obtained in majority of the patients, to visualize the IMA and its branches. Two patients were contraindicated to receive a contrast study, hence, was unable to undergo 3D-CT angiography. The resected specimen was grossly examined for the study. The bifurcation types were identified and compared using different modalities: preoperative 3D-CT, IOUS, and gross examination of the resected specimen.
RESULTS:
The branching of the IMA revealed by IOUS was consistent to the findings preoperatively by the 3D-CT and postoperatively by the resected specimen. The IOUS result of the two patients without preoperative 3D-CT evaluation was also consistent with the post-operative bifurcation type.
CONCLUSIONS:
IOUS is an easy and feasible modality which aids in detecting the branching of the IMA during LT and HT ligation in laparoscopic left-sided colorectal surgery. It can serve as an adjunct modality for 3D-CT angiography and can also be considered a safe alternative option for cases wherein 3D-CT angiography is unavailable
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| 18. |
Manabe T, Koba R, Nagayoshi K, Sadakari Y, Fujita H, Nagai S, Ueki T, Nagai E, Nakamura M, Laparoscopic excision of neurogenic retrorectal tumors, Asian J Endosc Surg, 10.1111/ases.12337., 10, 2, 223-226, 2017.04, Abstract
Retrorectal tumors (RT) are uncommon and usually managed by open surgical excision. Laparoscopic excision for RT has been reported in only a small number of papers. We aimed to assess the laparoscopic approach for RT and to discuss the factors that made this procedure difficult. We performed laparoscopic excision using a five-trocar technique for neurogenic RT in three patients. Tumors were successfully excised laparoscopically in two patients. However, the third patient required open conversion because the tumor was strongly adhered to the sacrum and could not be mobilized by dissection, resulting in poor visualization of the dissected site. Laparoscopic excision for RT provides excellent intraoperative visualization and good cosmesis in selected patients, but firm adherence to the sacrum may cause difficulty with this procedure.. |
| 19. |
Manabe T, Ueki T, Nagayoshi K, Moriyama T, Yanai K, Nagai S, Esaki M, Nakamura K, Nakamura M, Feasibility of laparoscopic surgery for complex Crohn's disease of the small intestine., Asian J Endosc Surg, 10.1111/ases.12287, 9, 4, 265-269, 2016.04, Abstract
BACKGROUND:
The laparoscopic approach for complex Crohn's disease (CD), which involves abscess formation, fistula formation, and recurrent CD, is controversial. The aim of this study was to investigate the feasibility and safety of the laparoscopic approach for complex CD.
METHODS:
Fifty-six patients who had undergone surgery for CD of the small bowel from January 2007 to August 2014 were divided into two groups: the laparoscopic approach for complex CD group (LC group, n = 31) and the laparoscopic approach for simple CD group (LS group, n = 25). The preoperative data and surgical outcomes of the LC group were compared with those of the LS groups.
RESULTS:
There were no significant differences in preoperative data and operating time between the two groups. Blood loss was not significantly different between the LC and LS groups. The incision length was longer in the LC group than the LS group (P = 0.004). The incidence of severe postoperative complications in the LC group was higher than in the LS group (P = 0.026). The length of postoperative stay was similar in the LC and LS groups.
CONCLUSIONS:
The laparoscopic approach for complex CD is feasible and provides good cosmesis that is comparable to that offered by simple CD.. |
| 20. |
Nagayoshi K, Ueki T, Manabe T, Moriyama T, Yanai K, Oda Y, Tanaka M, Laparoscopic lateral pelvic lymph node dissection is achievable and offers advantages as a minimally invasive surgery over the open approach, Surg Endosc, 30, 5, 1938-1947, 2016.04, Abstract
BACKGROUND:
Laparoscopic lateral pelvic lymph node dissection (LPLD) is a minimally invasive alternative to open surgical therapy for advanced low rectal cancer patients. This study assessed potential risk factors for lateral pelvic lymph node metastasis (LPLM) and evaluated the feasibility and oncological safety of laparoscopic LPLD compared with the conventional open approach.
METHODS:
We retrospectively reviewed the clinical records of 90 patients with advanced low rectal cancer who underwent LPLD following total mesorectal excision at Kyushu University Hospital between January 2001 and July 2014. We compared the clinicopathological features between the patients with and without LPLM and the surgical outcomes between patients who underwent laparoscopic LPLD (LL) and open LPLD (OL).
RESULTS:
Fourteen (15.6 %) patients had LPLM. Univariate analysis revealed that undifferentiated cancer, positive lymphatic invasion, >50 % circumferential cancer extent, mesorectal lymph node metastases (MLM), and distant metastasis were associated with LPLM. In the multivariate analysis, MLM was the only independent risk factor for LPLM. Forty-six (51.1 %) patients underwent LL, and 44 (48.9 %) patients underwent OL. The mean surgical duration was longer in the LL group than in the OL group (641.0 vs. 312.0 min, P CONCLUSIONS:
Patients with advanced low rectal cancer presenting MLM are good candidates for LPLD. Laparoscopic LPLD enables retrieval of more lymph nodes and may be acceptable for the treatment of advanced low rectal cancer.
