詳細

木村　豊 （キムラ　ユタカ）

  • 近畿大学奈良病院　教授/部長
Last Updated :2024/04/25

コミュニケーション情報 byコメンテータガイド

  • コメント

    胃癌、食道癌の治療、特に外科手術（内視鏡手術）と化学療法を専門としています。癌の進行度だけでなく年齢、体力、QOLなどを総合的に判断して、最善・最新の治療を行うように努めています。

  • 報道関連出演・掲載一覧

    さらに詳しい胃がんのお話http://www.kindai-geka.jp/general/esophagus/more/ 胃がんについて詳しく記載しておりますので、ご覧ください。 ＜報道関連出演・掲載一覧＞ ●2019/2/12 朝日放送「キャスト」　 食道がんについて

研究者情報

学位

  • 博士（医学）（1998年03月 大阪大学医学部）

ホームページURL

J-Global ID

プロフィール

  • 近畿大学外科

現在の研究分野（キーワード）

    胃癌、食道癌の治療、特に外科手術（内視鏡手術）と化学療法を専門としています。癌の進行度だけでなく年齢、体力、QOLなどを総合的に判断して、最善・最新の治療を行うように努めています。

研究分野

  • ライフサイエンス / 消化器外科学

経歴

  • 2022年09月 - 現在  近畿大学近畿大学奈良病院教授
  • 2021年04月 - 2022年09月  近畿大学奈良病院消化器外科教授
  • 2016年04月 - 2021年03月  近畿大学医学部外科（上部消化管部門）准教授

学歴

  •         - 1998年03月   大阪大学医学部大学院
  •         - 1990年03月   大阪大学   医学部・医学研究科

研究活動情報

論文

  • Atsushi Yasuda; Yutaka Kimura; Hiroaki Kato; Tomoya Nakanishi; Masashi Koda; Yoko Hiraki; Takaomi Hagi; Osamu Shiraishi; Masayuki Shinkai; Motohiro Imano; Takushi Yasuda
    Updates in surgery 2024年01月 
    Recent reports have described the practicality of laparoscopic intragastric surgery (l-IGS) as an alternative for resecting submucosal tumors (SMTs) near the esophagogastric junction (EGJ), where excision using an exogastric approach would be difficult. However, even using IGS to perform a full-thickness resection of SMTs that are in or extremely close to the EGJ is very difficult to do safely and avoid disrupting or causing stenosis of the EGJ, without advanced experience. This study retrospectively examined the usefulness of l-IGS for gastric SMTs located in or extremely close to the EGJ. Fourteen patients with gastric SMTs < 2 cm of the EGJ and underwent l-IGS were eligible for this study. We examined the tumor location, operative time, intraoperative hemorrhage, degree of deformation, gastroesophageal reflux disease, perioperative complications, and recurrence. Furthermore, we compared patients with tumors in the EGJ with those with tumors near the EGJ and patients in whom three-port l-IGS was performed with those who underwent single-incision laparoscopic surgery. The average tumor size, operative time, intraoperative hemorrhage, and postoperative hospitalization of the 14 patients were 30.9 ± 21.3 mm, 125.2 ± 31.1 min, 30.7 ± 103.3 mL, and 9.2 ± 3.1 d, respectively. No differences in these parameters according to the type of l-IGS or tumor location were observed. All patients underwent l-IGS without complications and were free from EGJ deformation or esophagitis. We believe that l-IGS is useful for gastric SMTs located < 2 cm of the EGJ as it can be safely performed for difficult tumor locations and does not cause deformation of the EGJ.
  • Yutaka Kimura; Hisato Kawakami; Shigeyuki Tamura; Kazumasa Fujitani; Jin Matsuyama; Hiroshi Imamura; Shohei Iijima; Daisuke Sakai; Yukinori Kurokawa; Toshio Shimokawa; Toshimasa Tsujinaka; Hiroshi Furukawa; Taroh Satoh
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 26 5 788 - 797 2023年09月 
    BACKGROUND: S-1 plus docetaxel (DS) therapy followed by S-1 is the standard of care in Japan in postoperative adjuvant chemotherapy for stage III gastric cancer, but long-term survival and the number of DS cycles required are unclear. The purpose of this study was to investigate the impact of the number of cycles of DS therapy on the 5-year survival in stage III gastric cancer in a pooled analysis of two phase II trials (OGSG0604 and OGSG1002). PATIENTS AND METHODS: Patients with histologically confirmed stage III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were enrolled in this pooled analysis. They received DS therapy for four or eight cycles, followed by S-1 until 1 year postgastrectomy. The 5-year overall survival (OS) and the 5-year disease free survival (DFS) by the landmark analysis was evaluated. RESULTS: In total, 113 patients from the OGSG0604 and OGSG1002 trials were enrolled in this study. The landmark analysis showed a 5-year OS that was better with four to eight cycles of DS therapy than with one to three cycles of DS therapy, with the best 5-year OS of 77.4% (95% confidence interval, 66.5-90.1%) for eight cycles. The 5-year DFS was approximately 66% when four or eight cycles of DS therapy were given. CONCLUSION: Although eight cycles of DS therapy may prolong prognosis, the present study did not provide a clear conclusion as to how many DS therapy cycles are needed to improve prognosis after D2 gastrectomy for stage III gastric cancer. TRIAL REGISTRATION: Registration number: UMIN00000714 and UMIN000004440.
  • Chihiro Sato; Hisato Kawakami; Ryo Tanaka; Hironaga Satake; Kentaro Inoue; Yutaka Kimura; Junya Fujita; Ryohei Kawabata; Yasutaka Chiba; Taroh Satoh; Kazuhiko Nakagawa
    Scientific reports 13 1 10826 - 10826 2023年07月 
    Adjuvant S-1 monotherapy is the standard of care for stage II gastric cancer (GC) after curative resection in Japan, but its efficacy for microsatellite instability-high (MSI-H) tumors has remained unknown. Among a multi-institutional cohort of patients with stage II GC who underwent R0 resection followed by S-1 adjuvant chemotherapy between February 2008 and December 2018, we assessed MSI status with an MSI-IVD Kit (Falco). MSI status was assessable for 184 (88.5%) of the 208 enrolled patients, with MSI-H being identified in 24 (13.0%) individuals. Although neither relapse-free survival (RFS) (hazard ratio [HR] = 1.00, p = 0.997) nor overall survival (OS) (HR = 0.66, p = 0.488) differed between MSI-H versus microsatellite-stable (MSS) patients, MSI-H patients showed a nonsignificant but better RFS (HR = 0.34, p = 0.064) and OS (HR = 0.22, p = 0.057) than did MSS patients after adjustment for background characteristics by propensity score (PS) analysis. Gene expression analysis in the PS-matched cohort suggested that recurrence was associated with the immunosuppressive microenvironment in MSI-H tumors but with expression of cancer/testis antigen genes in MSS tumors. Our data reveal a better adjusted survival for MSI-H versus MSS stage II GC treated with S-1 adjuvant therapy, and they suggest that mechanisms of recurrence differ between MSI-H and MSS tumors.
  • 消化器外科手術におけるICTとASTの活動状況の検討
    橋本 和彦; 天野 智佳子; 嶋田 高広; 額原 敦; 福田 泰也; 福田 周一; 大塚 正久; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会総会 78回 P060 - 2 (一社)日本消化器外科学会 2023年07月
  • 肝内胆管癌における腫瘍内因性CXCL9による肝臓内抗腫瘍免疫応答
    福田 泰也; 浅岡 忠史; 小林 省吾; 高橋 秀典; 野田 剛広; 橋本 和彦; 石川 原; 木村 豊; 土岐 祐一郎; 江口 英利
    日本消化器外科学会総会 78回 P085 - 6 (一社)日本消化器外科学会 2023年07月
  • 当院における切除不能進行・再発胃癌に対する化学療法+ニボルマブの使用経験
    額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会総会 78回 P167 - 4 (一社)日本消化器外科学会 2023年07月
  • 肝内胆管癌における腫瘍内因性CXCL9による肝臓内抗腫瘍免疫応答
    福田 泰也; 浅岡 忠史; 小林 省吾; 高橋 秀典; 野田 剛広; 橋本 和彦; 石川 原; 木村 豊; 土岐 祐一郎; 江口 英利
    日本消化器外科学会総会 78回 P085 - 6 (一社)日本消化器外科学会 2023年07月
  • 消化器外科手術におけるICTとASTの活動状況の検討
    橋本 和彦; 天野 智佳子; 嶋田 高広; 額原 敦; 福田 泰也; 福田 周一; 大塚 正久; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会総会 78回 P060 - 2 (一社)日本消化器外科学会 2023年07月
  • 当院における切除不能進行・再発胃癌に対する化学療法+ニボルマブの使用経験
    額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会総会 78回 P167 - 4 (一社)日本消化器外科学会 2023年07月
  • Yuto Kubo; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Kotaro Yamashita; Osamu Shiraishi; Keijiro Sugimura; Hiroshi Miyata; Masaaki Motoori; Kazumasa Fujitani; Atsushi Takeno; Motohiro Hirao; Yutaka Kimura; Taroh Satoh; Masahiko Yano; Hidetoshi Eguchi; Takushi Yasuda; Yuichiro Doki
    Annals of surgical oncology 30 9 5899 - 5907 2023年06月 
    BACKGROUND: Three-course neoadjuvant chemotherapy (NAC) followed by surgery has become a standard of care for locally advanced esophageal cancer (EC). However, some patients occasionally experience a poor tumor response to the third course and have a poor clinical outcome. METHODS: An exploratory analysis of data from the authors' recent multicenter randomized phase 2 trial compared patients with locally advanced EC who received two courses (n = 78) and those who received three courses (n = 68) of NAC. The association between tumor response and clinico-pathologic factors, including survival, was evaluated to identify risk factors in the three-course group. RESULTS: Of 68 patients who received three courses of NAC, 28 (41.2%) had a tumor reduction rate lower than 10% during the third course. This rate was associated with unfavorable overall survival (OS) and progression-free survival (PFS) compared with a tumor reduction rate of 10% or higher (2-year OS rate: 63.5% vs. 89.3%, P = 0.007; 2-year PFS rate: 52.6% vs. 79.7%, P = 0.020). The independent prognostic factors for OS were tumor reduction rate lower than 10% during the third course (hazard ratio [HR], 2.735; 95% confidence interval [CI] 1.041-7.188; P = 0.041) and age of 65 years or older (HR, 9.557, 95% CI 1.240-73.63; P = 0.030). Receiver operating characteristic curve and multivariable logistic regression analyses identified a tumor reduction rate lower than 50% after the first two courses as an independent predictor of a tumor reduction rate lower than 10% during the third course of NAC (HR, 4.315; 95% CI 1.329-14.02; P = 0.015). CONCLUSION: Continuing NAC through a third course may worsen survival for patients who do not experience a response to the first two courses in locally advanced EC.
  • Yuto Kubo; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Kotaro Yamashita; Osamu Shiraishi; Keijiro Sugimura; Hiroshi Miyata; Masaaki Motoori; Kazumasa Fujitani; Atsushi Takeno; Motohiro Hirao; Yutaka Kimura; Taroh Satoh; Masahiko Yano; Hidetoshi Eguchi; Takushi Yasuda; Yuichiro Doki
    Annals of surgical oncology 30 9 5910 - 5911 2023年06月
  • 切除不能進行・再発食道癌に対するニボルマブ療法の治療成績
    福田 周一; 額原 敦; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 77回 239 - 239 (NPO)日本食道学会 2023年06月
  • 当院における食道癌・胃管癌術後乳び胸の8症例の検討
    額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 77回 283 - 283 (NPO)日本食道学会 2023年06月
  • 切除不能進行・再発食道癌に対するニボルマブ療法の治療成績
    福田 周一; 額原 敦; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 77回 239 - 239 (NPO)日本食道学会 2023年06月
  • 当院における食道癌・胃管癌術後乳び胸の8症例の検討
    額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 77回 283 - 283 (NPO)日本食道学会 2023年06月
  • Atsushi Yasuda; Yutaka Kimura; Osamu Shiraishi; Masayuki Shinkai; Motohiro Imano; Takushi Yasuda
    International journal of surgery case reports 106 108156 - 108156 2023年05月 
    INTRODUCTION AND IMPORTANCE: Laparoscopic wedge resection has been widely performed for gastric gastrointestinal stromal tumors (GISTs). However, because GISTs in the esophagogastric junction (EGJ) are prone to deformity and postoperative functional disorders, laparoscopic resection is technically very difficult and rarely reported. Herein, we report a case of a GIST in the EGJ successfully treated by laparoscopic intragastric surgery (IGS). CASE PRESENTATION: A 58-year-old man with a GIST, which was intragastric growth type, 2.5 cm in diameter, located in the EGJ, and confirmed by upper gastrointestinal endoscope and endoscopic ultrasound-guided fine needle aspiration biopsy. We successfully performed IGS and the patient was discharged without complications. CLINICAL DISCUSSION: Using laparoscopic wedge resection by exogastric approach, it is problematic to resect a gastric SMT located at the EGJ because of the difficulty in viewing the surgical field and additional concerns of deformation of the EGJ. We suppose IGS as a suitable method for such tumors. CONCLUSION: Laparoscopic IGS for gastric GIST was useful in terms of safety and convenience even though the tumor was in the ECJ.
  • 高齢胃癌患者における術後補助化学療法の現状
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 123回 DP - 6 (一社)日本外科学会 2023年04月
  • 当院における切除不能進行・再発食道癌に対するニボルマブ療法の治療成績
    福田 周一; 額原 敦; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 123回 DP - 8 (一社)日本外科学会 2023年04月
  • Shu Aoyama; Masaaki Motoori; Makoto Yamasaki; Osamu Shiraishi; Hiroshi Miyata; Motohiro Hirao; Atsushi Takeno; Keijiro Sugimura; Tomoki Makino; Koji Tanaka; Takuya Hamakawa; Kotaro Yamashita; Yutaka Kimura; Kazumasa Fujitani; Takushi Yasuda; Masahiko Yano; Yuichiro Doki
    Esophagus : official journal of the Japan Esophageal Society 20 2 225 - 233 2023年04月 
    BACKGROUND: Neoadjuvant therapy followed by surgery is the standard treatment for locally advanced esophageal cancers. During neoadjuvant therapy, tumor-induced esophageal stenosis or adverse events often cause weight loss. However, little is known about the effects of weight loss during neoadjuvant therapy on postoperative complications or prognosis. We investigated the association between weight loss during neoadjuvant chemotherapy, postoperative infectious complications, and prognosis. METHODS: Data from OGSG1003, a randomized phase-II trial comparing two regimens of neoadjuvant chemotherapy, cisplatin and fluorouracil plus Adriamycin and cisplatin and fluorouracil plus docetaxel, for locally advanced esophageal squamous cell carcinoma were used. Body weight was measured before neoadjuvant chemotherapy and esophagectomy. Multivariate analysis for infectious complications and prognosis was performed. RESULTS: The study included 134 patients. The median weight loss during neoadjuvant chemotherapy was 2.83% (-2.07% to 6.29%). Postoperative infectious complications were observed in 37 patients who had a significantly higher weight loss during neoadjuvant chemotherapy (5.18% vs. 1.90%, P = 0.002). Multivariate analysis revealed that > 5% of weight loss during neoadjuvant chemotherapy was the only independent factor associated with postoperative infectious complications (odds ratio 2.69, 95% confidence interval 1.12-6.46, P = 0.027). Weight loss during neoadjuvant chemotherapy was significantly associated with worse recurrence-free survival in the univariate analysis (log-rank test, P = 0.002), but this association was marginal in the multivariate analysis (hazard ratio 1.73, 95% confidence interval 0.98-3.08, P = 0.058). CONCLUSIONS: Severe weight loss during neoadjuvant chemotherapy was an independent risk factor for postoperative infectious complications. Weight maintenance during neoadjuvant chemotherapy may reduce the incidence of postoperative infectious complications.
  • 当院における若手外科医のリクルートストラテジー
    橋本 和彦; 寺下 大補; 額原 敦; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 石川 原; 肥田 仁一; 金泉 博文; 橋本 幸彦; 塩野 裕之; 米倉 竹夫; 木村 豊
    日本外科学会定期学術集会抄録集 123回 SF - 4 (一社)日本外科学会 2023年04月
  • 高齢胃癌患者における術後補助化学療法の現状
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 123回 DP - 6 (一社)日本外科学会 2023年04月
  • 当院における切除不能進行・再発食道癌に対するニボルマブ療法の治療成績
    福田 周一; 額原 敦; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 123回 DP - 8 (一社)日本外科学会 2023年04月
  • 額原 敦; 福田 周一; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    癌と化学療法 50 3 375 - 377 (株)癌と化学療法社 2023年03月 
    症例は74歳,男性。食道癌に対し,食道亜全摘,胸腔内高位胃管吻合後,下咽頭癌CRT後で経過観察中であった。フォローの内視鏡検査で胃管下部に潰瘍性病変を認め,生検でgroup 5,tub1を認めた。内視鏡的切除は困難であり,手術の方針となった。右開胸胃管切除,皮下有茎空腸再建を行った。術後乳び胸水を認めた。経腸栄養を中止,TPN管理とし,オクトレオチド持続皮下注,エチレフリン持続点滴を開始した。保存的治療開始後も右胸腔ドレーンから2,000mL/日ほどの胸水を認めた。術後14日目に左鼠径リンパ節からリピオドールリンパ管造影を行った。一時的に胸水500mL/日以下まで減少を認めたが,再度1,000mL/日の排液を認めるようになった。術後30日目に肺炎・膿胸が原因と思われる炎症上昇あり,その後に排液が徐々に減少した。乳び胸が治癒したと判断し,術後41日目にドレーン抜去した。術後72日目に自宅退院した。(著者抄録)
  • 額原 敦; 石川 原; 寺下 大補; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 橋本 和彦; 肥田 仁一; 若狭 朋子; 木村 豊
    癌と化学療法 50 3 378 - 380 (株)癌と化学療法社 2023年03月 
    症例:症例は76歳,男性。検診で異常を指摘され,精査目的に当院紹介受診となった。上部消化管内視鏡検査で,十二指腸下行脚～水平脚に凹凸不整を伴う全周性の平坦な病変を認めた。生検で乳頭腺癌と診断された。腹部造影CTではリンパ節腫大や遠隔転移を認めなかった。内視鏡的深達度はM癌と推定されたが,大きさは約60mmで全周性,Vater乳頭近傍に位置していた。そのため,内視鏡的切除は困難と判断した。亜全胃温存膵頭十二指腸切除術を施行した。術後病理診断で0-IIa型,tub1>pap,pTis,Ly0,V0,80×50mm,BD1,Ex0,Pn0,pPM0,pDM0,pN0,pStage 0であった。その後,再発なく経過している。側方発育型の十二指腸癌はまれな疾患であり,内視鏡的切除や縮小手術,膵頭十二指腸切除などが報告されている。広範な側方発育型十二指腸癌の1切除例を経験したため,文献的考察を加えて報告する。(著者抄録)
  • Atsushi Gakuhara; Shuichi Fukuda; Daisuke Terashita; Hideo Tomihara; Masahisa Otsuka; Kotarou Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jinnichi Hida; Yutaka Kimura
    Gan to kagaku ryoho. Cancer & chemotherapy 50 3 375 - 377 2023年03月 
    A 74-year-old man was under follow-up after esophageal cancer surgery and CRT for hypopharyngeal cancer. Follow-up endoscopy revealed an ulcerative lesion in the lower gastric tube, and biopsy showed group 5(tub1). Endoscopic resection was difficult, and surgery was decided. Gastric tube resection and subcutaneous jejunum reconstruction were performed. Postoperatively, chylothorax was observed. Enteral nutrition was discontinued, and the patient was managed with TPN, and continuous subcutaneous octreotide and continuous intravenous etyrefrine were started. Even after conservative treatment was started, the pleural effusion of about 2,000 mL/day was observed from the right thoracic drain. On postoperative day 14, lymphangiography was performed with lipiodol from the left inguinal lymph node. The pleural fluid was temporarily decreased to less than 500 mL/day, but it began to drain again at a rate of 1,000 mL/day. On postoperative day 30, the patient developed fever and elevated inflammatory findings due to pneumonia and empyema, and drain drainage gradually decreased. The drain was removed on postoperative day 41. The patient was discharged home on postoperative day 72.
  • Atsushi Gakuhara; Hajime Ishikawa; Daisuke Terashita; Hideo Tomihara; Shuichi Fukuda; Masahisa Otsuka; Kotarou Kitani; Kazuhiko Hashimoto; Jinnichi Hida; Tomoko Wakasa; Yutaka Kimura
    Gan to kagaku ryoho. Cancer & chemotherapy 50 3 378 - 380 2023年03月 
    A 76-year-old man came to our hospital for a close examination after an abnormal finding during a medical checkup. Upper gastrointestinal endoscopy revealed a circumferential flat lesion with irregularity in the second to third portions of the duodenum. Biopsy diagnosed papillary adenocarcinoma. Contrast-enhanced CT of the abdomen showed no evidence of lymph node enlargement and distant metastasis. Endoscopic depth of the lesion was estimated to be intramucosal carcinoma, but it was approximately 60 mm in size, circumferential, and located near the papilla Vater. Therefore, endoscopic resection was deemed difficult. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Postoperative pathological examination revealed type 0-Ⅱa, tub1>pap, pTis, Ly0, V0, 80×50 mm, BD1, Ex0, Pn0, pPM0, pDM0, pN0, pStage 0. There has been no recurrence since then. Lateral spreading duodenal carcinoma is a rare disease, and endoscopic resection, local resection, and pancreaticoduodenectomy have been reported as treatment options. We report a case of resection of a large lateral spreading duodenal carcinoma with a review of the literature.
  • Moyuru Yamada; Koji Tanaka; Makoto Yamasaki; Kotaro Yamashita; Tomoki Makino; Takuro Saito; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Oncology letters 25 2 58 - 58 2023年02月 
    Studies have shown that neoadjuvant chemotherapy (NAC) followed by surgical resection improves the survival of patients with esophageal squamous cell carcinoma (ESCC), and that the neutrophil-to-lymphocyte ratio (NLR) nay be a prognostic biomarker in various types of cancer. Despite the noTable changes in the tumor and its microenvironment during NAC, it remains unclear how the NLR changes and which values (before or after NAC) best predict prognosis. The present study aimed to analyze changes in the NLR before and after NAC, and to determine which was a better prognostic factor. This study retrospectively analyzed 338 consecutive patients with ESCC who received NAC followed by curative resection. NLRs before (pre-NLR) and after (post-NLR) NAC were calculated, after which the impact of NAC on NLR, overall survival (OS) and recurrence-free survival (RFS), as well as the relationship between hematological toxicities and NLR, was evaluated. Cutoff values for pre- and post-NLR were 3.7 and 2.5, respectively. Patients with high post-NLR had a worse OS (P=0.0001) and 3-year RFS (P=0.03) than those with low post-NLR. Multivariate analysis identified high post-NLR, pN1 and clinical response as independent prognostic factors. In conclusion, post-NLR was revealed as a better prognostic factor than pre-NLR for patients receiving NAC followed by surgical resection.
  • 進行再発胃癌に対するアナモレリンの使用経験
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 95回 412 - 412 (一社)日本胃癌学会 2023年02月
  • 当院における腹腔鏡下食道空腸吻合Overlap法の手術手技と短期成績
    福田 周一; 額原 敦; 寺下 大補; 富原 英生; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 95回 488 - 488 (一社)日本胃癌学会 2023年02月
  • 額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    外科と代謝・栄養 57 3 175 - 175 日本外科代謝栄養学会 2023年
  • 胃癌悪液質患者に対するアナモレリン投与症例の検討
    額原 敦; 福田 周一; 寺下 大補; 福田 泰也; 大塚 正久; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    外科と代謝・栄養 57 3 175 - 175 日本外科代謝栄養学会 2023年
  • Yukinori Kurokawa; Yuichiro Doki; Junki Mizusawa; Takaki Yoshikawa; Takanobu Yamada; Yutaka Kimura; Shuji Takiguchi; Yasunori Nishida; Norimasa Fukushima; Haruhiko Cho; Masahide Kaji; Motohiro Hirao; Mitsuru Sasako; Masanori Terashima
    The British journal of surgery 110 1 50 - 56 2022年12月 
    BACKGROUND: Bursectomy, the total resection of the bursa omentalis, is a standard procedure in gastrectomy for resectable gastric cancer. A phase III trial (JCOG1001) comparing bursectomy and omentectomy alone was terminated early at the interim analysis. The final results of the updated analysis after a minimum follow-up of 5 years are reported here. METHODS: Patients with histologically proven adenocarcinoma of the stomach (cT3-T4a) were randomized (1 : 1) during surgery to bursectomy or omentectomy-alone groups and then underwent D2 gastrectomy. The primary endpoint was overall survival, analysed on an intention-to-treat basis. RESULTS: A total of 1204 patients (602 bursectomy and 602 omentectomy alone) were enrolled between June 2010 and March 2015. The bursectomy group had a significantly higher incidence of Clavien-Dindo grade III-IV intra-abdominal abscess than the omentectomy-alone group (5.5 versus 2.5 per cent respectively; P = 0.008). The updated 5-year overall survival rates were 74.9 (95 per cent c.i. 71.2 to 78.2) per cent in the bursectomy group and 76.5 (72.8 to 79.7) per cent in the omentectomy-alone group; the adjusted HR for death in the bursectomy group was 1.03 (95 per cent c.i. 0.83 to 1.27) (1-sided P = 0.598). Bursectomy did not decrease peritoneal recurrence (12.1 versus 12.3 per cent respectively; P = 1.000). In a multivariable analysis, old age (above 65 years), tumour located in the lower third or posterior wall of the stomach, macroscopic type 3/5, total gastrectomy, and cT4a were independent predictors of poor overall survival, but omentectomy alone was not. CONCLUSION: In D2 gastrectomy, bursectomy is not recommended as a standard procedure for cT3-T4a gastric cancer. Registration number: UMIN000003688 (https://www.umin.ac.jp/ctr/).
  • 寺下 大補; 額原 敦; 福田 周一; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    癌と化学療法 49 13 1841 - 1843 (株)癌と化学療法社 2022年12月 
    症例は79歳,男性。労作時息切れを主訴に前医を受診した。CTで右胸水貯留,腹水貯留を認め,胸水細胞診で腺癌を認めた。上部消化管内視鏡検査で幽門狭窄を伴う胃前庭部腫瘍を認め,同部位からの生検にてGroup 5(tub2)と判明した。幽門狭窄,腹膜・胸膜播種を伴う切除不能進行胃癌と診断した。化学療法を施行する方針となり,幽門部狭窄に対し消化管ステントを留置した後にSOX療法を開始した。ステント留置から3ヵ月後,化学療法効果判定目的のCTにてステント内狭窄および口側ステントの一部破損,胃内への脱落を認めた。腹痛などの症状はなく,待機的に脱落ステントの回収を行う方針とした。内視鏡的に脱落ステントを回収し,stent in stentで追加留置した。以降通過障害なく,現在も化学療法を継続中である。切除不能進行胃癌の化学療法中の消化管ステント破損はまれな偶発症であり,文献的考察を含め報告する。(著者抄録)
  • Hikari Teranishi; Atsushi Yasuda; Motohiro Imano; Yoko Hiraki; Kota Momose; Hiroaki Kato; Osamu Shiraishi; Masayuki Shinkai; Yutaka Kimura; Takushi Yasuda
    Gan to kagaku ryoho. Cancer & chemotherapy 49 13 1512 - 1514 2022年12月 
    Intraperitoneal chemotherapy, in which an anticancer drug is administered directly into the abdominal cavity through an intraperitoneal access port(IP port), is one of the treatment options for advanced gastric cancer with peritoneal metastasis. Herein, we report a case of sheath-like obstruction of the entire catheter of the IP port due to tissue reaction within a short period of time after IP port implantation. The case was a 35-year-old woman with advanced type 4 gastric cancer with peritoneal dissemination. The IP port was placed and intravenous and intraperitoneal chemotherapy using S-1 plus paclitaxel was started. However, in the middle of the second course, the entire catheter was covered with a fibrous capsule and a sheath-like obstruction occurred, so the IP port was removed and a new IP port was reinserted. One of the IP port troubles is obstruction, but such short-term and special obstruction is rare, and the cause is considered to be a foreign body reaction of the catheter.
  • Daisuke Terashita; Atsushi Gakuhara; Shuichi Fukuda; Hideo Tomihara; Katsuya Ota; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jinichi Hida; Yutaka Kimura
    Gan to kagaku ryoho. Cancer & chemotherapy 49 13 1841 - 1843 2022年12月 
    A 79-year-old man with shortness of breath on exertion had right pleural effusion and ascites effusion on CT, and was diagnosed with adenocarcinoma on pleural cytology. Upper gastrointestinal endoscopy revealed a gastric cancer with pyloric stenosis, and biopsy from the same site revealed Group 5(tub2). The patient was diagnosed as unresectable advanced gastric cancer with pyloric stenosis and peritoneal and pleural dissemination. After placement of an uncovered metallic stent for the pyloric stenosis, SOX therapy was started. Three months after stent placement, a CT scan to determine the effect of chemotherapy showed stenosis in the gastrointestinal stent, partial breakage of the stent on the mouth side, and prolapse of the stent into the stomach. There were no symptoms such as abdominal pain, and the patient was placed on standby for retrieval of the dislodged stent. The prolapsed stent was retrieved endoscopically, and a covered metallic stent was additionally implanted as a"stent in stent". The patient has had no further passage obstruction and is currently undergoing chemotherapy. We report a case of fracture of a gastrointestinal stent during chemotherapy for unresectable advanced gastric cancer.
  • Hayato Kaida; Takushi Yasuda; Osamu Shiraishi; Hiroaki Kato; Yutaka Kimura; Kohei Hanaoka; Minoru Yamada; Yuko Matsukubo; Masakatsu Tsurusaki; Kazuhiro Kitajima; Satoshi Hattori; Kazunari Ishii
    BMC cancer 22 1 1176 - 1176 2022年11月 
    BACKGROUND: Induction or adjuvant therapies are not always beneficial for thoracic esophageal squamous cell carcinoma (ESCC) patients, and it is thus important to identify patients at high risk for postoperative ESCC recurrence. We investigated the usefulness of the total metabolic tumor volume (TMTV) for predicting the postoperative recurrence of thoracic ESCC. METHODS: We retrospectively analyzed the cases of 163 thoracic ESCC patients (135 men, 28 women; median age of 66 [range 34-82] years) treated at our hospital in 2007-2012. The TMTV was calculated from the fluorine-18 fluorodeoxyglucose (18F-FDG) uptake in the primary lesion and lymph node metastases. The optimal cut-off values for relapse and non-relapse were obtained by the time-dependent receiver operating curve analyses. Relapse-free survival (RFS) was evaluated by the Kaplan-Meier method, and between-subgroup differences in survival were analyzed by log-rank test. The prognostic significance of metabolic parameters and clinicopathological variables was assessed by a Cox proportional hazard regression analysis. The difference in the failure patterns after surgical resection was evaluated using the χ2-test. RESULTS: The optimal cut-off value of TMTV for discriminating relapse from non-relapse was 3.82. The patients with a TMTV ≥3.82 showed significantly worse prognoses than those with low values (p < 0.001). The TMTV was significantly related to RFS (model 1 for preoperative risk factors: TMTV: hazard ratio [HR] =2.574, p = 0.004; model 2 for preoperative and postoperative risk factors: HR = 1.989, p = 0.044). The combination of the TMTV and cN0-1 or pN0-1 stage significantly stratified the patients into low-and high-risk recurrence groups (TMTV cN0-1, p < 0.001; TMTV pN0-1, p = 0.004). The rates of hematogenous and regional lymph node metastasis were significantly higher in the patients with TMTV ≥3.82 than those with low values (hematogenous metastasis, p < 0.001, regional lymph node metastasis, p = 0.011). CONCLUSIONS: The TMTV was a more significantly independent prognostic factor for RFS than any other PET parameter in patients with resectable thoracic ESCC. The TMTV may be useful for the identifying thoracic ESCC patients at high risk for postoperative recurrence and for deciding the patient management.
  • 75歳以上の高齢胃癌患者におけるGNRIと合併症および予後の検討
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会雑誌 55 Suppl.2 316 - 316 (一社)日本消化器外科学会 2022年10月
  • 当院における外科志望者確保のための取り組み
    橋本 和彦; 寺下 大補; 額原 敦; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 石川 原; 肥田 仁一; 金泉 博文; 橋本 幸彦; 塩野 裕之; 木村 豊
    日本臨床外科学会雑誌 83 増刊 S529 - S529 日本臨床外科学会 2022年10月
  • 胃癌術後経過観察中に発症した鼠径部子宮内膜症を背景とした類内膜腺癌の1例
    松元 哲也; 額原 敦; 寺下 大補; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 若狹 朋子; 木村 豊
    日本臨床外科学会雑誌 83 増刊 S541 - S541 日本臨床外科学会 2022年10月
  • 75歳以上の高齢胃癌患者におけるGNRIと合併症および予後の検討
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本消化器外科学会雑誌 55 Suppl.2 316 - 316 (一社)日本消化器外科学会 2022年10月
  • ドレーン非留置基準を提案する 胃手術におけるドレーン管理の現状
    木村 豊; 額原 敦; 福田 周一; 富原 英生; 大塚 正友; 木谷 光太郎; 橋本 和彦; 肥田 仁一
    日本外科感染症学会雑誌 19 1 139 - 139 (一社)日本外科感染症学会 2022年10月
  • 肝臓外科手術における周術期感染対策
    橋本 和彦; 天野 智佳子; 田村 さやか; 吉川 知宏; 寺口 皓; 額原 敦; 富原 英生; 福田 周一; 大塚 正久; 木谷 光太郎; 石川 原; 肥田 仁一; 嶋田 高広; 村木 正人; 木村 豊
    日本外科感染症学会雑誌 19 1 281 - 281 (一社)日本外科感染症学会 2022年10月
  • 胃管癌術後乳び胸に対しリンパ管造影を含めた保存的治療で治癒しえた1例
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 76回 218 - 218 (NPO)日本食道学会 2022年09月
  • 食道癌根治的CRT後の小彎リンパ節再発に対するSalvageリンパ節郭清を含む集学的治療の経験
    福田 周一; 額原 敦; 田嶋 馨; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本食道学会学術集会プログラム・抄録集 76回 282 - 282 (NPO)日本食道学会 2022年09月
  • Hiroshi Miyata; Keijiro Sugimura; Takashi Kanemura; Tomohira Takeoka; Takahito Sugase; Koji Tanaka; Tomoki Makino; Kotaro Yamashita; Makoto Yamasaki; Masaaki Motoori; Osamu Shiraishi; Yutaka Kimura; Takushi Yasuda; Masahiko Yano; Yuichiro Doki
    Annals of surgical oncology 29 9 5657 - 5665 2022年09月 
    BACKGROUND: Outcomes of salvage surgery after failed definitive chemoradiation (CRT) for esophageal cancer have been well defined. However, only a few studies have focused on salvage esophagectomy for recurrent disease after CRT. METHODS: In 227 patients with esophageal cancer who underwent salvage esophagectomy after definitive CRT, consisting of 116 patients who underwent esophagectomy for persistent disease (the persistent group) and 111 patients who underwent esophagectomy for recurrent disease (the recurrent group), the short- and long-term outcomes were investigated. RESULTS: The rates of any postoperative complication were similar between the groups (49.1% in the persistent group vs. 49.5% in the recurrent group, p = 0.951), although there was a higher rate of anastomotic leakage in the recurrent group (p = 0.027). Thirty-day mortality was also similar between the groups (1.7% in the persistent group vs. 0.9% in the recurrent group, p = 0.587). The 3-year and 5-year overall survival rates were 33.7% and 28.0% in the persistent group and 48.7% and 41.7% in the recurrent group, respectively (p = 0.0175). In the recurrent group, clinically nodal status before CRT as well as pathologically nodal status and time to relapse were identified as independent prognostic factors. In the persistent group, pT and resection margin were identified as independent factors associated with survival. CONCLUSIONS: The present study showed that salvage surgery for recurrent disease can provide acceptable short- and long-term outcomes. Considering clinically and pathologically nodal status and time to relapse, adjuvant therapy might be offered for patients who underwent salvage esophagectomy for recurrent disease after definitive CRT.
  • Yuto Kubo; Koji Tanaka; Makoto Yamasaki; Kotaro Yamashita; Tomoki Makino; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Journal of clinical medicine 11 11 2022年06月 
    BACKGROUND: Perioperative fluid balance is an important indicator in the management of esophageal cancer patients who undergo esophagectomy. However, the association between perioperative fluid balance and postoperative complications after minimally invasive esophagectomy (MIE) remains unclear. METHODS: This study included 115 patients with thoracic esophageal squamous cell cancer who underwent MIE between January 2018 and January 2020. We retrospectively evaluated the association between perioperative fluid balance from during surgery to postoperative day (POD) 2, and postoperative complications. RESULTS: The patients were divided into lower group and higher group based on the median fluid balance during surgery and at POD 1 and POD 2. We found that the higher group at POD 1 (≥3000 mL) was the most important indicator of postoperative complications, such as acute pneumonia within 7 days after surgery, and anastomotic leakage (p = 0.029, p = 0.024, respectively). Moreover, the higher group at POD 1 was a significant independent factor for acute postoperative pneumonia by multivariate analysis (OR: 3.270, 95% CI: 1.077-9.929, p = 0.037). CONCLUSION: This study showed that fluid overload at POD 1 had a negative influence on postoperative complications in patients with esophageal cancer. The fluid balance must be strictly controlled during the early postoperative management of patients undergoing esophageal cancer surgery.
  • 木村 豊; 西川 和宏; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 田村 茂行; 川田 純司; 川瀬 朋乃; 川端 良平; 柳本 喜智; 下川 敏雄; 今村 博司
    外科と代謝・栄養 56 3 85 - 85 日本外科代謝栄養学会 2022年06月
  • 当院における進行再発胃癌に対するアナモレリンの使用経験
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    外科と代謝・栄養 56 3 99 - 99 日本外科代謝栄養学会 2022年06月
  • Masaaki Motoori; Keijiro Sugimura; Koji Tanaka; Osamu Shiraishi; Yutaka Kimura; Hiroshi Miyata; Makoto Yamasaki; Tomoki Makino; Yasuhiro Miyazaki; Mitsuru Iwama; Kotaro Yamashita; Mai Niikura; Takuya Sugimoto; Takashi Asahara; Kazumasa Fujitani; Takushi Yasuda; Yuichiro Doki; Masahiko Yano
    Clinical nutrition (Edinburgh, Scotland) 41 5 1112 - 1121 2022年05月 
    BACKGROUND & AIMS: Established supportive care to reduce the toxicity of neoadjuvant chemotherapy (NAC) is lacking. This multicenter randomized study compared the administration of synbiotics combined with enteral nutrition (EN) versus that of prophylactic antibiotics as supportive care treatment for patients with esophageal cancer undergoing NAC. METHODS: Patients with advanced esophageal cancer scheduled to receive NAC were randomly administered either prophylactic antibiotics (antibiotic group) or synbiotics combined with EN (Syn + EN group). The primary endpoint was the febrile neutropenia (FN) incidence during the first course, and the secondary endpoints were other adverse events, changes in intestinal environment, including fecal microbiota, organic acid concentrations, pH, and chemotherapy tolerability. RESULTS: Eighty-one patients were enrolled. The FN incidence was nonsignificantly lower (P = 0.088) in the Syn + EN group. The incidences of grade 4 neutropenia and grades 2-4 diarrhea were significantly lower in the Syn + EN group (P = 0.014 and 0.033, respectively). Relative dose intensity was significantly higher in the Syn + EN group (92.0 ± 10.9%) than in the antibiotic group (83.2 ± 18.2%) (P = 0.01). Alpfa diversity was significantly higher in the Syn + EN group than in the antibiotic after chemotherapy (P = 0.002). The numbers of Bifidobacterium (P < 0.05), Lacticaseibacillus (P < 0.001), and Enterobacteriaceae (P < 0.001) and the concentration of acetic acid (P < 0.001) were significantly higher in the Syn + EN group than in the antibiotic group after chemotherapy. The severity of diarrhea and occurrence of FN were significantly correlated with Clostridioides difficile abundance and were significantly inversely correlated with acetic acid concentration after chemotherapy. CONCLUSIONS: Synbiotics combined with EN may be an alternative supportive care treatment to prophylactic antibiotics in patients with cancer undergoing toxic chemotherapy (https://jrct.niph.go.jp; jRCTs051180153).
  • Hideo Tomihara; Kazuhiko Hashimoto; Hajime Ishikawa; Daisuke Terashita; Atsushi Gakuhara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Jin-Ichi Hida; Tomoko Wakasa; Yutaka Kimura
    Surgical case reports 8 1 79 - 79 2022年04月 
    BACKGROUND: Undifferentiated carcinoma is a very rare histologic subtype, representing only 0.8% to 5.7% of all pancreatic exocrine neoplasms. Additionally, spontaneous abdominal hemorrhage is a particularly rare, life-threatening cause. CASE PRESENTATION: A 68-year-old man was taken by ambulance to our hospital because of sudden-onset abdominal pain. Contrast-enhanced abdominal computed tomography revealed a huge mass measuring 99 × 70 mm in the pancreatic tail with enhanced rim staining in the peripheral area. Imaging also showed extravasation and fluid collection beside the tumor. Hence, spontaneous rupture of the pancreatic tumor and intra-abdominal bleeding were diagnosed. Emergency laparotomy was performed because of acute abdominal pain with peritoneal signs. With an intraoperative diagnosis of rupture of the pancreatic tumor, distal pancreatectomy was successfully performed. Histologically, hematoxylin and eosin staining showed round to spindle-shaped, highly pleomorphic mononuclear cells and multinucleated giant cells as well as a component of ductal adenocarcinoma. Immunohistochemical staining showed that the tumor cells were negative for AE1/AE3, whereas the non-neoplastic osteoclast-like giant cells were positive for CD68. Taken together, these results led to a diagnosis of undifferentiated carcinoma with osteoclast-like giant cells. The patient's postoperative course was uneventful. CONCLUSION: We experienced an extremely rare case of spontaneous rupture of an undifferentiated carcinoma with osteoclast-like giant cells presenting as intra-abdominal bleeding. Obtaining a correct preoperative diagnosis is quite difficult at the first evaluation. Undifferentiated carcinoma should be considered as a differential diagnosis in the case with spontaneous rupture of a pancreatic tumor.
  • 食道癌2次化学療法におけるDTXとPTXのランダム化比較第II相試験(OGSG1201)
    川田 純司; 山本 幸子; 紀 貴之; 原 浩紀; 川端 良平; 竹野 淳; 松山 仁; 上田 修吾; 川上 尚人; 大北 仁裕; 遠藤 俊治; 木村 豊; 柳原 一広; 奥野 達哉; 黒川 幸典; 下川 敏雄; 佐藤 太郎
    日本外科学会定期学術集会抄録集 122回 SF - 5 (一社)日本外科学会 2022年04月
  • 食道癌2次化学療法におけるDTXとPTXのランダム化比較第II相試験(OGSG1201)
    川田 純司; 山本 幸子; 紀 貴之; 原 浩紀; 川端 良平; 竹野 淳; 松山 仁; 上田 修吾; 川上 尚人; 大北 仁裕; 遠藤 俊治; 木村 豊; 柳原 一広; 奥野 達哉; 黒川 幸典; 下川 敏雄; 佐藤 太郎
    日本外科学会定期学術集会抄録集 122回 SF - 5 (一社)日本外科学会 2022年04月
  • 創部を追加することなくJ型に挿入する3ポート腹腔鏡下虫垂切除術におけるドレーン留置
    福田 周一; 木谷 光太郎; 寺下 大輔; 額原 敦; 富原 英生; 太田 勝也; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 122回 SF - 7 (一社)日本外科学会 2022年04月
  • 当院における外科手術の周術期感染対策とICT活動状況
    橋本 和彦; 木谷 光太郎; 天野 智佳子; 田村 さやか; 寺口 皓; 吉川 知宏; 澤口 博千代; 嶋田 高広; 村木 正人; 橋本 幸彦; 塩野 裕之; 木村 豊
    日本外科学会定期学術集会抄録集 122回 SF - 2 (一社)日本外科学会 2022年04月
  • 80歳以上の高齢胃癌患者におけるGNRIと予後の検討
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本外科学会定期学術集会抄録集 122回 DP - 7 (一社)日本外科学会 2022年04月
  • 80歳以上の高齢胃癌患者におけるNLRと予後の検討
    額原 敦; 福田 周一; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 94回 471 - 471 (一社)日本胃癌学会 2022年03月
  • 胃癌と原発性右副腎リンパ腫が併存した1例(A case of synchronous gastric cancer and primary lymphoma of right adrenal gland)
    福田 周一; 額原 敦; 若狹 朋子; 花本 仁; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 94回 489 - 489 2022年03月
  • 潰瘍を伴う粘膜下腫瘍様の内視鏡像を呈した壁外発育型胃肝様腺癌の1例(Extraluminal growth type gastric hepatoid adenocarcinoma with submucosal tumor-like appearance)
    福田 周一; 額原 敦; 若狹 朋子; 寺下 大補; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本胃癌学会総会記事 94回 495 - 495 2022年03月
  • Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Kotaro Yamashita; Shinya Urakawa; Tomo Ishida; Osamu Shiraishi; Keijiro Sugimura; Hiroshi Miyata; Masaaki Motoori; Kazumasa Fujitani; Atsushi Takeno; Motohiro Hirao; Yutaka Kimura; Taroh Satoh; Masahiko Yano; Hidetoshi Eguchi; Yuichiro Doki; Takushi Yasuda
    British journal of cancer 126 11 1555 - 1562 2022年02月 
    BACKGROUND: The optimal number of neoadjuvant chemotherapy (NAC) cycles remains to be established for treating oesophageal squamous cell carcinoma (ESCC). We compared two versus three courses of NAC for treating locally advanced ESCC in a multi-institutional, randomised, Phase II trial. METHODS: We randomly assigned 180 patients with locally advanced ESCC at 6 institutions to either two (N = 91) or three (N = 89) courses of DCF (docetaxel 70 mg/m2, cisplatin 70 mg/m2 i.v. on day 1, fluorouracil 700 mg/m2 continuous infusion for 5 days) every 3 weeks, prior to surgery. The primary endpoint was 2-year progression-free survival (PFS) with an intention-to-treat analysis. RESULTS: Patient background parameters were well-balanced. The R0 resection rates were 98.9 and 96.5% in the two- and three-course groups, respectively (P = 0.830). In resected cases, the two- and three-course groups had comparable pN0 rates (P = 0.225) and histological responses (P = 0.898). The 2-year PFS rate was also comparable between the two groups (71.4 vs. 71.1%, P = 0.669). Among subgroups based on baseline characteristics, only patients aged under 65 years old showed a tendency for better survival with the three-course treatment (hazard ratio = 2.612, 95% confidence interval: 1.012-7.517). CONCLUSIONS: Two courses of a DCF regimen showed potential as an optional NAC treatment for locally advanced ESCC. CLINICAL TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry of Japan (identification number UMIN 000015788).
  • 腹腔鏡下虫垂切除術におけるJ型に挿入するドレーン留置
    福田 周一; 木谷 光太郎; 寺下 大補; 額原 敦; 富原 英生; 太田 勝也; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本腹部救急医学会雑誌 42 2 316 - 316 (一社)日本腹部救急医学会 2022年02月