KEYWORDS:
Laparoscopic surgery; Lateral pelvic lymph node dissection; Rectal cancer. |
| 21. |
Nishioka Y, Ueki T, Hokazono K, Nagayoshi K, Tanaka M, Comparative detection of aberrantly methylated DNA in preoperative and postoperative stool from patients with colorectal cancers, Int J Biol Markers , 30, 1, e81-e87, 2015.04, BACKGROUND:
Early detection of colorectal cancer (CRC) is crucial to reducing tumor-related mortality. Evaluating aberrantly methylated DNA in stool is promising for CRC screening. However, DNA methylation in the colonic epithelium of background mucosa may compromise stool DNA (sDNA) test results. Thus, we compared aberrant methylation of cancer-related genes in preoperative and postoperative sDNA, with the aim of demonstrating that a cancer-specific methylated allele in sDNA originates from CRCs.
METHODS:
Patients who were to undergo CRC resection in Kyushu University Hospital during 2003-2010 were prospectively enrolled. Preoperative (pre) stool samples from 54 patients, postoperative (post) samples from 52 of the patients and tumor samples were collected. Aberrant promoter methylation of CDH4 and GATA5 was assessed in the primary tumors by methylation-specific polymerase chain reaction (MSP) and in stool samples by real-time MSP.
RESULTS:
Aberrant methylation of CDH4 and/or GATA5 was detected in 45 of CRC tissue samples (83.3%) and identified in 23 pre sDNA samples (42.3%) from CRC patients. Aberrant methylation was not found in pre sDNA obtained from CRC patients without aberrant methylation of these genes or in post sDNA in any patient. The detection rate of methylated alleles did not correlate with depth of invasion or tumor stage.
CONCLUSION:
Our findings demonstrate that aberrantly methylated alleles identified in sDNA originate from CRCs. Although tumor-specific aberrant methylation is found in sDNA from patients harboring early and advanced CRC throughout the colon and rectum, the sensitivity of this test needs to be improved for early detection of CRC.
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| 22. |
Nagayoshi K, Ueki T, Tashiro K, Mizuuchi Y, Manabe T, Araki H, Oda Y, Kuhara S, Tanaka M, Galanin plays an important role in cancer invasiveness and is associated with poor prognosis in stage II colorectal cancer, Oncol Rep, 33, 2, 539-546, 2015.04, Reliable predictors of tumor recurrence for patients with stage II colorectal cancer (CRC) are needed to select patients who should receive adjuvant chemotherapy. Although galanin (GAL) is expressed in several malignant tumors and is associated with cell proliferation and tumor growth, the prognostic value of GAL expression in CRC is poorly understood. We compared GAL expression between 56 patients with stage II and III CRC who developed tumor recurrences and 56 patients who did not. The clinical and prognostic significance of GAL expression was examined using our data and independent public datasets. We also analyzed the influence of GAL expression on the proliferation and invasive activity of CRC cells. Higher expression of GAL was associated with tumor recurrence among the CRC patients (P |
| 23. |
Ueki T, Nagayoshi K, Manabe T, Maeyama R, Yamamoto H, Oda Y, Tanaka M, Laparoscopic en bloc excision of gastrointestinal stromal tumors of the rectum after neoadjuvant imatinib therapy: anteriorly extended intersphincteric resection combined with partial resection of the prostate, Tech Coloproctol, 19, 4, 247-251, 2015.04, We herein present a novel technique for laparoscopic en bloc excision involving anteriorly extended intersphincteric resection with partial resection of the posterior lobe of the prostate for large rectal gastrointestinal stromal tumors (GISTs). The sequence of neoadjuvant imatinib therapy and this less invasive surgery for marginally resectable rectal GISTs has the potential to obviate the need for urinary reconstruction and permanent stomas without jeopardizing the tumor margin status.. |
| 24. |
Ueki T, Manabe T, Nagayoshi K, Yanai K, Moriyama T, Shimizu S, Tanaka M, Reduced-port laparoscopic restorative proctocolectomy without diverting ileostomy, Asian J Endosc Surg, 8, 4, 487-490, 2015.04, Abstract
INTRODUCTION:
We introduced a reduced-port procedure for laparoscopic restorative proctocolectomy without diverting ileostomy for patients with familial adenomatous polyposis and ulcerative colitis.
MATERIALS AND SURGICAL TECHNIQUE:
A multichannel port was inserted through a 2.5-cm umbilical incision. A 12-mm port in the right lower abdomen and a 3- or 5-mm port were also employed. A proctocolectomy was performed intracorporeally, and the entire colon and rectum were delivered through the umbilical incision. An ileal J-pouch was made extracorporeally following division of the mesenteric vessels. Ileal j-pouch-anal anastomosis was performed intracorporeally or transanally after rectal mucosectomy. A drain was inserted through the 12-mm port incision, and a transanal decompression tube was placed in the pouch. Two women and one man underwent this surgery, and their postoperative recovery was uneventful.
DISCUSSION:
Laparoscopic restorative proctocolectomy without a diverting stoma by a reduced-port technique is feasible and provides excellent cosmetic outcomes in selected patients.
© 2015 Japan Society for Endoscopic Surgery, Asia Endosurgery Task Force and Wiley Publishing Asia Pty Ltd.
KEYWORDS:
One-stage operation; reduced-port surgery; restorative proctocolectomy. |
| 25. |
Hokazono K, Ueki T, Nagayoshi K, Nishioka Y, Hatae T, Koga Y, Hirahashi M, Oda Y, Tanaka M, A CpG island methylator phenotype of colorectal cancer that is contiguous with conventional adenomas, but not serrated polyps, Oncol Lett, 8, 5, 1937-1944, 2014.04, A subset of colorectal cancers (CRCs) harbor the CpG island methylator phenotype (CIMP), with concurrent multiple promoter hypermethylation of tumor-related genes. A serrated pathway in which CIMP is developed from serrated polyps is proposed. The present study characterized CIMP and morphologically examined precursor lesions of CIMP. In total, 104 CRCs treated between January 1996 and December 2004 were examined. Aberrant promoter methylation of 15 cancer-related genes was analyzed. CIMP status was classified according to the number of methylated genes and was correlated with the clinicopathological features, including the concomitant polyps in and around the tumors. The frequency of aberrant methylation in each CRC showed a bimodal pattern, and the CRCs were classified as CIMP-high (CIMP-H), CIMP-low (CIMP-L) and CIMP-negative (CIMP-N). CIMP-H was associated with aberrant methylation of MLH1 (P=0.005) and with an improved recurrence-free survival (RFS) rate following curative resection compared with CIMP-L/N (five-year RFS rate, 93.8 vs. 67.1%; P=0.044), while CIMP-N tumors were associated with frequent distant metastases at diagnosis (P=0.023). No concomitant serrated lesions were present in the tumors, whereas conventional adenoma was contiguous with 11 (10.6%) of 104 CRCs, including four CIMP-H CRCs. CIMP-H was classified in CRCs by a novel CIMP marker panel and the presence of concomitant tumors revealed that certain CIMP-H CRCs may have arisen from conventional adenomas.. |
| 26. |
Nagayoshi K, Ueki T, Nishioka Y, Manabe T, Mizuuchi Y, Hirahashi M, Oda Y, Tanaka M, Tumor deposit is a poor prognostic indicator for patients who have stage II and III colorectal cancer with fewer than 4 lymph node metastases but not for those with 4 or more., Dis Colon Rectum, 57, 4, 467-474, 2014.04, BACKGROUND: Extranodal tumor deposit is involved in TNM classification. However, it is uncertain whether tumor deposit is a regular lymph node metastasis and its prognostic significance in patients with stage II or III colorectal cancer remains to be established.OBJECTIVE: This study aimed to determine the prognostic significance of tumor deposit for stage II and III colorectal cancer. DESIGN: A retrospective review of clinicopathological data.SETTING: This study was conducted at a tertiary care hospital /referral center in Japan.PATIENTS: We reviewed the clinical course of 171 stage II and 173 stage III consecutive patients between January 1999 and December 2006. MAIN OUTCOME AND MEASURES: We examined the clinicopathological features of colorectal cancers with tumor deposits and calculated overall survival and recurrence-free survival of the patients according to the status of tumor deposit. The primary outcome was the impact of tumor deposits on patient sur
vival.RESULTS: Thirty-five (10.2%) patients with colorectal cancers had tumor deposits in the pericolic and/or mesocolic region. Survival rates among the patients with tumor deposits were significantly lower than those without (5-year overall survival, 58.4% vs. 81.0%, p < 0.0001; 5-year recurrence-free survival, 47.1% vs. 73.4%, p < 0.0001). Tumor deposit was an independent prognostic factor for colorectal cancer patients in multivariate analysis (overall survival, hazard ratio = 2.30, 95% confidence interval = 1.26–4.04, p = 0.04; recurrence-free survival, hazard ratio = 2.42, 95% confidence interval = 1.04–4.90, p = 0.04). Tumor deposit was an independent prognostic factor in N0 and N1 colorectal cancer, whereas N2 cancer had poor survival outcome regardless of tumor deposit.LIMITATIONS: Our study was a single-institution retrospective study and the numbers of patients were relatively small to draw firm conclusions.CONCLUSION: Tumor deposit may be an independent
adverse prognostic factor for stage II and III N1 colorectal cancer.. |