  • 回腸人工肛門閉鎖後の縫合不全・腸管皮膚瘻に対し、TPNでの保存的治療で治癒しえた1例
    額原 敦; 平田 幸一郎; 石川 原; 木村 豊
    学会誌JSPEN 4 Suppl.1 645 - 645 (一社)日本臨床栄養代謝学会 2022年
  • 肝癌における術前のPrognostic Nutrition Indexと治療成績についての検討
    石川 原; 額原 敦; 木村 豊
    学会誌JSPEN 4 Suppl.1 742 - 742 (一社)日本臨床栄養代謝学会 2022年
  • 下部進行直腸癌の術前化学放射線治療後の局所再発に対して経肛門的内視鏡下直腸切除術を施行した一例
    木谷 光太郎; 太田 勝也; 額原 敦; 富原 英夫; 福田 周一; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊
    日本内視鏡外科学会雑誌 26 7 MO023 - 4 (一社)日本内視鏡外科学会 2021年12月
  • 石川 原; 額原 敦; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 木村 豊
    日本外科感染症学会雑誌 18 1 205 - 205 (一社)日本外科感染症学会 2021年11月
  • 橋本 和彦; 木谷 光太郎; 寺口 皓; 吉川 知宏; 天野 智佳子; 田村 さやか; 澤口 博千代; 嶋田 高広; 木村 豊; 村木 正人
    日本外科感染症学会雑誌 18 1 265 - 265 (一社)日本外科感染症学会 2021年11月
  • Kotaro Yamashita; Makoto Yamasaki; Yasuhiro Miyazaki; Norihiro Matsuura; Koji Tanaka; Tomoki Makino; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Masaaki Motoori; Yukinori Kurokawa; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Surgery today 52 4 624 - 632 2021年10月 
    PURPOSE: To evaluate if nutritional supplements can attenuate postoperative catabolism in esophageal cancer patients after radical esophagectomy. METHODS: We analyzed data prospectively from 30 patients who underwent curative esophagectomy for esophageal cancer between August and December, 2019. We compared postoperative nitrogen balance and changes in body composition between patients who received protein-enhanced enteral feeds (PEF) or other enteral feeds (OF). RESULTS: Postoperative enteral feeding was administered safely to all patients. The average nitrogen balance was significantly higher in the PEF group than in the OF group on postoperative days (PODs) 3 (2.41 vs. - 1.50 g, P = 0.002), 4 (3.74 vs. - 0.08 g, P = 0.006), and 5 (3.27 vs. 0.11 g, P = 0.031). The cumulative nitrogen balance in the 7 days after surgery was significantly higher in the PEF group than in the OF group (6.12 vs. - 8.40 g, P = 0.025). The bodyweight loss and lean body mass loss on POD 14 were equivalent in the two groups (bodyweight loss 3.70 vs. 2.87%, P = 0.25; lean body mass loss, 4.34 vs. 1.91%, P = 0.33). CONCLUSIONS: PEF improved the postoperative nitrogen balance significantly in patients who underwent esophagectomy.
  • 消化器外科手術部位感染サーベイランスと周術期感染対策
    橋本 和彦; 木谷 光太郎; 天野 智佳子; 寺下 大補; 額原 敦; 富原 英生; 福田 周一; 太田 勝也; 石川 原; 肥田 仁一; 木村 豊
    日本臨床外科学会雑誌 82 増刊 S922 - S922 日本臨床外科学会 2021年10月
  • 胃切除術後障害を考えた栄養管理 胃切除術後障害に対する成分栄養剤の効果
    西川 和宏; 木村 豊; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 田村 茂行; 柳本 喜智; 川田 純司; 川瀬 朋乃; 川端 良平; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    学会誌JSPEN 3 Suppl.1 130 - 130 (一社)日本臨床栄養代謝学会 2021年10月
  • 成分栄養剤のこれまで・今・これから 胃癌外科治療周術期における成分栄養剤の有効性
    木村 豊; 西川 和宏; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 田村 茂行; 川田 純司; 川瀬 朋乃; 川端 良平; 柳本 喜智; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    学会誌JSPEN 3 Suppl.1 154 - 154 (一社)日本臨床栄養代謝学会 2021年10月
  • Hideo Tomihara; Kazuhiko Hashimoto; Hajime Ishikawa; Daisuke Terashita; Atsushi Gakuhara; Shuichi Fukuda; Katsuya Ohta; Kotaro Kitani; Jin-Ichi Hida; Tomoko Wakasa; Yutaka Kimura
    Clinical journal of gastroenterology 14 5 1544 - 1549 2021年10月 
    Hepatocellular adenoma (HCA) is a rare benign liver tumor that has been reported to occur particularly more often in women who use contraceptives. A 72-year-old woman with no history of using contraceptives presented to our hospital for further examination of a liver tumor. Contrast-enhanced computed tomography and gadoxetic acid-enhanced magnetic resonance imaging revealed a huge solitary hepatic tumor measuring 83 × 76 mm in segments 4, 5, and 8. The differential diagnoses were cholangiocarcinoma and mixed-type hepatocellular carcinoma. Percutaneous needle biopsies were performed twice, and no malignant components were found. Central bi-segmentectomy of the liver was successfully performed. Immunohistochemical staining showed that β-catenin was positive in the membrane of the tumor cells, while fatty acid-binding protein, glutamine synthetase, and amyloid A were negative. These results led to a diagnosis of HCA, hepatocyte nuclear factor-1α-inactivated subtype. The patient's postoperative course was uneventful, and she developed no recurrence for 10 months after surgery. We experienced a rare case of benign HCA. Obtaining a correct preoperative diagnosis is sometimes difficult at the first evaluation. HCA should be considered as a differential diagnosis of liver tumors.
  • 西川 和宏; 木村 豊; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 田村 茂行; 柳本 喜智; 川田 純司; 川瀬 朋乃; 川端 良平; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    外科と代謝・栄養 55 4 75 - 75 日本外科代謝栄養学会 2021年09月
  • Noriko Wada; Tsuyoshi Takahashi; Yukinori Kurokawa; Kiyokazu Nakajima; Toshirou Nishida; Masahiro Koh; Yusuke Akamaru; Masaaki Motoori; Yutaka Kimura; Koji Tanaka; Yasuhiro Miyazaki; Tomoki Makino; Makoto Yamasaki; Hidetoshi Eguchi; Yuichiro Doki
    Surgery today 51 9 1506 - 1512 2021年09月 
    PURPOSE: Imatinib is the standard treatment for unresectable and metastatic GIST. In the late stages, patients undergoing imatinib show drug resistance. Surgical intervention has been occasionally performed for resistant lesions. However, the clinical significance of such intervention remains unclear. METHODS: Between 2006 and 2015, 37 patients were diagnosed with imatinib-resistant GISTs. We performed surgical intervention only for localized resistant lesions. We retrospectively investigated the background characteristics, data on surgical intervention and subsequent treatment, progression-free survival (PFS), and overall survival (OS). RESULTS: Eighteen patients diagnosed with localized resistance received surgical intervention (S-group) and 19 patients diagnosed with generalized resistance were received other TKIs (M-group). In S-group, no serious complications occurred, and all patients restarted imatinib after resection. The median PFS was 14.5 months. Five patients underwent surgical intervention multiple times followed by the continuation of imatinib, and the median duration of imatinib continuation was 22.2 months. Second-line TKIs were administered to 93% of the patients and the dose-intensity and outcome were similar in both groups. The median OS was 47.2 months after surgery. CONCLUSIONS: Surgical intervention could be performed safely and therefore could be followed by the continuation of TKI therapy. Surgical intervention based on the appropriate criteria of resistance might thus be useful for imatinib-resistant GISTs.
  • Tomono Kawase; Hiroshi Imamura; Masahiro Goto; Yutaka Kimura; Shugo Ueda; Jin Matsuyama; Kazuhiro Nishikawa; Naotoshi Sugimoto; Junya Fujita; Takao Tamura; Norimasa Fukushima; Hisato Kawakami; Daisuke Sakai; Yukinori Kurokawa; Toshio Shimokawa; Taroh Satoh
    International journal of clinical oncology 26 10 1871 - 1880 2021年08月 
    BACKGROUND: To compare irinotecan-alone, paclitaxel-alone, and each combination chemotherapy with S-1 in patients with advanced gastric cancer (AGC) that is refractory to S-1 or S-1 plus cisplatin (SP). METHODS: Patients with AGC after first-line chemotherapy with S-1 or SP, or patients during adjuvant chemotherapy or within 26 weeks after adjuvant chemotherapy completion with S-1 with confirmed disease progression were eligible. Patients were randomly divided into four groups based on treatment: irinotecan-alone (irinotecan; 150 mg/m2, day 1, q14 days), paclitaxel-alone (paclitaxel; 80 mg/m2, days 1, 8, 15, q28 days), S-1 plus irinotecan (irinotecan; 80 mg/m2, days 1, 15, S-1; 80 mg/m2, days 1-21, q35 days), and S-1 plus paclitaxel (paclitaxel; 50 mg/m2, day1, 8, S-1; 80 mg/m2, days 1-14, q21 days). The primary endpoint was overall survival (OS) and secondary endpoints were progression-free survival (PFS), response rate, and safety. RESULTS: From July 2008 to March 2012, 127 patients were enrolled. No difference in median OS was observed in the irinotecan vs. paclitaxel groups or in the monotherapy groups vs. the S-1 combination therapy groups. Median PFS was longer in the paclitaxel group compared with the irinotecan group (4.1 vs. 3.6 months, p = 0.035), although no difference was observed when comparing monotherapy vs. S-1 combination. The most common grade 3 to 4 hematological adverse events were neutropenia with no difference in incidence rate across the treatment groups. CONCLUSIONS: There was no difference in OS between irinotecan and paclitaxel no in OS prolongation of S-1 combination therapy in second-line chemotherapy.
  • Tomo Ishida; Tsuyoshi Takahashi; Toshirou Nishida; Hiromitsu Ohnishi; Takahiro Tsuboyama; Shinsuke Sato; Yujiro Nakahara; Yasuhiro Miyazaki; Atsushi Takeno; Yukinori Kurokawa; Takuro Saito; Kotaro Yamashita; Koji Tanaka; Kazuyoshi Yamamoto; Tomoki Makino; Makoto Yamasaki; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 25 1 218 - 225 2021年08月 
    BACKGROUND: The introduction of molecularly targeted drugs, including imatinib, has greatly improved the prognosis of gastrointestinal stromal tumor (GIST), and based on the different response image, the methods of response evaluation have been established for GISTs. Furthrmore, the best response evaluation using them has been reported to be associated with progression-free survival (PFS) in imatinib treatment. However, since it is more important to predict the clinical outcomes of imatinib treatment in "early treatment phase", new predicting factor in earlier stage is desired to work out the whole strategy of each patient. Early morphological change (EMC) was previously reported as a predictive marker for molecularly targeted drugs in metastatic colorectal cancer. The purpose of the present study was to verify the efficacy of EMC in predicting the outcome in patients with GIST receiving imatinib at early evaluation. METHODS: We retrospectively reviewed 66 patients. EMC in computed tomography (CT) image was evaluated, and the patients were categorized into two groups: active MR (morphological response) (+) group and active MR (-) group. We investigated the association between the presence of active MR and clinical outcomes. RESULTS: Forty-five patients had active MR ( +). The median progression-free survival (PFS) in patients with/without active MR was 49/23 months (P = 0.0039). CONCLUSION: The evaluation criteria based on EMC could be a sensitive method to predict the clinical outcome of imatinib treatment for patients with unresectable GIST.
  • Koji Tanaka; Makoto Yamasaki; Teruyuki Kobayashi; Kotaro Yamashita; Tomoki Makino; Takuro Saitoh; Tsuyoshi Takahashi; Yukinori Kurokawa; Kiyokazu Nakajima; Masaaki Motoori; Yutaka Kimura; Masaki Mori; Hidetoshi Eguchi; Yuichiro Doki
    Surgery 170 2 469 - 477 2021年08月 
    BACKGROUND: The impact of pneumonia on prognosis is controversial, and no report has focused on its onset. This study aimed to examine the impact of pneumonia according to its onset on prognosis and its associated risk factors after esophagectomy. METHODS: In total, 484 patients who underwent curative resection for esophageal squamous cell carcinoma were retrospectively reviewed. Patients with pneumonia were divided into two groups by the date of onset: pneumonia in the acute phase within 7 days after surgery (n = 59) and pneumonia in the subacute phase 8 days after surgery (n = 49). RESULTS: The disease-free survival of patients with acute pneumonia was significantly lower than that of those without pneumonia (P = .0002), whereas the disease-free survival of patients with subacute pneumonia was similar to that of patients without pneumonia (P = .5363). In multivariate analysis for disease-free survival, P-stage III to IV (hazard ratio [HR], 3.344; P < .0001), transfusion (HR, 1.4078; P = .0291), and acute pneumonia (HR, 1.8463; P = .0009) were independent prognostic factors. Multivariate analysis revealed that age >75 years (odds ratio [OR], 2.1746; P = .0232), respiratory disease comorbidity (OR, 4.3869; P = .0002), cT3-4 (OR, 2.0143; P = .0477), extended surgery duration (OR, 2.3406; P = .0152), and posterior mediastinal reconstruction (OR, 0.1432; P = .0439) were independent risk factors for acute pneumonia. CONCLUSION: Post-esophagectomy pneumonia in the acute phase was an independent prognostic factor, whereas advanced age, respiratory disease comorbidity, and extended surgery duration were risk factors for acute pneumonia.
  • Koji Tanaka; Makoto Yamasaki; Keijiro Sugimura; Osamu Shiraishi; Masaaki Motoori; Takuya Hamakawa; Atsushi Takeno; Kotaro Yamashita; Tomoki Makino; Yutaka Kimura; Hiroshi Miyata; Motohiro Hirao; Hidetoshi Eguchi; Takushi Yasuda; Masahiko Yano; Yuichiro Doki
    Annals of surgical oncology 28 8 4402 - 4410 2021年08月 
    BACKGROUND: The impact of thoracic duct (TD) resection on prognosis is controversial. This study aimed to examine the impact of TD resection. METHODS: In this six-institution, matched-cohort study, 2269 consecutive patients with esophageal squamous cell carcinoma who underwent esophagectomy between 2000 and 2017 were enrolled for analysis of long-term outcomes, including overall survival (OS), disease-free survival (DFS), cause-specific survival (CSS), and recurrence patterns. RESULTS: Based on a propensity score, 642 TD-resected and 642 TD-preserved patients with all stages of disease were selected. At 5 years, the TD-resected group had an OS of 57.7%, a DFS of 50.9%, and a CSS of 62.2%. These rates were significantly higher than the corresponding rates of 48.7% (p = 0.0078), 41.0% (p = 0.0297), and 55.3% (p = 0.0473) in the TD-preserved group. The OS in the TD-preserved and TD-resected groups was similar for the patients with cStage 1 or 2 (p = 0.6265), but it was significantly higher in the TD-resected group for the patients with cStage 3 or 4 (p = 0.0052). The incidence of total recurrence did not differ between the two groups. However, the incidence of hematogenous recurrence in the TD-resected group (19.0%) was significantly lower than in the TD-preserved group (26.2%) (p = 0.0021). For cT4a tumors, the incidence of local recurrence in the TD-resected group (2.4%) was significantly lower than in the TD-preserved group (18.4%) (p = 0.0183). CONCLUSIONS: Performance of TD resection may help to improve prognosis, especially for patients with advanced esophageal squamous cell carcinoma, by reducing hematogenous and local recurrence. Prospective trials are needed to determine whether prophylactic TD resection has a positive impact on the prognosis of patients with esophageal cancer.
  • Kotaro Yamashita; Yasuhiro Miyazaki; Daisaku Nakatani; Yasunori Masuike; Koji Tanaka; Keijiro Sugimura; Tomoki Makino; Osamu Shiraishi; Tsuyoshi Takahashi; Yukinori Kurokawa; Makoto Yamasaki; Hiroshi Miyata; Yutaka Kimura; Hiroyuki Araki; Tomomi Yamada; Takushi Yasuda; Masahiko Yano; Hidetoshi Eguchi; Yuichiro Doki
    Anticancer research 41 8 3875 - 3884 2021年08月 
    BACKGROUND/AIM: An excessive postoperative inflammatory response is correlated with the development of pneumonia and an unfavourable prognosis in patients undergoing esophagectomy for esophageal cancer. We assessed the influence of OSK-0028, a synthetic human ghrelin on inflammatory response and energy metabolism, on the postoperative course of patients following radical esophagectomy. PATIENTS AND METHODS: Esophageal cancer patients were randomly assigned to low-dose (LD; 0.25 μg/kg/h) or high-dose (HD; 0.5 μg/kg/h) intravenous OSK-0028 or placebo for 7 days after esophagectomy. The primary endpoint was serum interleukin-6 level on postoperative day (POD) 3. RESULTS: A total of 75 patients were enrolled (23 LD, 26 HD, 26 placebo). The median interleukin-6 levels on POD 3 were 40.95, 35.85, and 64.50 pg/ml in the placebo, LD, and HD groups, respectively, with no significant differences (p=0.78). Postoperative complications did not differ between groups. Bodyweight loss was significantly lower in patients receiving OSK-0028 than in those receiving placebo (-0.17% vs. 1.78%, p=0.043). CONCLUSION: Although OSK-0028 did not attenuate inflammatory response after esophagectomy, it prevented postoperative bodyweight loss.
  • Sachiko Yamamoto; Hisato Kawakami; Takayuki Kii; Hiroki Hara; Ryohei Kawabata; Junji Kawada; Atsushi Takeno; Jin Matsuyama; Shugo Ueda; Yoshihiro Okita; Shunji Endo; Yutaka Kimura; Kazuhiro Yanagihara; Tatsuya Okuno; Yukinori Kurokawa; Toshio Shimokawa; Taroh Satoh
    European journal of cancer (Oxford, England : 1990) 154 307 - 315 2021年07月 
    BACKGROUND: There is no standard chemotherapy for esophageal squamous cell carcinoma (ESCC) refractory to first-line fluoropyrimidine- and platinum-based chemotherapy. We therefore performed a randomized, selection-design phase II trial to compare docetaxel (DTX) and paclitaxel (PTX) in this setting. PATIENTS AND METHODS: Eligible patients were randomly assigned to receive either DTX (70 mg/m2 on day 1 of each 21-day cycle) or PTX (100 mg/m2 on days 1, 8, 15, 22, 29 and 36 of each 49-day cycle). The primary end-point was overall survival (OS), and secondary end-points included progression-free survival (PFS), time to treatment failure (TTF), response rate (RR) and safety. RESULTS: Seventy-eight eligible patients (N = 39 in each group) were included for efficacy analysis. OS was significantly longer in the PTX group than in the DTX group (median, 8.8 versus 7.3 months; hazard ratio [HR], 0.62; P = 0.047). A significant benefit of PTX over DTX was also apparent in PFS (median, 4.4 versus 2.1 months; HR, 0.49; P = 0.002) and TTF (median, 3.8 versus 2.1 months; HR, 0.45; P < 0.001). RR (25.6% versus 7.7%, P = 0.065) were higher in the PTX group than in the DTX group. Compared to the PTX group, neutropenia (28% versus 80%) and leukopenia (28% versus 76%) of grade ≥3 as well as febrile neutropenia (0% vs. 46%, P < 0.0001) occurred more frequently in the DTX group. CONCLUSION: PTX showed a significantly better efficacy as well as a more manageable toxicity compared with DTX. CLINICAL TRIAL REGISTRATION: UMIN000007940.
  • Shuichi Fukuda; Tomoko Wakasa; Hitoshi Hanamoto; Taichi Koyama; Yoshio Ohta; Masatoshi Inoue; Daisuke Terashita; Atsushi Gakuhara; Hideo Tomihara; Katsuya Ohta; Kotaro Kitani; Kazuhiko Hashimoto; Hajime Ishikawa; Jin-Ichi Hida; Yutaka Kimura
    Clinical journal of gastroenterology 14 5 1350 - 1357 2021年07月 
    This report presents an extremely rare case of synchronous gastric cancer and primary adrenal diffuse large B-cell lymphoma (DLBCL). An 82-year-old man underwent computed tomography, which revealed a heterogeneous appearing and hypodense adrenal mass and a gastric mass with no enlarged lymph nodes in the neck, mediastinum, abdomen, and inguinal region. Upper gastrointestinal endoscopy revealed a protruding gastric tumor. The specimens obtained from endoscopic biopsy were histologically confirmed to be adenocarcinoma. The hormonal findings eliminated functional adrenal tumor. The patient underwent distal gastrectomy with regional lymph node resection for gastric cancer and incisional biopsy of the adrenal mass. Based on the pathological findings, diagnoses of mixed mucinous and tubular adenocarcinomas of the stomach and adrenal DLBCL were confirmed. Postoperation, the patient received rituximab combined with low-dose doxorubicin, cyclophosphamide, vincristine, and prednisone (R-miniCHOP). Six courses of R-miniCHOP were planned, but were completed in only one course at the patient's request. The patient died 2 months after surgery.
  • Nana Takao; Satoshi Kurose; Takumi Miyauchi; Katsuko Onishi; Atsuko Tamanoi; Ryota Tsuyuguchi; Aya Fujii; Sawako Yoshiuchi; Kazuhisa Takahashi; Hiromi Tsutsumi; Yutaka Kimura
    BMC endocrine disorders 21 1 147 - 147 2021年07月 
    BACKGROUND: An effective strategy for weight loss in patients who are overweight or obese is to reduce body fat mass while maintaining skeletal muscle mass. Adiponectin and myostatin are affected through changes in body composition due to weight loss, and examining their dynamics may contribute to strategies for maintaining skeletal muscle mass through weight loss. We aimed to examine the relationships among myostatin, adiponectin, and body composition, depending on the extent of weight loss, in patients with obesity undergoing a weight loss program. METHODS: We examined 66 patients with obesity (age: 46.8 ± 14.0 years, body mass index: 34.3 [31.0-38.4] kg/m2) attending a hospital weight loss program. We categorized the patients into two groups, namely an L group (those with a weight reduction of < 5% from baseline) and an M group (those with a weight reduction of > 5% from baseline). All patients underwent blood tests and were assessed for body composition, insulin resistance, adipocytokine and myokine levels, exercise tolerance, and muscle strength at baseline and post-intervention. RESULTS: Serum myostatin and adiponectin levels increased post-intervention in both groups. Body weight and %fat decreased, and the rate of lean body mass (%LBM) increased in both groups. Exercise capacity and muscle strength improved in the M group only. Change in (⊿) myostatin correlated with ⊿%fat, ⊿%LBM, and ⊿adiponectin. ⊿adiponectin (β = - 0.262, p = 0.035) was an independent predictor of ⊿myostatin. CONCLUSIONS: Myostatin and adiponectin might cross-talk and regulate changes in skeletal muscle and fat mass with or without successful weight loss. These findings indicate that evaluating serum myostatin and adiponectin levels in clinical practice could be used to predict the effects of weight loss and help prevent skeletal muscle mass loss.
  • Norihiro Matsuura; Koji Tanaka; Makoto Yamasaki; Kotaro Yamashita; Tomoki Makino; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Oncology 99 9 1 - 8 2021年07月 
    PURPOSE: Esophageal cancer patients may simultaneously have resectable esophageal cancer and undiagnosable incidental minute solid pulmonary nodules. While the latter is rarely metastatic, only a few studies have reported on the outcomes of such nodules after surgery. In this retrospective study, we assessed the incidence of such nodules, the probability that they are ultimately metastatic nodules, and the prognosis of patients after esophagectomy according to the metastatic status of the nodules. METHODS: Data of 398 patients who underwent esophagectomy for resectable esophageal cancer between January 2012 and December 2016 were collected. We reviewed computed tomography (CT) images from the first visit and searched for incidental minute pulmonary nodules <10 mm in size. We followed the outcomes of these nodules and compared the characteristics of metastatic and nonmetastatic nodules. We also assessed the prognosis of patients whose minute pulmonary nodules were metastatic. RESULTS: Among the patients who underwent esophagectomy, 149 (37.4%) had one or more minute pulmonary nodules, with a total of 285 nodules. Thirteen (4.6%) of these nodules in 12 (8.1%) patients were ultimately diagnosed as being metastatic. Thirteen (8.7%) patients experienced recurrence at a different location from where the nodules were originally identified. Characteristics of the metastatic nodules were not unique in terms of size, SUVmax, or location in the lungs. Two-year and 5-year overall survival rates of patients whose nodules were metastatic were 64.2 and 32.1%, respectively. CONCLUSION: The rate of minute pulmonary nodules which were ultimately metastatic was 4.6%. Our findings suggest that esophagectomy followed by the identification of minute pulmonary nodules is an acceptable strategy even if the nodules cannot be diagnosed as being metastatic on the first visit CT due to their small size.
  • 80歳以上の高齢胃癌患者に対する腹腔鏡下幽門側胃切除術の検討
    額原 敦; 福田 周一; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊; 湯川 真生
    日本消化器外科学会総会 76回 P006 - 1 (一社)日本消化器外科学会 2021年07月
  • 3ポート腹腔鏡下虫垂切除術におけるJ型に挿入するドレーン挿入手技
    福田 周一; 木谷 光太郎; 額原 敦; 富原 英生; 太田 勝也; 橋本 和彦; 石川 原; 木村 豊; 肥田 仁一; 湯川 真生
    日本消化器外科学会総会 76回 P234 - 6 (一社)日本消化器外科学会 2021年07月
  • 80歳以上の高齢胃癌患者に対する腹腔鏡下幽門側胃切除術の検討
    額原 敦; 福田 周一; 富原 英生; 太田 勝也; 木谷 光太郎; 橋本 和彦; 石川 原; 肥田 仁一; 木村 豊; 湯川 真生
    日本消化器外科学会総会 76回 P006 - 1 (一社)日本消化器外科学会 2021年07月
  • 3ポート腹腔鏡下虫垂切除術におけるJ型に挿入するドレーン挿入手技
    福田 周一; 木谷 光太郎; 額原 敦; 富原 英生; 太田 勝也; 橋本 和彦; 石川 原; 木村 豊; 肥田 仁一; 湯川 真生
    日本消化器外科学会総会 76回 P234 - 6 (一社)日本消化器外科学会 2021年07月
  • Hiroshi Imamura; Jin Matsuyama; Kazuhiro Nishikawa; Shunji Endo; Tomono Kawase; Yutaka Kimura; Junichi Fukui; Junji Kawada; Yukinori Kurokawa; Kazumasa Fujitani; Daisuke Sakai; Hisato Kawakami; Toshimasa Tsujinaka; Toshio Shimokawa; Yoshihiro Matsubara; Taroh Satoh; Hiroshi Furukawa
    ANNALS OF GASTROENTEROLOGICAL SURGERY 2021年07月 
    Aim Post-surgical weight loss influences chemotherapy compliance and may be a risk factor for survival. Intake of an oral elemental nutritional supplement (OENS) can reduce weight loss after gastric cancer (GC) surgery. We assessed whether therapy completion levels would increase in patients receiving postoperative adjuvant chemotherapy in combination with an OENS. Methods This was a multicenter, open-label, single-arm, phase II study in GC patients who underwent curative total or distal gastrectomy (TG/DG) and received adjuvant S-1 chemotherapy. The primary endpoint was the S-1 completion rate for 1 year with a relative performance (RP) value of >= 70%; secondary endpoints included factors affecting the completion rate of S-1, RP value after eight S-1 courses, S-1 and OENS persistence rates, nutritional index, OENS compliance, and safety. Results In 71 efficacy-evaluable patients, the S-1 completion rate was 69.0% (TG, 68.0%; DG, 69.6%) and the RP value was 87.5 (TG, 89.1; DG, 87.5). Over eight treatment courses, median persistence rates were 89.0% for S-1 and 93.8% for the OENS. The mean OENS compliance was 81.8% at the fourth S-1 course and 52.9% at the eighth course. The incidence of Grade 3 or 4 adverse events was 27.2%, most commonly neutropenia (12.3%). Conclusions The completion rate of S-1 for 1 year in patients who could take the OENS exceeded the pre-defined threshold level. Randomized controlled trials are warranted to confirm the role of OENS in adjuvant chemotherapy.
  • Atsushi Yasuda; Yutaka Kimura; Yoko Hiraki; Kota Momose; Hiroaki Kato; Osamu Shiraishi; Masayuki Shinkai; Motohiro Imano; Haruhiko Imamoto; Takushi Yasuda
    Asian journal of endoscopic surgery 14 3 658 - 664 2021年07月 
    INTRODUCTION: Control of postoperative gastroesophageal reflux (GER) is a critical consideration for patients who undergo proximal gastrectomy. This report describes a new and simple reconstruction method by esophagogastrostomy with placement of the remnant stomach into the lower mediastinum (EG-PRIME). This approach not only suppresses postoperative GER, but it can also be easily performed by total laparoscopy. Detailed herein are the methods for EG-PRIME and the results for three patients with cancer of the upper gastric body. MATERIALS AND SURGICAL TECHNIQUE: At the start of the EG-PRIME surgical procedure, a pseudo-fornix and lozenge-shaped gastric conduit were made by cutting the stomach diagonally. Next, the pseudo-fornix was inserted into the esophageal hiatus to form a new angle of His. Then overlap anastomosis was performed and the entry site was closed longitudinally. The outcomes assessed were operative time, intraoperative blood loss, postoperative complications and GER according to 24-hour pH monitoring. DISCUSSION: The operative times were 339, 288 and 236 minutes; in two patients, intraoperative blood loss was 260 and 343 mL, and in the third, blood loss was minimal. No postoperative complications were observed in any of the three patients. The degree of the GER resulting in fraction time pH<4 was 9.0%, 0.3%, and 2.9%, respectively. No esophagitis by upper gastrointestinal endoscopy was observed in any patient. This EG-PRIME method was technically feasible for reconstruction after proximal gastrectomy by total laparoscopy. This approach may be as simple and useful as esophagogastrostomy for preventing postoperative GER, but more experience with this method is required.
  • Takushi Yasuda; Osamu Shiraishi; Hiroaki Kato; Yoko Hiraki; Kota Momose; Atsushi Yasuda; Masayuki Shinkai; Yutaka Kimura; Motohiro Imano
    Esophagus : official journal of the Japan Esophageal Society 18 3 468 - 474 2021年07月 
    BACKGROUND: A challenge in esophageal reconstruction after esophagectomy is that the distance from the neck to the abdomen must be replaced with a long segment obtained from the gastrointestinal tract. The success or failure of the reconstruction depends on the blood flow to the reconstructed organ and the tension on the anastomotic site, both of which depend on the reconstruction distance. There are three possible esophageal reconstruction routes: posterior mediastinal, retrosternal, and subcutaneous. However, there is still no consensus as to which route is the shortest. METHODS: The length of each reconstruction route was retrospectively compared using measurements obtained during surgery, where the strategy was to pull up the gastric conduit through the shortest route. The proximal reference point was defined as the left inferior border of the cricoid cartilage and the distal reference point was defined as the superior border of the duodenum arising from the head of the pancreas. RESULTS: This study involved 112 Japanese patients with esophageal cancer (102 men, 10 women). The mean distances of the posterior mediastinal, retrosternal, and subcutaneous routes were 34.7 ± 2.37 cm, 32.4 ± 2.24 cm, and 36.3 ± 2.27 cm, respectively. The retrosternal route was significantly shorter than the other two routes (both p < 0.0001) and shorter by 2.31 cm on average than the posterior mediastinal route. The retrosternal route was longer than the posterior mediastinal route in only 5 patients, with a difference of less than 1 cm. CONCLUSION: The retrosternal route was the shortest for esophageal reconstruction in living Japanese patients.
  • 安田 卓司; 白石 治; 加藤 寛章; 百瀬 洸太; 木村 豊
    手術 75 7 1125 - 1133 金原出版(株) 2021年06月
  • 白石 治; 安田 卓司; 加藤 寛章; 百瀬 洸太; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊
    臨床外科 76 6 669 - 675 (株)医学書院 2021年06月 
    ＜文献概要＞ポイント ◆郭清の前に周囲組織の授動を十分に行い,郭清組織を衝立化する.◆残すべき神経走行を確認し,切離ラインのデザインを決める.◆残す神経からの枝を鋭的に神経沿いに切離することで,衝立化された郭清組織から神経はスライドするように外れていく.
  • 安田 卓司; 白石 治; 加藤 寛章; 百瀬 洸太; 木村 豊
    手術 75 7 1125 - 1133 金原出版(株) 2021年06月
  • 白石 治; 安田 卓司; 加藤 寛章; 百瀬 洸太; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊
    臨床外科 76 6 669 - 675 (株)医学書院 2021年06月 
    ＜文献概要＞ポイント ◆郭清の前に周囲組織の授動を十分に行い,郭清組織を衝立化する.◆残すべき神経走行を確認し,切離ラインのデザインを決める.◆残す神経からの枝を鋭的に神経沿いに切離することで,衝立化された郭清組織から神経はスライドするように外れていく.
  • Ryosuke Kita; Hiroshi Miyata; Keijiro Sugimura; Koji Tanaka; Tomoki Makino; Kotaro Yamashita; Makoto Yamasaki; Masaaki Motoori; Osamu Shiraishi; Yutaka Kimura; Takushi Yasuda; Masahiko Yano; Yuichiro Doki
    Clinical nutrition (Edinburgh, Scotland) 40 6 4380 - 4385 2021年06月 
    BACKGROUND & AIMS: Reductions in skeletal muscle mass during neoadjuvant therapy can have a negative effect on short- and long-term outcomes in patients with esophageal cancer. However, effective treatment for suppressing reductions in skeletal muscle mass during neoadjuvant therapy has not been established. METHODS: Eighty-seven patients were included in this study who were enrolled in a previous randomized study comparing the effects of enteral nutrition (EN) and parenteral nutrition (PN) on chemotherapy-related toxicities during neoadjuvant chemotherapy in esophageal cancer patients. Changes in skeletal muscle mass during neoadjuvant therapy were compared between the two groups. RESULTS: Skeletal muscle mass index (SMI) decreased from 45.8 cm2/m2 before treatment to 43.7 cm2/m2 after neoadjuvant chemotherapy in 87 patients (p = 0.092). The total calorie intake during neoadjuvant therapy was equal between the two groups. SMI reduction was significantly smaller in the EN group than in the PN group (-1.4 cm2/m2 vs -3.0 cm2/m (Gebski et al., 2007) [2], p < 0.001). EN support was identified as the only independent factor adversely associated with severe SMI reduction (p < 0.001). Patients with low SMI after neoadjuvant chemotherapy were more susceptible to postoperative complications than patients with moderate SMI (47.6% vs 16.7%, p = 0.007), especially pulmonary complications (31.8% vs 10.8%, p = 0.003). Patients with low SMI after neoadjuvant chemotherapy tended to show worse prognosis than patients with moderate SMI (5-year overall survival rate: 43.8% vs 62.1%, p = 0.194). CONCLUSIONS: Compared with PN support, EN support during neoadjuvant chemotherapy suppressed reductions in skeletal muscle mass in patients with esophageal cancer.
  • がん腹膜播種に対する治療戦略 腹膜播種を伴う胃癌症例化学療法後non-CR症例に対する外科的治療介入の可能性
    新海 政幸; 今野 元博; 平木 洋子; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本外科系連合学会誌 46 3 341 - 341 日本外科系連合学会 2021年05月
  • Takaomi Hagi; Yukinori Kurokawa; Tsuyoshi Takahashi; Takuro Saito; Kotaro Yamashita; Koji Tanaka; Tomoki Makino; Makoto Yamasaki; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Surgery today 51 5 777 - 784 2021年05月 
    PURPOSE: To investigate the relationship between changes in taste due to surgical procedures and other clinical factors, we performed a detailed investigation of taste alteration in patients who underwent gastrectomy. METHODS: Questionnaires on taste alteration were distributed to patients who visited our outpatient clinic from July 2018 to January 2019 for the postoperative evaluation of gastric cancer. Associations of clinical characteristics with changes in sensitivity to the four major taste types (sweet, sour, salty, and bitter) were examined. RESULTS: Of the 243 eligible patients, 42 (17.3%) experienced taste alteration after gastrectomy; taste sensitivity decreased in 21 (8.6%) patients and increased in 31 (12.7%) patients. The frequency of a decreased sensitivity to sweet was significantly higher in patients who underwent total gastrectomy than in those who underwent distal gastrectomy (18.8% vs. 3.3%, P = 0.001). Patients who underwent total gastrectomy were significantly more likely than those who received distal gastrectomy to experience increased sensitivity to sour (12.5% vs. 2.2%, respectively; P = 0.004) and bitter (15.6% vs. 3.8%, respectively; P = 0.007) tastes. A multivariate analysis revealed that total gastrectomy was an independent risk factor for total taste alteration. CONCLUSIONS: Patients who underwent total gastrectomy showed a high likelihood of both loss and gain of taste sensitivity.
  • Takahito Sugase; Tsuyoshi Takahashi; Shuji Takiguchi; Yukinori Kurokawa; Ryugo Teranishi; Takuro Saito; Yasuhiro Miyazaki; Kazuyoshi Yamamoto; Kotaro Yamashita; Koji Tanaka; Tomoki Makino; Kiyokazu Nakajima; Masaaki Motoori; Yutaka Kimura; Makoto Yamasaki; Hidetoshi Eguchi; Yuichiro Doki
    Asian journal of endoscopic surgery 14 4 756 - 766 2021年04月 
    INTRODUCTION: The pancreas often interferes with the surgical field during laparoscopic gastrectomy (LG) and its disorders cause severe postoperative complications. This study aimed to evaluate the association between the anatomical location of the pancreas and surgical outcome and to investigate the optimal surgical position in LG. METHODS: We newly defined the angle formed between the supra-pancreatic region and the root of the left gastric artery (LGA) as the pancreas-LGA angle (PLA). The association between PLA and surgical outcomes in 107 consecutive patients who underwent laparoscopic distal gastrectomy (LDG) was investigated. Then, the change in PLA before and after insertion of the back pillow in 30 patients with gastric cancer was examined. RESULTS: The median PLA was 62° (range, 2°-157°). No differences were found in the patient background between patients with small PLA (PLA < 62°; n = 53) and those with large PLA (PLA ≧ 62°; n = 54). The postoperative inflammation response (white blood cells, neutrophils, and C-reactive protein) and amylase concentration in the drainage fluid (D-AMY) were significantly higher in the small PLA group than large PLA group. Multivariable analyses demonstrated that small PLA was an independent risk factor for high D-AMY. After insertion of a back pillow, PLA was noninvasively increased in all patients, and the median PLA was changed to 92° (range, 8°-151°) from 61° (range, 2°-140°). Of 17 patients with small PLA, nine developed large PLA. CONCLUSIONS: These results suggest that PLA can become one of the indicators of postoperative complications related to anatomical patient factors in LDG.
  • Tomo Ishida; Tomoki Makino; Makoto Yamasaki; Kotaro Yamashita; Koji Tanaka; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Annals of Surgical Oncology 2021年04月
  • Yuto Kubo; Koji Tanaka; Makoto Yamasaki; Kotaro Yamashita; Tomoki Makino; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Annals of surgical oncology 28 12 7173 - 7182 2021年04月 
    BACKGROUND: The Charlson Comorbidity Index (CCI), an indicator that objectively quantifies comorbidities, reduces nutritional status; however, the impact of the CCI on the postoperative nutrition indexes of patients with esophageal cancer remains unclear. METHODS: In total, 336 patients with esophageal cancer who underwent surgery between January 2011 and April 2017 were included in this study. We investigated the relationship between the CCI and postoperative nutrition indexes. RESULTS: Patients were divided into two groups: CCI ≤1 (low CCI group) and CCI ≥2 (high CCI group). A high CCI was significantly associated with shortened overall survival (OS; 3-year OS rate of 77.9% in the low CCI group versus 59.7% in the high CCI group; p = 0.008). Nutritional indexes, such as the Prognostic Nutritional Index (PNI), at 1 month after esophagectomy were significantly lower in the high CCI group than in the low CCI group (p = 0.031); however, the PNI at 6 months after surgery was similar between the high and low CCI groups. Multivariate analysis identified high CCI as an independent risk factor associated with PNI <45 in esophageal cancer patients at 1 month after esophagectomy (p = 0.047). CONCLUSION: This study showed that CCI ≥2 was significantly associated with poor PNI at 1 month after surgery for esophageal cancer, indicating that it is necessary to administer effective nutritional interventions for patients with postoperative malnutrition, especially those with multiple comorbidities.
  • 切除不能高度進行食道癌に対する挑戦 T4b胸部食道癌に対する導入療法としての化学放射線療法と化学療法の比較に関する多施設共同ランダム化第2相試験
    本告 正明; 杉村 啓二郎; 山崎 誠; 平尾 素宏; 竹野 淳; 木村 豊; 宮田 博志; 西川 和弘; 白石 治; 牧野 知紀; 宮崎 安弘; 田中 晃司; 浜川 卓也; 山下 公太郎; 藤谷 和正; 安田 卓司; 土岐 祐一郎; 矢野 雅彦
    日本外科学会定期学術集会抄録集 121回 SY - 6 (一社)日本外科学会 2021年04月
  • 食道癌の術式を「再考」する-胸管切除vs胸管非切除- 胸部食道癌に対する食道切除術における胸管切除が長期予後に及ぼす影響 多施設共同データベース研究
    田中 晃司; 山崎 誠; 牧野 知紀; 山下 公太郎; 杉村 啓二郎; 宮田 博志; 白石 治; 百瀬 洸太; 木村 豊; 宮崎 安弘; 本告 正明; 益澤 徹; 竹野 淳; 浜川 卓也; 平尾 素宏; 藤谷 和正; 矢野 雅彦; 安田 卓司; 江口 英利; 土岐 祐一郎
    日本外科学会定期学術集会抄録集 121回 DB - 2 (一社)日本外科学会 2021年04月
  • 噴門側胃切除後における食道内圧からみた至適な食道残胃吻合法
    安田 篤; 木村 豊; 平木 洋子; 百瀬 光汰; 加藤 寛章; 白石 治; 新海 政幸; 今野 元博; 安田 卓司
    日本外科学会定期学術集会抄録集 121回 SF - 3 (一社)日本外科学会 2021年04月
  • 術前化学療法後cN1-ypN0陰転化群と前治療なし手術pN0群との予後比較
    白石 治; 安田 卓司; 木村 豊; 加藤 寛章; 百瀬 洸太; 土岐 祐一郎; 山崎 誠; 牧野 知紀; 田中 浩司; 山下 公太郎; 矢野 雅彦; 宮田 博志; 杉村 啓二郎; 平尾 素宏; 西川 和宏; 浜川 卓也; 藤谷 和正; 本告 正明; 宮崎 安弘; 竹野 淳
    日本外科学会定期学術集会抄録集 121回 SF - 2 (一社)日本外科学会 2021年04月
  • 進行食道癌に対する術前化学療法後のリンパ節における微小転移が再発に及ぼす影響
    平木 洋子; 木村 豊; 今野 元博; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 新海 政幸; 牧野 知紀; 本告 正明; 山崎 誠; 宮田 博志; 矢野 雅彦; 土岐 祐一郎; 安田 卓司
    日本外科学会定期学術集会抄録集 121回 SF - 3 (一社)日本外科学会 2021年04月
  • cN0胸部中部(Mt)食道癌症例における3領域リンパ節郭清の意義 多施設共同データベース研究
    百瀬 洸太; 安田 卓司; 木村 豊; 白石 治; 加藤 寛章; 土岐 祐一郎; 山崎 誠; 牧野 知紀; 田中 晃司; 山下 公太郎; 矢野 雅彦; 宮田 博志; 杉村 啓二郎; 平尾 素宏; 西川 和宏; 浜川 卓也; 藤谷 和正; 本告 正明; 宮崎 安弘; 竹野 淳
    日本外科学会定期学術集会抄録集 121回 SF - 6 (一社)日本外科学会 2021年04月
  • 腹膜播種陽性胃癌におけるfirst-line化学療法後、播種遺残例に対する2nd-line治療としての外科治療介入の可能性
    新海 政幸; 今野 元博; 平木 洋子; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本外科学会定期学術集会抄録集 121回 PS - 8 (一社)日本外科学会 2021年04月
  • 高用量CDDの使用が困難な進行食道癌患者に対する術前5-FU+docetaxel+nedaplatin(UDON)療法の治療成績
    木村 豊; 白石 治; 加藤 寛章; 百瀬 洸太; 川上 尚人; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 安田 卓司
    日本外科学会定期学術集会抄録集 121回 SF - 6 (一社)日本外科学会 2021年04月
  • Koji Tanaka; Makoto Yamasaki; Tomoki Makino; Kotaro Yamashita; Takuro Saitoh; Tsuyoshi Takahashi; Yukinori Kurokawa; Kiyokazu Nakajima; Masaaki Motoori; Yutaka Kimura; Masayuki Mano; Masaki Mori; Hidetoshi Eguchi; Yuichiro Doki
    Esophagus 18 2 195 - 202 2021年04月
  • Osamu Shiraishi; Takushi Yasuda; Hiroaki Kato; Kota Momose; Yoko Hiraki; Atsushi Yasuda; Masayuki Shinkai; Yutaka Kimura; Motohiro Imano
    Annals of surgical oncology 28 11 6366 - 6375 2021年03月 
    INTRODUCTION: We compare planned salvage surgery after definitive chemoradiotherapy (SALV) versus neoadjuvant chemoradiotherapy plus surgery (NCRS) for borderline resectable T4 esophageal squamous cell carcinoma. PATIENTS AND METHODS: A total of 37 patients underwent planned SALV, and 20 underwent NCRS from 2004 to 2017. The short-term outcome measures were the R0 resection rate, complications, and treatment-related mortality. The long-term outcome measures were the 5-year overall survival rate and causes of death. RESULTS: R0 resection rate was similar between the SALV and NCRS groups (81% versus 85%). The incidence of postoperative pneumonia (35% versus 18%) and treatment-related mortality rate (9% versus 0%) tended to be higher in the SALV. ypT grade 2-3 (65% versus 30%, p = 0.012) and Clavien-Dindo grade ≥ IIIb complications (32% versus 0%, p = 0.008) were significantly more frequent in the SALV group. The groups had similar 5-year overall survival (26% versus 27%). The causes of death in the SALV and NCRS groups were primary esophageal cancer in 35% and 55% of patients, respectively, and pulmonary-related mortality in 24% and 5%, respectively. Multivariable Cox regression analysis revealed the following significant poor prognostic factors: stable disease as the clinical response, preoperative body mass index (BMI) of < 18.5 kg/m2, ypN stage 1-3, and R1-2 resection. CONCLUSIONS: SALV was associated with a higher incidence of late pulmonary-related mortality but had a stronger antitumor effect than NCRS. Consequently, the survival rate was similar between the groups. Surgery is recommended for patients with a partial response and preoperative BMI of ≥ 18.5 kg/m2.
  • Osamu Shiraishi; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Kotaro Yamashita; Tomo Ishida; Keijiro Sugimura; Hiroshi Miyata; Masaaki Motoori; Kazumasa Fujitani; Atsushi Takeno; Motohiro Hirao; Yutaka Kimura; Taroh Satoh; Masahiko Yano; Yuichiro Doki; Takushi Yasuda
    Esophagus : official journal of the Japan Esophageal Society 18 4 825 - 834 2021年03月 
    OBJECTIVE: To compare short-term outcomes between two- vs. three courses of neoadjuvant chemotherapy (NAC) to clarify the optimal treatment for esophageal squamous cell cancer (ESCC) in a multicenter, randomized, phase II trial. BACKGROUND: An optimal number of NAC cycles remains to be established for locally advanced ESCC. METHODS: Patients with locally advanced ESCC were randomly assigned to either two (N = 91) or three (N = 89) courses of DCF (70 mg/m2 intravenous docetaxel and 70 mg/m2 intravenous cisplatin on day 1, and a continuous 700 mg/m2 fluorouracil infusion for 5 days) every 3 weeks followed by surgery. We compared the two groups for perioperative parameters, adverse events, and the response to NAC. RESULTS: The two- and three-course groups showed similar completion rates and overall NAC dose reductions. Although the two-course group showed significantly lower overall grades 3-4 leukopenia and anemia compared to the three-course group, the two groups had similar overall toxicity rates. Postoperative complications were not significantly different between the two groups, except arrhythmia (13 vs. 0%, P = 0.0007). Only two postoperative in-hospital deaths occurred in the three-course group, due to sepsis following severe pneumonia. Compared to the two-course group, the three-course group was associated with a significantly better clinical response (42.9 vs. 65.2%, P = 0.0027) and a relatively higher rate of pathological complete response (9.1 vs. 15.3%, P = 0.212). CONCLUSION: Both two- and three-course DCF regimens in the NAC setting seemed to be equally feasible in locally advanced ESCC patients. Additional DCF courses led to a better NAC response without increasing the incidence of adverse events or postoperative morbidity. CLINICAL TRIAL REGISTRATION: University Hospital Medical Information Network Clinical Trials Registry of Japan (Identification Number UMIN 000015788).
  • 胃癌治療における栄養治療戦略 胃切除術後の成分栄養剤による栄養介入の有効性
    木村 豊; 西川 和宏; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 田村 茂行; 川田 純司; 川瀬 朋乃; 川端 良平; 柳本 喜智; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    日本胃癌学会総会記事 93回 215 - 215 (一社)日本胃癌学会 2021年03月
  • 消化管疾患における低侵襲治療の最前線 管内発育型の胃粘膜下腫瘍に対する腹腔鏡下胃内手術に関する検討
    木村 豊; 安田 篤; 安田 卓司
    日本消化器病学会雑誌 118 臨増総会 A104 - A104 (一財)日本消化器病学会 2021年03月
  • 食道内圧測定と24時間pHモニターからみた噴門側胃切除後食道裂孔挿入食道残胃吻合法の検討
    安田 篤; 木村 豊; 平木 洋子; 百瀬 洸太; 加藤 寛章; 白石 治; 新海 政幸; 今野 元博; 安田 卓司
    日本胃癌学会総会記事 93回 299 - 299 (一社)日本胃癌学会 2021年03月
  • 胃癌異時性孤立性脾転移をきたした3例の報告
    平木 洋子; 安田 篤; 百瀬 洸太; 加藤 寛章; 白石 治; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本胃癌学会総会記事 93回 361 - 361 (一社)日本胃癌学会 2021年03月
  • Kazumasa Fujitani; Kohei Shitara; Atsuo Takashima; Keisuke Koeda; Hiroki Hara; Norisuke Nakayama; Shuichi Hironaka; Kazuhiro Nishikawa; Yutaka Kimura; Kenji Amagai; Hisashi Hosaka; Yoshito Komatsu; Ken Shimada; Ryohei Kawabata; Hideki Ohdan; Yasuhiro Kodera; Masato Nakamura; Takako Eguchi Nakajima; Yoshinori Miyata; Toshikazu Moriwaki; Tetsuya Kusumoto; Kazuo Nishikawa; Kazuhiro Ogata; Masashi Shimura; Satoshi Morita; Wasaburo Koizumi
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 24 2 477 - 478 2021年03月
  • Yoshiaki Iwasaki; Masanori Terashima; Junki Mizusawa; Hiroshi Katayama; Kenichi Nakamura; Hitoshi Katai; Takaki Yoshikawa; Seiji Ito; Masahide Kaji; Yutaka Kimura; Motohiro Hirao; Makoto Yamada; Akira Kurita; Masakazu Takagi; Sang-Woong Lee; Akinori Takagane; Hiroshi Yabusaki; Jun Hihara; Narikazu Boku; Takeshi Sano; Mitsuru Sasako
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 24 2 492 - 502 2021年03月 
    BACKGROUND: Specific treatment strategies are sorely needed for scirrhous-type gastric cancer still, which has poor prognosis. Based on the promising results of our previous phase II study (JCOG0210), we initiated a phase III study to confirm the efficacy of neoadjuvant chemotherapy (NAC) in type 4 or large type 3 gastric cancer. METHODS: Patients aged 20-75 years without a macroscopic unresectable factor as confirmed via staging laparoscopy were randomly assigned to surgery followed by adjuvant chemotherapy with S-1 (Arm A) or NAC (S-1plus cisplatin) followed by D2 gastrectomy plus adjuvant chemotherapy with S-1 (Arm B). The primary endpoint was overall survival (OS). RESULTS: Between October 2005 and July 2013, 316 patients were enrolled, allocating 158 patients to each arm. In Arm B, in which NAC was completed in 88% of patients. Significant downstaging based on tumor depth, lymph node metastasis, and peritoneal cytology was observed using NAC. Excluding the initial 16 patients randomized before the first revision of the protocol, 149 and 151 patients in arms A and B, respectively, were included in the primary analysis. The 3-year OS rates were 62.4% [95% confidence interval (CI)  54.1-69.6] in Arm A and 60.9% (95% CI  52.7-68.2) in Arm B. The hazard ratio of Arm B against Arm A was 0.916 (95% CI  0.679-1.236). CONCLUSIONS: For type 4 or large type 3 gastric cancer, NAC with S-1 plus cisplatin failed to demonstrate a survival benefit. D2 surgery followed by adjuvant chemotherapy remains the standard treatment.
  • Kazumasa Fujitani; Kohei Shitara; Atsuo Takashima; Keisuke Koeda; Hiroki Hara; Norisuke Nakayama; Shuichi Hironaka; Kazuhiro Nishikawa; Yutaka Kimura; Kenji Amagai; Hisashi Hosaka; Yoshito Komatsu; Ken Shimada; Ryohei Kawabata; Hideki Ohdan; Yasuhiro Kodera; Masato Nakamura; Takako Eguchi Nakajima; Yoshinori Miyata; Toshikazu Moriwaki; Tetsuya Kusumoto; Kazuo Nishikawa; Kazuhiro Ogata; Masashi Shimura; Satoshi Morita; Wasaburo Koizumi
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 24 2 467 - 476 2021年03月 
    BACKGROUND: This study evaluated the association between early tumor response at 8 weeks, previously reported as a positive outcome prognosticator, and health-related quality of life (HRQOL) in advanced gastric cancer (AGC) patients enrolled in the ABSOLUTE trial. METHODS: HRQOL was assessed using the EuroQol-5 Dimension (EQ-5D) utility index score in patients with complete response (CR) + partial response (PR) and progressive disease (PD) at 8 weeks, and time-to-deterioration (TtD) of the EQ-5D score, with the preset minimally important difference (MID) of 0.05, was compared between these populations. Among the enrolled patients, 143 and 160 patients were assessable in weekly solvent-based paclitaxel (Sb-PTX) arm and weekly nanoparticle albumin-bound paclitaxel (nab-PTX) arm, respectively. RESULTS: Changes of the EQ-5D score from baseline to 8 weeks in the nab-PTX arm were 0.0009 and - 0.1229 in CR + PR and PD patients, respectively; the corresponding values for the Sb-PTX arm were - 0.0019 and - 0.1549. For both treatments, changes of the EQ-5D score from baseline at 8 weeks were significantly larger in patients with PD than in those with CR + PR. The median TtD was 3.9 and 2.2 months in patients with CR + PR and PD, respectively, for nab-PTX [hazard ratio (HR) = 0.595, 95% confidence interval (CI) 0.358-0.989]. For Sb-PTX, the corresponding values were 4.7 and 2.0 months (HR = 0.494, 95% CI 0.291-0.841). CONCLUSIONS: Early tumor shrinkage was associated with maintained HRQOL in AGC patients on the second-line chemotherapy with taxanes.
  • Norihiro Matsuura; Makoto Yamasaki; Kotaro Yamashita; Koji Tanaka; Tomoki Makino; Takuro Saito; Kazuyoshi Yamamoto; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Hidetoshi Eguchi; Yuichiro Doki
    Esophagus 2021年02月
  • 消化器外科術後感染対策 高齢者に対する上部消化管手術における遠隔部位感染の予防対策
    木村 豊; 安田 篤; 白石 治; 平木 洋子; 百瀬 洸太; 加藤 寛章; 新海 政幸; 今野 元博; 安田 卓司
    日本腹部救急医学会雑誌 41 2 203 - 203 (一社)日本腹部救急医学会 2021年02月
  • RY脚吻合部出血の血腫閉塞により輸入脚閉塞症をきたした2例
    加藤 寛章; 平木 洋子; 百瀬 洸太; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本腹部救急医学会雑誌 41 2 228 - 228 (一社)日本腹部救急医学会 2021年02月
  • Yoko Hiraki; Yutaka Kimura; Motohiro Imano; Hiroaki Kato; Mitsuru Iwama; Osamu Shiraishi; Atsushi Yasuda; Masayuki Shinkai; Tomoki Makino; Masaaki Motoori; Makoto Yamasaki; Hiroshi Miyata; Takao Satou; Taroh Satoh; Hiroshi Furukawa; Masahiko Yano; Yuichiro Doki; Takushi Yasuda
    Surgery today 51 1 118 - 126 2021年01月 
    PURPOSE: The purpose of this study is to determine the clinical significance of micrometastases after neoadjuvant chemotherapy (NAC) and the difference in controlling micrometastases using different NAC regimens in resectable advanced esophageal squamous cell carcinoma (ESCC). METHODS: We analyzed patients with ESCC who underwent esophagectomy with lymph node dissection after NAC with Adriamycin + cisplatin + 5-fluorouracil (ACF) or docetaxel + cisplatin + 5-fluorouracil (DCF). Micrometastasis was defined as a single isolated cancer cell or cluster of cancer cells on the cervical, recurrent nerve, or abdominal LNs as shown by immunohistochemical staining with anti-cytokeratin antibody (AE1/AE3). The associations between micrometastases, recurrence, prognosis, and regimen differences were investigated. RESULTS: One hundred and one cases (ACF group: 51 cases; DCF group: 50 cases) were analyzed. Micrometastases occurred in 24 patients (23.8%): 17/51 (33.3%) in the ACF group and 7/50 (13.5%) in the DCF group (p = 0.0403). The 5-year recurrence-free survival (RFS) rates for patients without (n = 77) and with (n = 24) micrometastases were 62 and 32%, respectively, (hazard ratio, 2.158; 95% confidence interval, 1.170-3.980; stratified log-rank test, p = 0.0115). A multivariate analysis showed that stage pN1 or higher and micrometastases were significant risk factors affecting RFS. CONCLUSION: In resectable advanced ESCC, controlling micrometastases in the LNs after NAC varied by regimen and may be associated with preventing ESCC recurrence.
  • Satoshi Kurose; Katsuko Onishi; Nana Takao; Takumi Miyauchi; Kazuhisa Takahashi; Yutaka Kimura
    PloS one 16 1 e0245678  2021年 
    BACKGROUND: Adiponectin has been reported to be associated with lower skeletal muscle mass and skeletal strength and may be involved in skeletal muscle regulation along with myostatin. This study aims to evaluate the association between serum adiponectin and myostatin levels and identify independent factors using body composition and metabolic parameters in patients with obesity. METHODS: Overall, 148 patients (age, 45.9 ± 14.3 years, body mass index, 37.2 ± 8.0 kg/m2) who initially visited the outpatient clinic of obesity between November 2013 and November 2019 were included. Body composition was measured using InBody 720 and dual energy X-ray absorptiometry. In addition, muscle strength, vascular function, and metabolic parameters were measured. Serum levels of adiponectin, leptin, myostatin, and irisin were measured from blood samples. RESULTS: The serum adiponectin level was 2.9 μg/mL (1.7-4.1 μg/mL), and the serum myostatin level was 2398.4 pg/mL (1,777.1-2952.5 pg/mL). The stepwise regression analysis revealed less leg strength, homeostasis model assessment of insulin resistance, and C-reactive protein as an independent predictor of serum adiponectin levels based on the significance of the univariate analysis (R2 = 0.190, P < 0.001). A high appendicular lean mass/body weight, reactive hyperemia index, and irisin were independent factors for serum myostatin levels (R2 = 0.260, P < 0.001). CONCLUSION: The serum adiponectin level was associated with less muscle strength. Although serum myostatin was associated with a high appendicular lean mass, it is possible that myostatin was regulated by the percentage of body weight from appendicular lean mass.
  • Keijiro Sugimura; Makoto Yamasaki; Takushi Yasuda; Masahiko Yano; Motohiro Hirao; Kazumasa Fujitani; Yutaka Kimura; Hiroshi Miyata; Masaaki Motoori; Atsushi Takeno; Osamu Shiraishi; Tomoki Makino; Takayuki Kii; Koji Tanaka; Taro Satoh; Masaki Mori; Yuichiro Doki
    Annals of gastroenterological surgery 5 1 75 - 82 2021年01月 
    Aim: The aim is to report the long-term outcomes of preoperative cisplatin and fluorouracil plus docetaxel (DCF) vs Adriamycin (ACF) for resectable esophageal squamous cell carcinoma (ESCC). Previously, this trial showed that DCF is associated with prolonged recurrence-free survival (RFS). Methods: Patients were randomly assigned to two cycles of ACF (35 mg/m2 of Adriamycin, 70 mg/m2 of cisplatin intravenously on day 1, and 700 mg/m2 of fluorouracil infusion for 7 days) every 4 weeks or DCF (70 mg/m2 of docetaxel, 70 mg/m2 of cisplatin intravenously on day 1, and 700 mg/m2 of fluorouracil infusion for 5 days) every 3 weeks, followed by surgery. The primary endpoint was RFS. The secondary endpoint was overall survival (OS). Results: Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, 162 of whom were eligible and randomly assigned to the two groups. The median follow-up for surviving patients was 69.8 months. The 5-year RFS was significantly better in the DCF group than in the ACF group (59.9% vs 40.7%, hazard ratio [HR] 0.55; 95% confidence interval [CI], 0.35-0.86; P = .009) and the 5-year OS was significantly better in the DCF group than in the ACF group (63.5% vs 49.4%, HR, 0.61; 95% CI, 0.38-0.96; P = .03). The benefit of DCF chemotherapy on survival was significantly greater in the subgroups with more advanced clinical T and N stage. Conclusions: Cisplatin and fluorouracil plus docetaxel are associated with better RFS and OS than ACF in resectable ESCC patients.
  • Yutaka Kimura; Jota Mikami; Makoto Yamasaki; Motohiro Hirao; Hiroshi Imamura; Junya Fujita; Atsushi Takeno; Jin Matsuyama; Kentaro Kishi; Takafumi Hirao; Hiroki Fukunaga; Koichi Demura; Yukinori Kurokawa; Shuji Takiguchi; Hidetoshi Eguchi; Yuichiro Doki
    Annals of gastroenterological surgery 5 1 93 - 101 2021年01月 
    Aim: We previously reported in a randomized controlled trial that Billroth I and Roux-en-Y reconstructions were generally equivalent regarding body weight change and nutritional status 1 year after distal gastrectomy for gastric cancer. We describe the long-term follow-up data 5 years after distal gastrectomy. Methods: We analyzed consecutive gastric cancer patients who were randomly assigned to undergo Billroth I or Roux-en-Y reconstruction after distal gastrectomy. We evaluated body weight change, nutritional status, late complications, quality of life (QOL) using the European Organization for Research and Treatment of Cancer Core QOL Questionnaire, and dysfunction using the Dysfunction After Upper Gastrointestinal Surgery for Cancer, 5 years after surgery. Results: A total of 228 patients (Billroth I = 105; Roux-en-Y = 123) were eligible for efficacy analyses in this study. Body weight loss 5 years after surgery did not differ significantly between the Billroth I and Roux-en-Y groups (10.0% ± 7.9% and 9.6% ± 8.4%, respectively; P = .70). There were no significant differences in other aspects of nutritional status between the two groups. Reflux esophagitis occurred in 19.0% of the patients in the Billroth I group vs 4.9% in the Roux-en-Y group (P = .002). Regarding QOL, Billroth I was significantly inferior to Roux-en-Y on the diarrhea scale (Billroth I: 28.6, Roux-en-Y: 16.0; P = .047). Regarding dysfunction, no score differed significantly between the two groups. Conclusions: Billroth I and Roux-en-Y reconstructions were generally equivalent regarding body weight change, nutritional status, and QOL 5 years after distal gastrectomy, although Roux-en-Y more effectively prevented reflux esophagitis and diarrhea.
  • [胃]胃切除後のQOL向上を目指したエビデンスの創生 胃切除術患者に対する術後早期の成分栄養剤による短期的介入が体重・骨格筋量に及ぼす長期的な効果
    木村 豊; 西川 和宏; 岸 健太郎; 井上 健太郎; 松山 仁; 赤丸 祐介; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    日本消化器外科学会総会 75回 WS3 - 9 (一社)日本消化器外科学会 2020年12月
  • [食道]進行食道癌に対するConversion surgery cT4食道癌に対するConversion surgeryの治療成績
    白石 治; 平木 洋子; 百瀬 洸太; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本消化器外科学会総会 75回 PD1 - 5 (一社)日本消化器外科学会 2020年12月
  • 腹水細胞診陽性(CY1)胃癌に対する腹腔内+全身化学療法奏功例におけるconversion手術
    新海 政幸; 今野 元博; 平木 洋子; 百瀬 洸太; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本消化器外科学会総会 75回 RS1 - 6 (一社)日本消化器外科学会 2020年12月
  • 当院で考案した噴門側胃切除後食道残胃吻合法 菱形胃管作成+偽穹窿部食道裂孔挿入法
    安田 篤; 木村 豊; 百瀬 洸太; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 75回 P032 - 5 (一社)日本消化器外科学会 2020年12月
  • 貧血と蛋白漏出症、通過障害を来し、腹腔鏡下胃全摘を施行した非家族性若年性胃ポリポーシスの1症例
    平木 洋子; 木村 豊; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 安田 卓司
    日本消化器外科学会総会 75回 P092 - 7 (一社)日本消化器外科学会 2020年12月
  • 初回治療後の病期診断の現況とブレークスルー(領域横断的セッション) 胸部食道扁平上皮癌におけるNAC前後のPET集積変化による予後予測
    白石 治; 平木 洋子; 百瀬 洸太; 加藤 寛章; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 74回 62 - 62 (NPO)日本食道学会 2020年12月
  • 再発癌への治療戦略(領域横断的セッション) 再発食道癌における積極的治療対象の検討とその成績
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博
    日本食道学会学術集会プログラム・抄録集 74回 70 - 70 (NPO)日本食道学会 2020年12月
  • 食道癌における臨床的にネガティブだが病理学的にポジティブなLN(Clinically negative but pathologically positive LNs in esophageal cancer)
    百瀬 洸太; 白石 治; 平木 洋子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 74回 164 - 164 2020年12月
  • 腹部大動脈周囲リンパ節転移Stage IV食道癌に対する導入化学療法+拡大郭清手術
    白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 百瀬 洸太; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 74回 364 - 364 (NPO)日本食道学会 2020年12月
  • Grade 3の病理組織学的効果の得られた食道癌症例の予後因子解析
    本告 正明; 木村 豊; 宮田 博志; 山崎 誠; 白石 治; 竹野 淳; 田中 晃司; 安田 卓司; 矢野 雅彦; 土岐 祐一郎
    日本食道学会学術集会プログラム・抄録集 74回 367 - 367 (NPO)日本食道学会 2020年12月
  • 高用量CDDPの使用が困難な食道癌患者に対する3剤併用術前化学療法の検討
    木村 豊; 白石 治; 川上 尚人; 岩間 密; 加藤 寛章; 百瀬 洸太; 安田 篤; 新海 政幸; 今野 元博; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 74回 349 - 349 (NPO)日本食道学会 2020年12月
  • 白石 治; 安田 卓司; 加藤 寛章; 百瀬 洸太; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博
    外科 82 13 1297 - 1302 (株)南江堂 2020年12月 
    ＜文献概要＞食道癌の機能温存縮小手術のめざすところは,生活の質(QOL)と根治性を両立した手術である.頸部食道癌では,舌骨上筋群の温存と下筋群の切離,反回神経麻痺を回避して嚥下能を維持し,輪状咽頭筋切離により最大限に口側切離距離を確保し,喉頭温存手術を可能とする.胸部中下部食道癌では,上縦隔リンパ節転移を認めないことを条件に,嚥下能の低下した高齢者や脳梗塞既往患者を対象に頸部操作を省略できる高位胸腔内胃管再建術を適応する.
  • Shigeyuki Tamura; Hirokazu Taniguchi; Kazuhiro Nishikawa; Hiroshi Imamura; Junya Fujita; Atsushi Takeno; Jin Matsuyama; Yutaka Kimura; Junji Kawada; Motohiro Hirao; Masashi Hirota; Kazumasa Fujitani; Yukinori Kurokawa; Daisuke Sakai; Hisato Kawakami; Toshio Shimokawa; Taroh Satoh
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 25 12 2035 - 2043 2020年12月 
    Background For unresectable or recurrent advanced gastric adenocarcinoma (AGC), tri-weekly administration of nanoparticle albumin-bound paclitaxel (nab-PTX) at 260 mg/m(2)achieved a response rate of 27.8% in a phase II trial in Japan. However, frequent neutropenia and peripheral neuropathy limit its use in clinical settings. We, thus, conducted a single-arm phase II trial to investigate the efficacy and safety of a reduced dose (220 mg/m(2)) of tri-weeklynab-PTX. Methods Eligible patients included those with AGC and ECOG performance status of 0-2 who had received one or more prior chemotherapy containing fluoropyrimidine regimens. A reduced dose ofnab-PTX (220 mg/m(2)) was administered tri-weekly. The primary endpoint was response rate (RR). Secondary endpoints were overall survival (OS), progression-free survival (PFS), disease-control rate (DCR), incidence of adverse events, relative dose intensity (RDI) and proportion of patients receiving subsequent chemotherapy. Results Among 33 patients enrolled, 32 were treated with protocol therapy. RR was 3.1% [95% confidence interval (CI), 0-16.2%], which did not reach the protocol-specified threshold (p = 0.966). DCR was 37.5% (95% CI, 21.1-56.3%). Median OS and PFS were 6.3 (95% CI, 4.4-14.2) and 2.2 (95% CI, 1.8-3.1) months, respectively. RDI was 97.8%. Twenty (62.5%) patients received subsequent chemotherapy. Toxicity was relatively mild with the most common grade >= 3 adverse events being neutropenia (38%), anemia (13%), fatigue (19%), anorexia (16%), and peripheral neuropathy (13%). Conclusion Tri-weeklynab-PTX with a reduced dose (220 mg/m(2)) is not recommended for AGC in a second-line or later setting, despite demonstrating less toxicity than at 260 mg/m(2). Clinical trial registration The OGSG1302 trial was registered with UMIN-CTR as UMIN000000714.
  • Shigeyuki Tamura; Hirokazu Taniguchi; Kazuhiro Nishikawa; Hiroshi Imamura; Junya Fujita; Atsushi Takeno; Jin Matsuyama; Yutaka Kimura; Junji Kawada; Motohiro Hirao; Masashi Hirota; Kazumasa Fujitani; Yukinori Kurokawa; Daisuke Sakai; Hisato Kawakami; Toshio Shimokawa; Taroh Satoh
    International journal of clinical oncology 25 12 2035 - 2043 2020年12月 
    BACKGROUND: For unresectable or recurrent advanced gastric adenocarcinoma (AGC), tri-weekly administration of nanoparticle albumin-bound paclitaxel (nab-PTX) at 260 mg/m2 achieved a response rate of 27.8% in a phase II trial in Japan. However, frequent neutropenia and peripheral neuropathy limit its use in clinical settings. We, thus, conducted a single-arm phase II trial to investigate the efficacy and safety of a reduced dose (220 mg/m2) of tri-weekly nab-PTX. METHODS: Eligible patients included those with AGC and ECOG performance status of 0-2 who had received one or more prior chemotherapy containing fluoropyrimidine regimens. A reduced dose of nab-PTX (220 mg/m2) was administered tri-weekly. The primary endpoint was response rate (RR). Secondary endpoints were overall survival (OS), progression-free survival (PFS), disease-control rate (DCR), incidence of adverse events, relative dose intensity (RDI) and proportion of patients receiving subsequent chemotherapy. RESULTS: Among 33 patients enrolled, 32 were treated with protocol therapy. RR was 3.1% [95% confidence interval (CI), 0-16.2%], which did not reach the protocol-specified threshold (p = 0.966). DCR was 37.5% (95% CI, 21.1-56.3%). Median OS and PFS were 6.3 (95% CI, 4.4-14.2) and 2.2 (95% CI, 1.8-3.1) months, respectively. RDI was 97.8%. Twenty (62.5%) patients received subsequent chemotherapy. Toxicity was relatively mild with the most common grade ≥ 3 adverse events being neutropenia (38%), anemia (13%), fatigue (19%), anorexia (16%), and peripheral neuropathy (13%). CONCLUSION: Tri-weekly nab-PTX with a reduced dose (220 mg/m2) is not recommended for AGC in a second-line or later setting, despite demonstrating less toxicity than at 260 mg/m2. Clinical trial registration The OGSG1302 trial was registered with UMIN-CTR as UMIN000000714.
  • 食道癌術後患者に対する、安全・簡便・低侵襲な経腸栄養ルートの造設法 内視鏡的経皮経胃管腸瘻造設
    加藤 寛章; 白石 治; 平木 洋子; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    学会誌JSPEN 2 Suppl.1 452 - 452 (一社)日本臨床栄養代謝学会 2020年11月
  • 食道 代謝・栄養
    本告 正明; 杉村 啓二郎; 田中 晃司; 白石 治; 岩間 密; 宮崎 安弘; 牧野 知紀; 山崎 誠; 宮田 博志; 木村 豊; 朝原 崇; 藤谷 和正; 安田 卓司; 土岐 祐一郎; 矢野 雅彦
    日本消化器外科学会雑誌 53 Suppl.2 336 - 336 (一社)日本消化器外科学会 2020年11月
  • 食道 診断
    木村 豊; 平木 洋子; 今野 元博; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 新海 政幸; 牧野 知紀; 本告 正明; 山崎 誠; 宮田 博志; 矢野 雅彦; 土岐 祐一郎; 安田 卓司
    日本消化器外科学会雑誌 53 Suppl.2 358 - 358 (一社)日本消化器外科学会 2020年11月
  • Osamu Shiraishi; Hiroaki Kato; Mitsuru Iwama; Yoko Hiraki; Atsushi Yasuda; Ying-Feng Peng; Masayuki Shinkai; Yutaka Kimura; Motohiro Imano; Takushi Yasuda
    Surgical endoscopy 34 11 4967 - 4974 2020年11月 
    BACKGROUND: Feeding jejunostomy (FJ) is a common treatment to support patients with esophageal cancer after esophagectomy. However, severe FJ-related complications, such as bowel obstruction, occasionally occur. We investigated the ability of our simple, novel FJ technique, the "curtain method," to prevent bowel obstruction. METHODS: In laparoscopic surgery, the main mechanism of bowel obstruction involves torsion of the mesentery accompanied by migration of the intestine across the fixed FJ through the space surrounded by a triangle comprising the ligament of Treitz, fixed FJ, and spleen rather than adhesion. Our "curtain method" involves closure of this triangle zone with omentum, and the appearance of the lifted omentum resembles a curtain. Sixty patients treated with this modified FJ were retrospectively compared with 13 patients treated with conventional FJ in terms of the incidence of bowel obstruction, peritonitis, stoma site infection, and catheter obstruction. RESULTS: From 2013 to 2017, 60 patients underwent esophagectomy and gastric conduit reconstruction accompanied by modified laparoscopic FJ. The median observation period, including the period after tube removal, was 644 days. No FJ-associated bowel obstruction, the prevention of which was the primary aim, occurred in any patient. Likewise, no peritonitis or dislodgement occurred. Eight patients (13%) developed a stoma site infection with granulation. The feeding tube became occluded in 11 patients (18%); however, a new feeding tube was reinserted under fluoroscopy for all of these patients. From 2003 to 2012, 13 patients underwent conventional FJ. The median observation period was 387 days. Three patients (23%) developed bowel obstruction by torsion 71 to 134 days after the first surgery, and all were treated by emergency operations. Other FJ-related complications were not different from those in the modified FJ group. CONCLUSION: Our simple, novel technique, the "curtain method," for prevention of laparoscopic FJ-associated bowel obstruction after esophagectomy is a safe additional surgery.
  • Keijiro Sugimura; Hiroshi Miyata; Koji Tanaka; Tomoki Makino; Atsushi Takeno; Osamu Shiraishi; Masaaki Motoori; Makoto Yamasaki; Yutaka Kimura; Motohiro Hirao; Kazumasa Fujitani; Takusi Yasuda; Masaki Mori; Hidetoshi Eguchi; Masahiko Yano; Yuichiro Doki
    Annals of surgery 274 6 e465-e472  2020年10月 
    OBJECTIVE: We conducted a multicenter randomized prospective phase 2 trial of chemoradiotherapy (CRT) versus chemotherapy (CT) as initial induction therapy for conversion surgery (CS) in clinical T4b esophageal cancer. We compared treatment effects and adverse events. SUMMARY BACKGROUND DATA: Although induction followed by CS is potentially curative for T4b esophageal cancer, the optimal initial induction treatment is unclear. METHODS: Ninety-nine patients with T4b esophageal cancer were randomly allocated to chemoradiotherapy (Group A, n = 49) or CT (Group B, n = 50) as initial induction treatment. CRT consisted of radiation (50.4 Gy) with cisplatin and 5-fluorouracil. CT consisted of 2 cycles of docetaxel plus cisplatin and 5-fluorouracil (DCF). CRT or CT was followed by CS if resectable. If unresectable, the patient received the other treatment as secondary treatment. CS was performed if resectable after secondary treatment. The primary end point was 2-year overall survival. RESULTS: In Group A, CS was performed in 34 (69%) and 7 patients (14%) after initial and secondary treatment. In Group B, CS was performed in 25 (50%) and 17 patients (34%) after initial and secondary treatment. The R0 resection rate after initial and secondary treatment was similar (78% vs 76%, P = 1.000). Adverse events including leukopenia, neutropenia, febrile neutropenia, and diarrhea were significantly more frequent in Group B. Group A had better histological complete response of the primary tumor (40% vs 17%, P = 0.028) and histological nodal status (P = 0.038). CONCLUSIONS: Upfront CRT was superior to upfront CT in terms of pathological effects and adverse events. The Japan Registry of Clinical Trials (s051180164).
  • 消化管腫瘍の診断と治療における工夫 胃粘膜下腫瘍に対する腹腔鏡下胃内手術に関する検討
    木村 豊; 安田 篤; 今本 治彦; 安田 卓司
    日本消化器病学会近畿支部例会プログラム・抄録集 113回 68 - 68 日本消化器病学会-近畿支部 2020年10月
  • 食道切除後の消化管再建 食道切除後胸骨後胃管再建における縫合不全対策の変遷と現況
    白石 治; 平木 洋子; 百瀬 洸太; 加藤 寛章; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本臨床外科学会雑誌 81 増刊 240 - 240 日本臨床外科学会 2020年10月
  • 機能温存手術(食道・胃)の現状 頸部・頸胸境界部食道癌に対する喉頭温存、高位吻合術における嚥下機能温存の工夫
    加藤 寛章; 白石 治; 平木 洋子; 百瀬 洸太; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本臨床外科学会雑誌 81 増刊 261 - 261 日本臨床外科学会 2020年10月
  • 高度進行胃癌、再発胃癌に対する治療戦略-薬物療法と手術との融合- 腹膜播種陽性胃癌に対する腹腔内パクリタキセル投与+全身化学療法奏功例に対するconversion手術の有用性
    新海 政幸; 今野 元博; 平木 洋子; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本臨床外科学会雑誌 81 増刊 299 - 299 日本臨床外科学会 2020年10月
  • 木村 豊; 吉岡 康太; 百瀬 洸太; 加藤 寛章; 白石 治; 安田 篤; 安田 卓司
    日本外科感染症学会雑誌 17 5 334 - 334 (一社)日本外科感染症学会 2020年10月
  • 木村 豊; 安田 篤; 白石 治; 平木 洋子; 百瀬 洸太; 加藤 寛章; 新海 政幸; 今野 元博; 安田 卓司
    日本外科感染症学会雑誌 17 5 337 - 337 (一社)日本外科感染症学会 2020年10月
  • 本告 正明; 杉村 啓二郎; 田中 晃司; 白石 治; 岩間 密; 宮崎 安弘; 牧野 知紀; 山崎 誠; 宮田 博志; 木村 豊; 朝原 崇; 藤谷 和正; 安田 卓司; 土岐 祐一郎; 矢野 雅彦
    日本外科感染症学会雑誌 17 5 395 - 395 (一社)日本外科感染症学会 2020年10月
  • 消化器癌化学療法の進歩と課題 CDDPを使用できない食道癌患者に対する3剤併用術前化学療法の検討
    木村 豊; 白石 治; 川上 尚人; 安田 卓司
    日本消化器病学会近畿支部例会プログラム・抄録集 113回 51 - 51 日本消化器病学会-近畿支部 2020年10月
  • 腫瘍免疫病態の多様性とがん治療 術前治療後治癒切除のpN(+)食道癌症例に対するペプチドワクチン術後補助療法に関する探索的単施設第2相臨床試験
    安田 卓司; 錦 耕平; 平木 洋子; 加藤 寛章; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 助川 寧; 千葉 康敬; 今野 元博; 竹田 和由; 佐藤 隆夫; 塩崎 均; 中村 祐輔
    日本癌学会総会記事 79回 S15 - 2 2020年10月
  • 吉岡 康多; 幕谷 悠介; 岩本 哲好; 和田 聡朗; 所 忠男; 木村 豊; 川村 純一郎
    日本外科感染症学会雑誌 17 5 466 - 466 (一社)日本外科感染症学会 2020年10月
  • Osamu Shiraishi; Takushi Yasuda; Hiroaki Kato; Mitsuru Iwama; Yoko Hiraki; Atsushi Yasuda; Masayuki Shinkai; Yutaka Kimura; Motohiro Imano
    Annals of surgical oncology 27 11 4433 - 4440 2020年10月 
    PURPOSE: We retrospectively investigated the risk factors for mediastinal lymph node (MLN) metastasis in esophagogastric junction (EGJ) cancer with an epicenter within 2 cm above and below the anatomical cardia, including both adenocarcinoma (AC) and squamous cell carcinoma (SCC). METHODS: Fifty patients who underwent initial surgery for EGJ cancer from January 2002 to December 2013 were included in this study. We defined metastatic lymph nodes as pathological metastases in resected specimens and recurrence within 2 years postoperatively. RESULTS: Thirty-four patients had AC and 16 had SCC; 24 patients underwent transhiatal resection and 26 underwent transthoracic resection. MLN metastasis was observed in 13 patients (26%) regardless of the histological type, 9 of whom had metastasis in the upper and middle mediastinum. Metastasis occurred when the esophageal invasion length (EIL) exceeded 20 mm. In addition, 10/13 patients had stage pN2-3 cancer. Multivariable analysis identified EIL ≥ 20 mm and stage pN2-3 as significant risk factors for MLN metastasis. The 5-year overall survival was 38% and 65% in the MLN-positive and -negative groups, respectively (p = 0.12). Multivariable Cox regression analysis showed that only stage pN2-3, and not the presence of MLN metastasis, was a significantly poor prognostic factor. CONCLUSION: MLN metastasis in EGJ cancer may have a close association with the EIL of the tumor, but the presence of MLN metastasis itself was not a poor prognostic factor. The significance and indications for MLN dissection should be clarified in prospective clinical trials.
  • Tsutomu Hayashi; Takaki Yoshikawa; Kentaro Sakamaki; Kazuhiro Nishikawa; Kazumasa Fujitani; Kazuaki Tanabe; Kazunari Misawa; Takanori Matsui; Akira Miki; Hiroshi Nemoto; Tetsu Fukunaga; Yutaka Kimura; Jun Hihara
    Annals of gastroenterological surgery 4 5 540 - 548 2020年09月 
    Aim: Neoadjuvant chemotherapy (NAC) is promising to improve the survival of resectable gastric cancer. However, suitable regimen and treatment duration for NAC have not yet been established. Methods: We conducted a randomized phase II trial to compare two and four courses of neoadjuvant S-1/cisplatin (SC) and S-1/cisplatin/docetaxel(DCS) using a two-by-two factorial design for locally resectable advanced gastric cancer. Patients with M0 and either T4 or T3 in case of junctional cancer or scirrhous-type cancer received two or four courses of SC or DCS. Then, patients underwent D2 gastrectomy and adjuvant S-1 chemotherapy for 1 year. The primary endpoint was 3-year overall survival. The planned sample size was 120 eligible patients. Results: Between October 2011 and September 2014, 132 patients were assigned to CS (n = 66; 33 in 2-courses and 33 in 4-courses) and DCS (n = 66; 33 in 2-courses and 33 in 4-courses). The 3-year OS was 58.1% in CS and 60.0% in DCS with hazard ratio of 0.80 (95% CI, 0.48-1.34), while it was 53.1% in the two courses and 65.0% in the four courses with hazard ratio of 0.72 (95% CI, 0.43-1.22). In the survival analysis by duration in each regimen, the 3-year OS was 58.1% for both two and four courses in CS, while it was 48.5% for two courses of DCS and 71.9% for four courses of DCS. Conclusions: Considering high 3-year OS, four courses DCS has a value to be tested in a future phase III study to confirm superiority of neoadjuvant chemotherapy for locally advanced gastric cancer.
  • Hisato Kawakami; Kazumasa Fujitani; Jin Matsuyama; Yusuke Akamaru; Shigeyuki Tamura; Shunji Endo; Yutaka Kimura; Youichi Makari; Takao Tamura; Naotoshi Sugimoto; Daisuke Sakai; Toshimasa Tsujinaka; Masahiro Goto; Yukinori Kurokawa; Toshio Shimokawa; Taroh Satoh
    International journal of clinical oncology 25 9 1635 - 1643 2020年09月 
    BACKGROUND: We previously reported the HERBIS-4A phase II trial comparing S-1 plus cisplatin (SP) with capecitabine plus cisplatin (XP) in chemotherapy-naïve patients with HER2-negative advanced gastric cancer (GC). We performed a pooled analysis of HERBIS-4A and HERBIS-2, the phase II trial comparing SP with XP in HER2-negative recurrent GC patients with a recurrence-free interval after S-1 adjuvant therapy of ≥ 6 months. PATIENTS AND METHODS: Patients were randomly assigned to receive either SP [S-1 (40-60 mg twice daily for 21 days) plus cisplatin (60 mg/m2 on day 8), every 5 weeks] or XP [capecitabine (1000 mg/m2 twice daily for 14 days) plus cisplatin (80 mg/m2 on day 1), every 3 weeks]. RESULTS: In the pooled analysis, SP (n = 44-50) showed a longer progression-free survival [6.4 versus 5.1 months; hazard ratio (HR), 0.666; P = 0.062], overall survival (14.8 versus 10.6 months; HR, 0.695; P = 0.099), and time to treatment failure (4.6 versus 3.6 months; HR, 0.668; P = 0.045) as well as a higher disease control rate (86.4% versus 68.1%, P = 0.149) compared with XP (n = 47-51). A significant survival advantage for SP over XP was apparent in patients with a performance status of 0, a differentiated-type tumor histology, or a primary tumor localization to the upper portion of the stomach. CONCLUSION: Our pooled analysis supports the use of SP in the first-line setting for patients with HER2-negative advanced or recurrent GC with a recurrence-free interval of ≥ 6 months. CLINICAL TRIAL REGISTRATION: The HERBIS-2 trial was registered with UMIN-CTR as UMIN000006105.
  • Takushi Yasuda; Kohei Nishiki; Yoko Hiraki; Hiroaki Kato; Mitsuru Iwama; Osamu Shiraishi; Atsushi Yasuda; Masayuki Shinkai; Yutaka Kimura; Yasushi Sukegawa; Yasutaka Chiba; Motohiro Imano; Kazuyoshi Takeda; Takao Satou; Hitoshi Shiozaki; Yusuke Nakamura
    Annals of surgery 275 1 e155-e162  2020年08月 
    OBJECTIVES: To elucidate the efficacy of adjuvant vaccine monotherapy using 3 Human Leukocyte Antigen (HLA)-A24-restricted tumor-specific peptide antigens for ESCC, upregulated lung cancer 10, cell division cycle associated 1, and KH domain-containing protein overexpressed in cancer 1. SUMMARY OF BACKGROUND DATA: ESCC patients with pathologically positive nodes (pN(+)) have a high risk for postoperative recurrence, despite curative resection after preoperative therapy. Subclinical micrometastases are an appropriate target for cancer vaccine. METHODS: This is a non-randomized prospective phase II clinical trial (UMIN000003557). ESCC patients curatively resected after preoperative therapy with pN(+) were allocated into the control and vaccine groups (CG and VG) according to the HLA-A status. One mg each of three epitope peptides was postoperatively injected 10 times weekly followed by 10 times biweekly to the VG. The primary and secondary endpoints were relapse-free survival (RFS) and esophageal cancer-specific survival (ECSS), respectively. RESULTS: Thirty were in the CG and 33 in the VG. No significant difference was observed in RFS between the CG and VG (5-year RFS: 32.5% vs 45.3%), but the recurrence rate significantly decreased with the number of peptides which induced antigen-specific cytotoxic T lymphocytes. The VG showed a significantly higher 5-year ECSS than the CG (60.0% vs 32.4%, P = 0.045) and this difference was more prominent in patients with CD8 and programmed death-ligand 1 double negative tumor (68.0% vs 17.7%, P = 0.010). CONCLUSIONS: Our cancer peptide vaccine might improve the survival of ESCC patients, which is warranted to be verified in the phase III randomized controlled study.
  • 腹膜播種陽性胃癌に対する腹腔内+全身化学療法奏功例におけるconversion手術
    新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本外科学会定期学術集会抄録集 120回 SF - 2 (一社)日本外科学会 2020年08月
  • 75歳以上の根治切除可能な大型3型/4型胃癌に対する術前TS-1併用化学放射線療法の第I相臨床試験(OGSG1303)
    木村 豊; 今野 元博; 古河 洋; 遠藤 俊治; 中川 朋; 足立 真一; 藤田 淳也; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 横川 正樹; 西村 恭昌; 安田 卓司; 坂井 大介; 黒川 幸典; 下川 敏雄; 佐藤 太郎
    日本外科学会定期学術集会抄録集 120回 SF - 8:[*] (一社)日本外科学会 2020年08月
  • 食道亜全摘術を行う胸部食道癌患者における急性肺合併症に対するOSK-0028(グレリン塩酸塩)の有効性及び安全性の検討(第II相医師主導治験)
    山下 公太郎; 宮崎 安弘; 田中 晃司; 牧野 知紀; 山崎 誠; 西塔 拓郎; 高橋 剛; 黒川 幸典; 中島 清一; 杉村 啓二郎; 宮田 博志; 白石 治; 木村 豊; 安田 卓司; 矢野 雅彦; 土岐 祐一郎
    日本外科学会定期学術集会抄録集 120回 SF - 4 (一社)日本外科学会 2020年08月
  • 食道胃接合部癌に対するリンパ節転移分布に基づく術式選択
    白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本外科学会定期学術集会抄録集 120回 DP - 2 (一社)日本外科学会 2020年08月
  • HER2陰性再発・進行胃癌に対するSP療法とXP療法との比較 HERBIS-2(OGSG 1103)とHERBIS-4A(OGSG 1105)試験との統合解析
    赤丸 祐介; 川上 尚人; 藤谷 和正; 松山 仁; 後藤 昌弘; 田村 茂行; 遠藤 俊治; 木村 豊; 辻仲 利政; 間狩 洋一; 田村 孝雄; 杉本 直俊; 坂井 大介; 黒川 幸典; 下川 敏雄; 佐藤 太郎
    日本外科学会定期学術集会抄録集 120回 SF - 2 2020年08月
  • Yukinori Kurokawa; Jin Matsuyama; Kazuhiro Nishikawa; Atsushi Takeno; Yutaka Kimura; Kazumasa Fujitani; Ryohei Kawabata; Yoichi Makari; Tetsuji Terazawa; Hisato Kawakami; Daisuke Sakai; Toshio Shimokawa; Taroh Satoh
    GASTRIC CANCER 2020年08月 
    Background Cisplatin plus S-1 (CS) is the standard first-line chemotherapy for advanced gastric cancer (AGC) in Japan. A previous phase III trial showed that docetaxel plus S-1 (DS) was effective for AGC without measurable lesions, but no studies have compared these two regimens. Methods Eligible patients had unresectable or recurrent HER2-negative AGC without measurable lesions. Patients were randomized to DS (docetaxel 40 mg/m(2)on day 1, S-1 80-120 mg on days 1-14, every 3 weeks) or CS (cisplatin 60 mg/m(2)on day 8, S-1 80-120 mg on days 1-21, every 5 weeks). The primary endpoint was overall survival (OS). Results All patients had unresectable primary disease. Sixty-one patients were randomly assigned to DS (n = 30) or CS (n = 31). One CS patient was ineligible due to HER2 positivity. The median number of cycles was 9.5 (range 2-49) with DS and 5.5 (range 1-10) with CS. There were no treatment-related deaths. The most common grade 3-4 non-hematological toxicity was fatigue (7% with DS, 13% with CS), followed by anorexia (3% with DS, 10% with CS) and diarrhea (3% with DS, 10% with CS). The 2-year OS rates were 43.3% with DS and 30.0% with CS (log-rankP = 0.113), with a hazard ratio of 0.617 (95% confidence interval 0.337-1.128), indicating non-inferiority of DS to CS with respect to OS (P < 0.001). Conclusions DS showed slightly but nonsignificantly less toxicity and higher efficacy than CS for AGC without measurable lesions. DS should be further investigated in phase III trials.
  • Takashi Oshima; Takaki Yoshikawa; Yohei Miyagi; Satoshi Morita; Michio Yamamoto; Kazuaki Tanabe; Kazuhiro Nishikawa; Yuichi Ito; Takanori Matsui; Yutaka Kimura; Tomoyuki Yokose; Yukihiko Hiroshima; Toru Aoyama; Tsutomu Hayashi; Takashi Ogata; Haruhiko Cho; Yasushi Rino; Munetaka Masuda; Akira Tsuburaya; Junichi Sakamoto
    Oncotarget 11 30 2906 - 2918 2020年07月 [査読有り]
     
    BACKGROUND: The findings of COMPASS, a randomized phase II study, suggested that the regimens and courses of neoadjuvant chemotherapy (NAC) for locally advanced gastric cancer (GC) did not affect the pathological response. However, pathological complete response was achieved in 10% patients who received four courses of either S-1/cisplatin or paclitaxel/cisplatin. We hypothesized that if relevant biomarkers could be used to predict the suitable NAC regimen before treatment initiation, further improvements could be ensured in the outcomes of locally advanced GC. MATERIALS AND METHODS: mRNA extraction, real-time polymerase chain reaction, and immunohistochemical analyses were performed using endoscopic biopsy specimens of primary tumors, collected prior to NAC, to determine the clinically relevant biomarkers. RESULTS: TIMP1, DSG2, RRM1, MUC2, EGFR, ZDHHC14, and CLDN18.2 were identified as biomarker candidates, since their expression was significantly associated with the pathological responses to each NAC regimen. Furthermore, TIMP1 and DSG2 were identified as predictive biomarkers of the pathological response to each NAC regimen. CONCLUSIONS: The effective prediction of the pathological response to NAC regimens in locally advanced GC using biomarkers identified from endoscopic biopsy specimens indicates the possibility of personalizing NAC based on biomarker analysis.
  • Takaomi Hagi; Tomoki Makino; Makoto Yamasaki; Kotaro Yamashita; Koji Tanaka; Takuro Saito; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Eiichi Morii; Hidetoshi Eguchi; Yuichiro Doki
    Annals of surgery 275 6 1121 - 1129 2020年07月 
    OBJECTIVE: To evaluate pathological response to NAC in metastatic LNs, and assess its clinical prognostic significance in patients with EC. SUMMARY OF BACKGROUND DATA: The pathological response to preoperative treatment is commonly evaluated in the PT. However, LN metastases strongly correlate with systemic micro-metastases. Thus, pathological evaluation of LN response could more accurately predict prognosis in EC patients undergoing NAC before surgery. METHODS: We enrolled 371 consecutive patients who underwent triplet NAC followed by surgery for EC between January 2010 and December 2016. Pathological LN regression grade was defined by the proportion of viable tumor area within the whole tumor bed area for all metastatic LNs: grade I, >50%; II, 10%-50%; III, <10%; and IV, 0%. We analyzed the correlation of grade with clinico-pathological parameters. RESULTS: Among 319 patients with clinically positive LNs, pathological LN regression grades were I/II/III/IV in 115/51/58/95 patients, and 191 patients (59.9%) showed discordance between the PT and LN pathological regression grades. LN regression grade significantly correlated with cN positive number, ypTNM, lymphovascular invasion, and clinical/pathological PT response. Multivariate analysis for recurrence-free survival revealed that LN regression grade [hazard ratio (HR) = 2.25, P < 0.001], ypT (HR = 1.65, P = 0.005), and ypT (HR = 1.62, P = 0.004) were independent prognostic factors, but not pathological PT regression grade (P = 0.67). CONCLUSIONS: Compared to PT response, pathological LN response better predicted long-term survival in EC patients who received NAC plus curative surgery.
  • Tadayoshi Hashimoto; Yukinori Kurokawa; Tsuyoshi Takahashi; Takuro Saito; Kotaro Yamashita; Koji Tanaka; Tomoki Makino; Makoto Yamasaki; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Surgery today 50 5 509 - 515 2020年05月 [査読有り]
     
    PURPOSE: Preoperative chemotherapy is an effective treatment option for resectable gastric cancer, but it is associated with various adverse events (AEs). This study aimed to identify the body composition parameters that most accurately predicted the incidence of AEs in preoperative chemotherapy for gastric cancer. METHODS: The present study included a total of 114 patients who received preoperative chemotherapy for resectable gastric cancer. We estimated various body composition parameters using computed tomography images obtained before preoperative chemotherapy. Their associations with the incidence of hematological (grade ≥ 3) and non-hematological (grade ≥ 2) AEs were analyzed by multivariate logistic regression analyses. RESULTS: Seventy-two of the 114 (63.2%) patients experienced hematological AEs (grade ≥ 3), specifically neutropenia in 68 (59.6%), anemia in 5 (4.9%), and thrombocytopenia in 3 (2.6%). Meanwhile, 59 patients (51.8%) experienced non-hematological AEs (grade ≥ 2), namely hypoalbuminemia in 31 (27.2%), anorexia in 24 (21.1%), and febrile neutropenia in 17 (14.9%). Multivariate analyses revealed that a low psoas muscle index (PMI) was an independent risk factor for the incidence of both hematological and non-hematological AEs. CONCLUSIONS: Patients with a low PMI experienced an increased incidence of hematological and non-hematological toxicities during preoperative chemotherapy for gastric cancer. Clinicians should be aware of these risks in this population.
  • Tadayoshi Hashimoto; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Eiichi Morii; Masaki Mori; Yuichiro Doki
    Annals of surgery 271 5 875 - 884 2020年05月 [査読有り]
     
    OBJECTIVES: To investigate the residual pattern of esophageal cancer in the esophageal wall after neoadjuvant chemotherapy (NAC) and its clinical significance. BACKGROUND: NAC is a standard treatment for locally advanced esophageal cancer; however, residual tumor patterns in resected specimens after NAC and their clinico-pathological characteristics remain unknown. METHODS: One hundred twenty consecutive patients with cT3 or deeper esophageal cancer underwent curative esophagectomy after NAC and achieved grade 2 histological responses between 2000 and 2016. Hematoxylin-eosin staining of residual tumor sections revealed 4 remnant categories: Type 1: shallow, Type 2: central, Type 3: deep, and Type 4: diffuse. We examined associations between these Types and clinico-pathological factors, including prognosis. RESULTS: Forty-five (38%) specimens had no residual tumor cells in the mucosal layer. The adventitia layer displayed the lowest residual tumor cell frequency (18%) among all layers. Types 1, 2, 3, and 4 residual tumor patterns were found in 49 (41%), 33 (28%), 9 (8%), and 29 (24%) patients, respectively. Type 4 showed the maximum standard uptake value after NAC; Types 3 and 4 had higher ratios of venous invasion than Type 1 or 2. Patients with Type 3 or 4 more frequently developed pleural dissemination or distant metastasis than patients with Type 1 or 2. Survival was similar among the 4 Types. CONCLUSIONS: After NAC for locally advanced esophageal cancer, the shallow residual tumor pattern was most common, but approximately 40% of specimens showed no tumor cells in the mucosal layer. Deep and diffuse remnant patterns were associated with high risks of pleural dissemination and distant metastasis.
  • 腹膜播種陽性進行胃癌に対するPaclitaxel+CDDP+S-1(PCS)療法の治療経験
    新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本胃癌学会総会記事 92回 453 - 453 (一社)日本胃癌学会 2020年03月
  • Atsushi Takeno; Yutaka Kimura; Naotoshi Sugimoto; Motohiro Hirao; Kohei Akiyoshi; Kohei Murakami; Daisuke Sakai; Toshio Shimokawa; Yukinori Kurokawa; Taro Sato
    Gan to kagaku ryoho. Cancer & chemotherapy 47 3 481 - 483 2020年03月 
    BACKGROUND: Gastric cancer with extensive lymph node metastasis(ELM)is commonly considered unresectable and has a poor prognosis. We conducted a phase Ⅱ study to evaluate the safety and efficacy of capecitabine and cisplatin(XP)as preoperative chemotherapy for gastric cancer with ELM. METHODS: The patients received 2 21-day cycles of XP therapy(ca- pecitabine at 2,000mg/m2 twice daily for 2 weeks and cisplatin at 80 mg/m2 on day 1)followed by gastrectomy with D2 plus para-aortic nodal dissection. After R0 resection, S-1 chemotherapy was administered for 1 year. The primary end point was response rate(RR). The planned sample size was 30. RESULTS: Between April 2015 and November 2016, 4 patients were enrolled, but the enrollment was terminated because of poor patient recruitment. The clinical RR was 50%, and R0 resection was achieved in 75% of the patients. The common Grade 3 adverse events during XP therapy were leukocytopenia(25%), anemia(25%), and hyperlipidemia(25%). The common Grade 3 surgical morbidity was abdominal abscess(33%)and pancreatic fistula(33%). The pathological RR was 25%. CONCLUSIONS: Preoperative XP therapy was feasible, but its efficacy was difficult to evaluate because of the small sample size.
  • Daisuke Takahari; Seiji Ito; Junki Mizusawa; Hiroshi Katayama; Masanori Terashima; Mitsuru Sasako; Shinji Morita; Takashi Nomura; Makoto Yamada; Yoshiyuki Fujiwara; Yutaka Kimura; Atsuki Ikeda; Yoshio Kadokawa; Takeshi Sano
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 23 2 293 - 299 2020年03月 
    BACKGROUND: Preoperative chemotherapy with cisplatin plus S-1 (CS) followed by gastrectomy with D2 plus para-aortic lymph node (PAN) dissection is regarded as a standard treatment in Japan for advanced gastric cancer with bulky lymph node (BN) and/or PAN metastasis. In the JCOG1002, we added docetaxel to CS (DCS) to further improve long-term outcomes. However, the primary endpoint, clinical response rate (RR), did not reach the expected level (Ito et al. in Gastric Cancer 20:322-31, 2017). Herein, we report our long-term survival results. METHODS: Patients with BN and/or PAN metastasis received 2 or 3 cycles of DCS therapy (docetaxel at 40 mg/m2 and cisplatin at 60 mg/m2 on day 1 and S-1 at 80 mg/m2 per day for 2 weeks, followed by a 2-week rest) followed by gastrectomy with D2 plus PAN dissection and postoperative S-1 for 1 year. RESULTS: Between July 2011 and May 2013, 53 patients were enrolled. Clinically, 17.0% had both PAN and BN metastasis, and the rest had either PAN (26.4%) or BN (56.6%) metastasis. Among all eligible patients, the 5-year overall survival was 54.9% (95% confidence interval 40.3-67.3%) at the last follow-up in May 2018. Among 44 eligible patients with R0 resection, the 5-year relapse-free survival was 47.7% (95% confidence interval 32.5-61.5%). CONCLUSIONS: Adding docetaxel to CS in preoperative chemotherapy for extensive nodal metastasis improved neither short-term outcomes nor long-term survival. Preoperative chemotherapy with CS followed by D2 + PAN dissection and postoperative S-1 remains the standard of care for patients with extensive nodal metastasis.
  • Atsushi Yasuda; Takushi Yasuda; Haruhiko Imamoto; Yoko Hiraki; Kohta Momose; Hiroaki Kato; Mitsuru Iwama; Osamu Shiraishi; Masayuki Shinkai; Motohiro Imano; Yutaka Kimura
    Surgical case reports 6 1 44 - 44 2020年02月 
    BACKGROUND: Granular cell tumors (GCT) in the gastrointestinal tract are rare. Herein, we describe a case of a gastric GCT diagnosed preoperatively by endoscopic ultrasound-guided fine needle aspiration biopsy (EUS-FNAB) and successfully resected by single-incision laparoscopic surgery (SILS). CASE PRESENTATION: A 46-year-old Japanese woman had a tumor located in the angle of the stomach that was approximately 1.5 cm in diameter. Abdominal computed tomography (CT) revealed a submucosal tumor (SMT), which was finally diagnosed as a gastric GCT using EUS-FNAB. The tumor was not identified by CT 1 year and 4 months before diagnosis; therefore, because there was a possibility that the tumor was malignant, we performed surgical wedge resection using SILS. The patient had an uneventful recovery postoperatively and was discharged without complications 3 days after surgery. The tumor was pathologically diagnosed as a benign GCT that remained within the muscular layer. No recurrence or complications have occurred in the first 16 months since the surgery. CONCLUSION: Because gastric GCTs are generally benign and are rarely associated with lymph node metastasis, SILS seems to be a safe and feasible surgical approach for treating GCTs.
  • Atsushi Gakuhara; Yasuhiro Miyazaki; Yukinori Kurokawa; Tsuyoshi Takahashi; Makoto Yamasaki; Tomoki Makino; Koji Tanaka; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Shuji Takiguchi; Masaki Mori; Yuichiro Doki
    Asian journal of endoscopic surgery 13 1 95 - 98 2020年01月 [査読有り]
     
    An asymptomatic 74-year-old man was diagnosed with early gastric cancer during screening. Preoperative CT revealed a 25-mm tumor surrounded by the abdominal aorta, inferior vena cava, and left renal vein. Based on the primary tumor stage, para-aortic lymph node metastasis was considered to be unlikely but could not be ruled out. For this reason, we planned a concurrent diagnostic and therapeutic laparoscopic resection with gastrectomy. The gastric cancer and para-aortic tumor were successfully resected laparoscopically. The tumor was diagnosed as a schwannoma. With care and skill, we were able to resect the para-aortic schwannoma and gastric cancer simultaneously and safely by using laparoscopic techniques.
  • 逆流防止機構を考慮した腹腔鏡下噴門側胃切除術後の簡便な食道残胃吻合法(完全鏡視下残胃食道裂孔挿入法)
    木村 豊; 安田 篤; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今本 治彦; 安田 卓司
    日本内視鏡外科学会雑誌 24 7 SF015 - 2 (一社)日本内視鏡外科学会 2019年12月
  • 木村 豊; 白石 治; 岩間 密; 加藤 寛章; 川上 尚人; 奥野 達哉; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 中川 和彦; 安田 卓司
    癌と化学療法 46 13 2173 - 2175 (株)癌と化学療法社 2019年12月 
    腎機能低下を伴う進行食道癌に対して術前化学療法(NAC)として5-FU+DTX+nedaplatin(NED)(UDON)療法を施行し、その有用性をretrospectiveに検討した。クレアチニン・クリアランス(Ccr)が50mL/min未満の進行食道癌5例を対象として、NACとしてUDON療法[5-FU640mg/m2(day1〜5)、NED72mg/m2(day1)、DTX28mg/m2(day1、15)、休薬2週間を1コース]を2コース施行した後に根治手術を施行した。化学療法の有害事象(AE)を評価し、臨床的な効果について検討した。患者背景は、男性4例、女性1例、年齢の中央値(範囲)79(58〜80)歳、performance status(PS)1:3、PS2:2例であった。腫瘍の主占居部位は、Ce 1、Ut 1、Mt 3例、進行度はcStage IIA1、IIIA2、IIIC2例であった。grade(Gr)3以上のAEは、好中球減少、低Na血症がそれぞれ2例、発熱性好中球減少、下痢がそれぞれ1例であった。抗腫瘍効果は部分奏効4例、安定1例、組織学的効果は、Gr 1a:Gr 1b=2:3であった。腎機能低下のため高用量CDDP投与が困難な進行食道癌患者に対するNACとして、UDON療法は有用である。(著者抄録)
  • 木村 豊; 大東 弘治; 安田 篤; 加藤 寛章; 上田 和毅; 今本 治彦; 川村 純一郎; 安田 卓司
    近畿大学医学雑誌 44 3-4 121 - 131 近畿大学医学会 2019年12月 
    消化器癌に対するロボット支援下手術(RS)は、2018年4月に胃癌に対する腹腔鏡下胃切除術(幽門側胃切除術)、腹腔鏡下噴門側胃切除術、腹腔鏡下胃全摘術の他に、食道癌に対する胸腔鏡下食道悪性腫瘍手術、直腸癌に対する腹腔鏡下直腸切除・切断術が保険収載され、今後ますます普及、発展していくことが予想される。RSで使用されるda Vinci Surgical Systemの利点として、手振れ防止機能、高解像度の3D内視鏡、多関節の鉗子、縮尺機能などがあげられる。一方、触覚がない、高額であるなどの欠点が指摘されているが、様々な科学技術の発展とともにRSも進歩していくことが期待される。消化器癌に対するRSに関して、一般的には時間はかかるが、出血量は少なく、合併症も低減できる可能性が報告されている。しかし、始まったばかりの手術であるため、エビデンスはまだ不十分であり、今後は、安全に行っていくともにエビデンスを構築していくことが求められている。(著者抄録)
  • 木村 豊; 大東 弘治; 安田 篤; 加藤 寛章; 上田 和毅; 今本 治彦; 川村 純一郎; 安田 卓司
    近畿大学医学雑誌 44 3-4 121 - 131 近畿大学医学会 2019年12月 [査読有り]
     
    消化器癌に対するロボット支援下手術(RS)は、2018年4月に胃癌に対する腹腔鏡下胃切除術(幽門側胃切除術)、腹腔鏡下噴門側胃切除術、腹腔鏡下胃全摘術の他に、食道癌に対する胸腔鏡下食道悪性腫瘍手術、直腸癌に対する腹腔鏡下直腸切除・切断術が保険収載され、今後ますます普及、発展していくことが予想される。RSで使用されるda Vinci Surgical Systemの利点として、手振れ防止機能、高解像度の3D内視鏡、多関節の鉗子、縮尺機能などがあげられる。一方、触覚がない、高額であるなどの欠点が指摘されているが、様々な科学技術の発展とともにRSも進歩していくことが期待される。消化器癌に対するRSに関して、一般的には時間はかかるが、出血量は少なく、合併症も低減できる可能性が報告されている。しかし、始まったばかりの手術であるため、エビデンスはまだ不十分であり、今後は、安全に行っていくともにエビデンスを構築していくことが求められている。(著者抄録)
  • Yutaka Kimura; Osamu Shiraishi; Mitsuru Iwama; Hiroaki Kato; Hisato Kawakami; Tatsuya Okuno; Yoko Hiraki; Atsushi Yasuda; Masayuki Shinkai; Motohiro Imano; Kazuhiko Nakagawa; Takushi Yasuda
    Gan to kagaku ryoho. Cancer & chemotherapy 46 13 2173 - 2175 2019年12月 [査読有り]
     
    BACKGROUND: In Japan, pre-operative 5-FU and cisplatin(CDDP)(FP)combination therapy has been the standard neoadjuvant chemotherapy(NAC)for advanced resectable esophageal cancer(EC); furthermore, the efficacy of the docetaxel (DTX)-containing triplet regimen, FP plus DTX, has been reported. However, patients with impaired renal function should not receive high-dose CDDP. We have been developing a non-CDDP-containing triplet regimen, comprising 5-FU, DTX, and nedaplatin(NED)(UDON), on a phase Ⅰ/Ⅱtrial basis. This retrospective study aimed to investigate the safety and efficacy of NAC with UDON in advanced EC patients with impaired renal function. METHODS: Five patients with advanced resectable EC with impaired renal function were enrolled in this study. Patients received NAC(5-FU, 640mg/m / 2, days 1-5; DTX, 28 mg/m2, days 1 and 15; and NED, 72mg/m2, day 1, q28, 2 courses); following this, they underwent esophagectomy. The primary endpoint was response rate, and the secondary endpoint was adverse event(AE). RESULTS: The median age was 79 years (range: 58-80 years). The ECOG performance status was 1/2 : 3/2. The main tumor locations were Ce/Ut/Mt : 1/1/3 and the cStages were ⅡA/ⅢA/ⅢC : 1/2/2. The RR(CR/PR/SD/PD : 0/4/1/0)was 80%. The pathological response was grade 1a/1b : 2/3. Major grade 3 or 4 AEs included neutropenia(40%), febrile neutropenia(20%), diarrhea(20%), and hyponatremia( 40%). There was no treatment-related death or reoperation. CONCLUSIONS: NAC with UDON might be feasible and effective in patients with advanced resectable EC with impaired renal function, who are ineligible for high-dose CDDP administration. We are planning a phaseⅡclinical study based on the present results.
  • Tomo Ishida; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Surgery 166 6 1041 - 1047 2019年12月 [査読有り]
     
    BACKGROUND: Some studies have reported that sarcopenia is linked to clinical outcomes in multiple types of malignancies, but this association has not been established in esophageal cancer. We assessed how sarcopenia affects clinical outcomes of multidisciplinary treatments for esophageal cancer. METHODS: We included 165 esophageal cancer patients who had undergone neoadjuvant chemotherapy followed by esophagectomy. Computed tomography was used for cross-sectional measurement of the psoas muscle at the third lumbar vertebra; we then calculated the height-adjusted psoas muscle index. Pre- and postneoadjuvant chemotherapy psoas muscle indices were evaluated for associations with neoadjuvant chemotherapy response and neoadjuvant chemotherapy -related adverse events and postoperative complications, in addition to survival. Psoas muscle index cutoffs were 6.36 cm2/m2 for men and 3.92 cm2/m2 for women. RESULTS: Psoas muscle index decreased after neoadjuvant chemotherapy (from 7.17 to 6.96 cm2/m2; P = .0008), and specifically in men (from 7.45 to 7.23 cm2/m2; P = .0001) but not in women (from 5.21 to 5.17 cm2/m2; P = .810). Preneoadjuvant chemotherapy psoas muscle index (low versus high) was associated with neoadjuvant chemotherapy response (response rate: 65.1% vs 80.3%; P = .0494) and neoadjuvant chemotherapy-related adverse events (neutropenia: 93.0% vs 78.7%; P = .0337; febrile neutropenia: 53.5% vs 34.3%; P = .0278; hyponatremia: 51.2% vs 31.2%; P = .0190). Post-neoadjuvant chemotherapy psoas muscle index correlated with postoperative rate of complications (56.9% vs 33.3%; P = .0046), especially pneumonia (31.4% vs 9.7% P = .0008). Psoas muscle index was not associated with survival. CONCLUSION: Cross sectional measures of sarcopenia before and after neoadjuvant chemotherapy could predict tumor response, neoadjuvant chemotherapy -related adverse events, and postoperative complications in multidisciplinary treatments for esophageal cancer.
  • Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasunori Masuike; Mitsuaki Tatsumi; Masaaki Motoori; Yutaka Kimura; Jun Hatazawa; Masaki Mori; Yuichiro Doki
    Annals of surgery 270 6 1090 - 1095 2019年12月 [査読有り]
     
    OBJECTIVE: Here, we assess the ability of metabolic tumor volume (MTV) as measured by F-fluorodeoxyglucose-positron emission tomography/computed tomography (F-FDG PET/CT) to evaluate neoadjuvant chemotherapy response for patients with locally advanced esophageal cancer (EC). BACKGROUND: Optimal methods to evaluate treatment response for EC patients have not yet been established. Although previous studies have reported the value of standardized uptake value (SUV), the accuracy of predicting histological response or long-term survival in EC is limited. METHODS: In all, 102 EC patients without distant metastasis who underwent F-FDG PET/CT both before and after the preoperative chemotherapy series were analyzed. RESULTS: The median primary tumor MTV values before and after preoperative chemotherapy were 22.55 (range 0.4-183.1) and 2.75 (0-52.9), respectively, and the median MVT reduction rate was 86.5%. We found the most significant difference in survival between PET responders and nonresponders with a cut-off value of 60% MTV reduction, using a 10% stepwise cut-off analysis [2-year progression-free survival (PFS): 79.2 vs 44.4%; hazard ratio (HR) 3.397; P < 0.0001). With this cut-off value, histological response (P = 0.0091), tumor location (P = 0.0102), pT (P = 0.0011), and pN (P = 0.0110) were significantly associated with PET response. Univariate analysis of PFS indicated a correlation between PFS and tumor size, cT, decrease of primary lesion by CT, SUVmax reduction rate, MTV reduction rate, pT, pN, and pM. Multivariate analysis further identified pM (HR 3.063; P = 0.0279) and MTV reduction rate (HR 2.471; P = 0.0263) to be independent prognostic predictors, but not decrease of primary lesion by CT or SUVmax reduction rate. CONCLUSION: MTV change is clinically useful in predicting both long-term survival and histological response to preoperative chemotherapy in EC patients, after determining the optimal cut-off value based on survival analysis.
  • Ryo Kato; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Surgery today 49 12 1058 - 1065 2019年12月 [査読有り]
     
    PURPOSE: Prolonged chest drain placement can extend the postoperative hospital stay after esophagectomy in esophageal cancer (EC) patients. This study aimed to identify whether or not the risk factors associated with this prolonged chest tube placement are clinically important. METHODS: A total of 138 patients who underwent subtotal esophagectomy for thoracic EC were retrospectively analyzed. Using the 75th percentile of the total drainage volume of chest tubes as a cutoff value, the high-output (HO; n = 35) and low-output (LO; n = 103) groups were compared in terms of the clinicopathological parameters. RESULTS: The median durations of right and left chest tube placement were 6 and 9 days, respectively, with a median total drainage volume of 2692 ml. When compared with the LO group, the HO group was significantly associated with male gender, a subcutaneous route for reconstruction, blood transfusion, higher morbidity, and prolonged chest drainage and postoperative hospital stays. A multivariable analysis further identified blood loss (p = 0.03) and the subcutaneous route for reconstruction (p = 0.04) as independent risk factors for increased chest tube drainage after esophagectomy. CONCLUSION: Blood loss and the subcutaneous route of reconstruction are risk factors for increased drainage of chest tube after esophagectomy for EC.
  • Takaomi Hagi; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Naohiro Nishida; Daisuke Sakai; Masaaki Motoori; Yutaka Kimura; Taroh Satoh; Masaki Mori; Yuichiro Doki
    Annals of surgical oncology 26 13 4754 - 4764 2019年12月 [査読有り]
     
    BACKGROUND: Dysphagia is a major symptom of esophageal cancer (EC) that significantly affects patient quality of life; however, little is known regarding its clinical impact on the treatment course in patients with EC. METHODS: This retrospective study included 434 consecutive patients with EC who received docetaxel, cisplatin, and 5-fluorouracil (DCF) chemotherapy as an initial treatment. We evaluated the relationships between the dysphagia score at diagnosis and clinicopathological factors, including DCF therapy-related adverse events, tumor response, and survival. RESULTS: The dysphagia scores were 0 in 208 patients (47.9%), 1 in 82 patients (18.9%), 2 in 52 patients (12.0%), 3 in 59 patients (13.6%), and 4 in 33 patients (7.6%). High (≥ 3) dysphagia scores were significantly associated with high incidences of grade 3/4 febrile neutropenia (FN) (79.3 vs. 35.7%, P < 0.001) and diarrhea (63.0 vs. 28.1%, P < 0.001) compared with low (≤ 2) scores. Logistic regression analysis further identified the dysphagia scores as an independent predictor of both FN and severe diarrhea during DCF chemotherapy. Furthermore, compared with low scores, high dysphagia scores were associated with a worse clinical response to chemotherapy (response rate 65.2 vs. 78.7%, P = 0.008) and worse 5-year overall survival (35.4 vs. 56.4%, P = 0.001). CONCLUSIONS: The dysphagia score at diagnosis was an independent predictor of FN and severe diarrhea. Furthermore, this score might be useful in predicting chemotherapy response and long-term survival in patients treated with DCF.
  • 木村 豊; 白石 治; 岩間 密; 加藤 寛章; 川上 尚人; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 中川 和彦; 安田 卓司
    日本消化器病学会雑誌 116 臨増大会 A832 - A832 (一財)日本消化器病学会 2019年11月
  • 高齢食道癌患者の術後誤嚥性肺炎の発症予測における血中substance P測定の意義と展望
    木村 豊; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 安田 卓司
    日本消化器外科学会雑誌 52 Suppl.2 274 - 274 (一社)日本消化器外科学会 2019年11月
  • Yutaka Kimura; Kazuhiro Nishikawa; Kentaro Kishi; Kentaro Inoue; Jin Matsuyama; Yusuke Akamaru; Shigeyuki Tamura; Junji Kawada; Tomono Kawase; Ryohei Kawabata; Yoshiyuki Fujiwara; Hitoshi Kanno; Takeshi Yamada; Toshio Shimokawa; Hiroshi Imamura
    Annals of gastroenterological surgery 3 6 648 - 656 2019年11月 
    Aim: The present study aimed to evaluate the efficacy of short-term nutritional intervention with an oral elemental diet (ED; Elental; EA Pharma Co., Ltd, Tokyo, Japan) at 300 kcal/day for 6-8 weeks in the early post-gastrectomy period on postoperative long-term body weight loss (BWL). Methods: We analyzed consecutive patients who were randomly divided to receive the regular diet with or without ED. The control group received regular diet alone post-gastrectomy, whereas the ED group received 300 kcal ED plus regular diet for 6-8 weeks. Primary endpoint was percentage (%) BWL (body weight loss; body weight before surgery minus that at postoperative 1 year) by surgical type. Secondary endpoints included changes in nutrition-related blood parameters. Results: Of the patients in the original trial, 106 were eligible for efficacy analyses. %BWL at postoperative 1 year was significantly lower in the ED group than in the control group among patients who underwent total gastrectomy (TG) (n = 19 and n = 17, respectively; 9.66 ± 5.98% [95% confidence interval, CI: 6.77-12.54] vs 15.11 ± 6.78% [95% CI: 11.63-18.60], P = .015), but not in patients who underwent distal gastrectomy (n = 38 and n = 32, respectively; 5.81 ± 7.91% [95% CI: 3.21-8.41] vs 5.96 ± 6.20% [95% CI: 3.72-8.19], P = .933). In multivariate analysis, ED was the only factor affecting %BWL at postoperative 1 year among patients who underwent TG. Conclusions: Daily nutritional intervention (300 kcal/day ED) for 6-8 weeks reduced %BWL not only at postoperative 6-8 weeks but also at 1 year in patients who underwent TG.
  • Tadayoshi Hashimoto; Yukinori Kurokawa; Jota Mikami; Tsuyoshi Takahashi; Yasuhiro Miyazaki; Koji Tanaka; Tomoki Makino; Makoto Yamasaki; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    World journal of surgery 43 11 2885 - 2893 2019年11月 [査読有り]
     
    BACKGROUND: Elderly patients with gastric cancer are frequently treated surgically in current clinical practice. Although several studies have investigated short-term outcomes after gastrectomy in elderly patients, most did not evaluate long-term outcomes. METHODS: We analyzed 1154 consecutive patients who underwent curative gastrectomy for gastric cancer between 2001 and 2013. We classified them into two groups: the elderly group (n = 241), consisting of patients aged ≥75 years, and the non-elderly group (n = 913), consisting of patients aged <75 years, and compared the short- and long-term outcomes between the two groups. The risk factors for death from other diseases in elderly patients were also examined. RESULTS: Although the incidence of postoperative pneumonia was significantly higher in the elderly group (P < 0.001), the proportion of overall postoperative complications did not differ significantly between the two groups (P = 0.097). The disease-specific survival was similar between the two groups (P = 0.743), whereas the overall survival in the elderly group was significantly shorter than that in the non-elderly group (P < 0.001) because of a higher incidence of death from other diseases throughout all gastric cancer stages. Multivariate analysis revealed that a low preoperative prognostic nutrition index (PNI) and multiple comorbidities were significant risk factors for death from other diseases within 5 years in the elderly group. CONCLUSIONS: Despite acceptable short-term outcomes, long-term outcomes in elderly patients with gastric cancer were poor due to the high incidence of death from other diseases. Indications for surgery in elderly patients with a low PNI or multiple comorbidities should be considered carefully.
  • Kazumasa Fujitani; Shigeyuki Tamura; Yutaka Kimura; Jin Matsuyama; Hiroshi Imamura; Kazuyoshi Yamamoto; Junya Fujita; Shohei Iijima; Shugo Ueda; Yukinori Kurokawa; Toshio Shimokawa; Taroh Satoh
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 23 3 520 - 530 2019年10月 [査読有り]
     
    BACKGROUND: Adjuvant S-1 monotherapy is standard of care for stage II and III gastric cancer (GC), but there is still a need to improve the efficacy of treatment for stage III disease. We conducted phase II study of eight cycles of S-1 plus docetaxel (DS) followed by S-1 monotherapy for up to 1 year after D2 gastrectomy for stage III GC. PATIENTS AND METHODS: Sixty-two patients with stage III GC were enrolled. They received oral S-1 (80 mg/m2/day) for 2 consecutive weeks and intravenous docetaxel (40 mg/m2) on day 1, repeated every 3 weeks for 8 cycles, followed by S-1 until 1 year postgastrectomy. Treatment safety, tolerability, and survival were evaluated. RESULTS: The completion rate for eight cycles of DS therapy was 77.4% [95% confidence interval (CI) 65.0-87.1%]. Subsequent S-1 monotherapy for 1 year was feasible in 71.0% (95% CI 58.1-81.8%) of patients. The incidence of neutropenia, leukopenia, anorexia, and fatigue of grade 3 or higher was 10% or higher. There were no treatment-related deaths. The 5-year overall survival (OS) and disease-free survival (DFS) rates were 72.4% (95% CI 62.1-84.5%) and 60.0% (95% CI 48.8-73.9%), respectively. Subgroup analyses by disease stage showed 5-year OS and DFS rates of 74.5% (95% CI 60.7-91.5%) and 59.3% (95% CI 43.8-80.2%) for stage IIIA and 70.0% (95% CI 55.4-88.5%) and 60.0% (95% CI 44.8-80.4%) for stage IIIB, respectively. CONCLUSIONS: Adjuvant eight cycles of DS therapy might be safe and manageable and has promising OS and DFS for stage III GC.
  • 加藤 寛章; 白石 治; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 安田 卓司
    臨床外科 74 11 94 - 97 (株)医学書院 2019年10月
  • ディベートセッション:最新のエビデンスに基づいた食道外科手術(開胸vs鏡視下) 食道外科手術における胸腔鏡の拡大視と開胸の術野展開イメージの融合
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博
    日本臨床外科学会雑誌 80 増刊 388 - 388 日本臨床外科学会 2019年10月
  • 上部胃癌に対する内視鏡外科手術の郭清と再建手技の定型化 逆流防止を考慮した安全で簡便な食道残胃吻合再建(残胃食道裂孔挿入法)の治療成績
    木村 豊; 安田 篤; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 80 増刊 431 - 431 日本臨床外科学会 2019年10月
  • 75歳以上の根治切除可能な大型3型/4型胃癌に対する術前S-1併用化学放射線療法OGSG1303
    遠藤 俊治; 今野 元博; 古河 洋; 安田 卓司; 横川 正樹; 西村 恭昌; 中川 朋; 足立 真一; 木村 豊; 坂井 大介; 川上 尚人; 下川 敏雄; 黒川 幸典; 佐藤 太郎
    日本癌治療学会学術集会抄録集 57回 P71 - 1 2019年10月
  • 外科感染症制御を念頭に置いた栄養管理 胃癌術後患者に対する成分栄養剤による早期栄養介入の長期的な効果に関する検討
    赤丸 祐介; 木村 豊; 西川 和宏; 岸 健太郎; 井上 健太郎; 松山 仁; 田村 茂行; 川田 純司; 菅野 仁士; 山田 岳史; 下川 敏雄; 今村 博司
    日本臨床外科学会雑誌 80 増刊 403 - 403 日本臨床外科学会 2019年10月
  • 家根 由典; 大東 弘治; 所 忠男; 木村 豊; 上田 和毅; 岩本 哲好; 吉岡 康多; 尾川 諒太郎; 牛嶋 北斗; 幕谷 悠介; 川村 純一郎
    日本外科感染症学会雑誌 16 5 564 - 564 (一社)日本外科感染症学会 2019年10月
  • FDG PET/CTによる食道癌術前化学療法の治療効果判定に関する検討
    甲斐田 勇人; 白石 治; 岩間 密; 加藤 寛章; 木村 豊; 花岡 宏平; 山田 穣; 北島 一宏; 安田 卓司; 石井 一成
    核医学 56 Suppl. S155 - S155 2019年10月 [査読有り]
  • 家根 由典; 大東 弘治; 所 忠男; 木村 豊; 上田 和毅; 岩本 哲好; 吉岡 康多; 尾川 諒太郎; 牛嶋 北斗; 幕谷 悠介; 川村 純一郎
    日本外科感染症学会雑誌 16 5 564 - 564 (一社)日本外科感染症学会 2019年10月 [査読有り]
  • Yasuhiro Miyazaki; Shuji Takiguchi; Yukinori Kurokawa; Tsuyoshi Takahashi; Yasunari Fukuda; Makoto Yamasaki; Tomoki Makino; Koji Tanaka; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Asian journal of endoscopic surgery 12 4 461 - 464 2019年10月 [査読有り]
     
    We present the case of a 46-year-old obese woman with a 3.5-cm adenoma in the descending part of the duodenum who was treated with a totally laparoscopic approach. The preoperative examination revealed a pedunculated superficial tumor on the side of pancreas from the inferior duodenal angulus to 5 cm proximal to the papilla that was associated with massive blood flow. We chose not to perform endoscopic submucosal dissection, pancreaticoduodenectomy, or transduodenal tumor excision with laparotomy for this obese patient because of the poor exposure, risk of bleeding, and substantial invasiveness. We performed endoscopy-assisted laparoscopic submucosal dissection as a novel laparoscopic-endoscopic cooperative surgical approach in this patient. This surgery was surgically and oncologically safe.
  • Terashima M; Iwasaki Y; Mizusawa J; Katayama H; Nakamura K; Katai H; Yoshikawa T; Ito Y; Kaji M; Kimura Y; Hirao M; Yamada M; Kurita A; Takagi M; Boku N; Sano T; Sasako M; Stomach Cancer; Study Group; Japan Clinical; Oncology Group
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 22 5 1044 - 1052 2019年09月 [査読有り]
     
    Background The prognosis of patients with linitis plastica (type 4) and large (>= 8 cm) ulcero-invasive-type (type 3) gastric cancer is extremely poor, even after extended surgery and adjuvant chemotherapy. Given the promising results of our previous phase II study evaluating neoadjuvant chemotherapy (NAC) with S-1 plus cisplatin (JCOG0210), we performed a phase III study to confirm the efficacy of NAC in these patients, with the safety and surgical results are presented here. Methods Eligible patients were randomized to gastrectomy plus adjuvant chemotherapy with S-1 (Arm A) or NAC followed by gastrectomy + adjuvant chemotherapy (Arm B). The primary endpoint was the overall survival (OS). This trial is registered at the UMIN Clinical Trials Registry as C000000279. Results From February 2007 to July 2013, 300 patients were randomized (Arm A 149, Arm B 151). NAC was completed in 133 patients (88%). Major grade 3/4 adverse events during NAC were neutropenia (29.3%), nausea (5.4%), diarrhea (4.8%), and fatigue (2.7%). Gastrectomy was performed in 147 patients (99%) in Arm A and 139 patients (92%) in Arm B. The operation time was significantly shorter in Arm B than in Arm A (median 255 vs. 240 min, respectively; p = 0.024). There were no significant differences in Grade 2-4 morbidity and mortality (25.2% and 1.3% in Arm A and 15.8% and 0.7% in Arm B, respectively). Conclusions NAC for type 4 and large type 3 gastric cancer followed by D2 gastrectomy can be safely performed without increasing the morbidity or mortality.
  • Tadayoshi Hashimoto; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Eiichi Morii; Masaki Mori; Yuichiro Doki
    Oncology letters 18 2 1872 - 1880 2019年08月 [査読有り]
     
    Primary malignant melanoma of the esophagus (PMME) has been reported to be a rare and highly malignant disease, and to date a standard treatment strategy has not been established due to limited evidence. The aim of the present study was to investigate the clinicopathological characteristics of this extremely rare disease. A total of 6 out of 2,093 patients with PMME treated in our institution between 1995 and 2016 were retrospectively analyzed and their clinicopathological parameters including treatment course and long-term survival were investigated. The major clinicopathological characteristics of patients were that they were >70 years of age, male sex, dysphagia at first diagnosis, and macroscopic black protruding tumors located in the lower third of the thoracic esophagus. Four of the five patients receiving pretherapeutic endoscopic biopsy were correctly diagnosed with PMME, and two patients received preoperative treatment with ineffective histopathological responses. There were two unresectable cases, one was treated with an immune-checkpoint inhibitor and the other received palliative care. Three of the four patients receiving curative surgery developed hematogenous recurrence within two years of surgery and only one patient with pT1aN0M0 achieved long-term survival. The median overall survival of all six patients was 19.6 (6.4-40.5) months. Patients with stage I disease exhibited significantly more favorable prognoses than those with stage II-IV (P=0.025) and surgically-treated patients had significantly better prognoses than those who did not receive surgery (P=0.018). In conclusion, PMME was associated with highly malignant features and tended to develop hematogenous metastases even after radical resection. Early diagnosis appears to be important to cure this refractory disease.
  • Tsuyuguchi R; Kurose S; Seto T; Takao N; Fujii A; Tsutsumi H; Otsuki S; Kimura Y
    Journal of physiological anthropology 38 1 11 - 11 2019年08月 [査読有り]
     
    BACKGROUND: Toe grip-related training requires individuals to actively exercise muscles that are not frequently used; therefore, it may improve not only toe grip strength but also cognitive function. The purpose of this study was to examine the effects of toe grip-related training on predictors of physical performance and cognitive function in nursing home residents. METHODS: A total of 35 nursing home residents (35 left and 35 right feet; mean age, 82.1 ± 7.9 years) were included in this study. The participants were divided into two groups: a training group and a control group. The Mini-Mental State Examination (MMSE) was used to assess the cognitive function of the participants, and the Fall Risk Index (FRI) was used to evaluate the risk of falls. Toe grip-related physical function was also assessed. Baseline endpoints were evaluated and the effects of toe grip-related training were examined following a 12-week training intervention. RESULTS: The training group showed significant improvements in MMSE score, FRI score, toe grip strength, and the toe skill (TS) test; however, the control group did not show these changes. The training group showed significant increases in Δ MMSE, Δ toe grip strength, and Δ TS (right foot) than the control group. Stepwise regression analysis revealed that Δ toe grip strength is an independent factor of Δ MMSE. CONCLUSIONS: Toe grip training improves not only toe grip strength itself, but also cognitive function. Furthermore, change in toe grip strength was an independent factor of change in MMSE in those populations. TRIAL REGISTRATION: UMIN, UMIN000027437 . Registered on 26 May 2017.
  • Shinya Urakawa; Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Annals of surgery 273 6 1141 - 1149 2019年07月 [査読有り]
     
    OBJECTIVE: The aim of this study was to evaluate primary tumor (PT) and lymph node (LN) responses to neoadjuvant chemotherapy (NACT) for predicting long-term survival in patients with metastatic esophageal cancer (EC). BACKGROUND: In evaluating NACT responses in patients with EC, imaging modalities typically target the PT in the esophagus, which is unmeasurable. Targeting measurable organs, like positive LNs, might provide more accurate assessments. METHODS: We enrolled 251 patients with EC and clinically positive LNs that underwent curative resections, after triplet NACT. The percent reduction of PT area was measured with bidimensional computed tomography. The LN response was defined as the percent reduction of the sum of the short diameters in all positive LNs. RESULTS: NACT reduced PTs and LNs by (median, range) 58.0% (38.1-94.9) and 34.5% (46.2-68.2), respectively. Based on the receiver-operating characteristic analyses for predicting a histological response and a 10% stepwise cutoff analyses of recurrence-free survival (RFS), responder/nonresponder cutoff values were ≥60% for PT area reductions and ≥30% for LN size reductions. 39.6% of patients showed discordant PT and LN responses. Compared with PT-responders, LN-responders had significantly less advanced pN (P < 0.0001) and pM (P = 0.015) in addition to less advanced pT (P < 0.0001) and better histological responses (P < 0.0001), and closer correlations to lymphatic, distant metastases and dissemination. A multivariate analysis of RFS identified 2 independent prognostic factors: the LN response [hazard ratio (HR) = 2.51, 95% confidence interval (CI) = 1.63-3.95, P < 0.0001] and the pN (HR = 2.72, 95% CI = 1.44-5.64, P = 0.0016), but not the PT response. CONCLUSIONS: The LN response to NACT predicted long-term survival more precisely than the PT response in patients with metastatic EC.
  • 食道癌に対する術前化学療法後のリンパ節における微小転移の臨床的意義
    平木 洋子; 木村 豊; 今野 元博; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 土岐 祐一郎; 安田 卓司
    日本消化器外科学会総会 74回 P2 - 3 (一社)日本消化器外科学会 2019年07月
  • 【食道】頸部〜頸胸境界部食道癌の治療戦略 当院における進行頸胸境界部食道癌の治療戦略とその成績
    白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 安田 卓司
    日本消化器外科学会総会 74回 WS1 - 2 (一社)日本消化器外科学会 2019年07月
  • 胃粘膜下腫瘍に対する腹腔鏡下胃内手術について
    安田 篤; 木村 豊; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 安田 卓司
    日本消化器外科学会総会 74回 P42 - 6 (一社)日本消化器外科学会 2019年07月
  • 【胃】切除不能胃癌に対するConversion Surgeryの現状 胃癌腹膜播種に対する腹腔内+全身化学療法奏功例に対するconversion手術の治療成績
    新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 安田 卓司
    日本消化器外科学会総会 74回 WS3 - 8 (一社)日本消化器外科学会 2019年07月
  • Kurose S; Miyauchi T; Yamashita R; Tamaki S; Imai M; Nakashima Y; Umeda Y; Sato S; Kimura Y; Masuda I
    Journal of cardiology 73 6 530 - 535 2019年06月 [査読有り]
     
    BACKGROUND: Because of the advanced age of patients with cardiovascular disease (CVD), prevention of sleep disorder and dementia is a priority for cardiac rehabilitation (CR) during their long-term care. This study aimed to investigate the association of physical activity with sleep quality and cognitive function in elderly patients with CVD in the CR maintenance phase. METHODS: We conducted a multicenter study through the Clinical Exercise Physiology Association Japan network, which included 102 elderly patients (mean age, 74±7.4 years) with CVD undergoing phase III CR at 6 institutions. Physical activity was assessed using a triaxial accelerometer for 7 consecutive days and was classified as locomotive and household activities. Physical fitness was assessed via 6-min walking distance (6MD), hand grip power, 10-m walking speed, one leg standing time with eyes open, and 10 times sit-to-stand tests. Sleep quality and cognitive function were evaluated using the Pittsburgh sleep quality index (PSQI) and mini-mental state examination (MMSE) scores, respectively. RESULTS: The patients performed 5506.8±3743.6 steps/day and scored 5.8±3.5 points in the PSQI and 28.4±1.7 points in the MMSE. Sleep latency and MMSE scores correlated with locomotive activity, but not with household activity. Locomotive activity and 6MD were independent predictors of sleep latency and MMSE score, respectively. When patients with heart failure were excluded, the relationship between sleep latency and locomotive activity was preserved, but the relationship between exercise tolerance and cognitive function disappeared. CONCLUSION: Locomotive activity and exercise tolerance are associated with sleep latency and cognitive function in elderly patients with CVD continuing phase III CR. However, in this study, the relationship between exercise tolerance and cognitive function was offset by the presence of heart failure.
  • Shiraishi O; Kato H; Iwama M; Hiraki Y; Yasuda A; Peng YF; Shinkai M; Kimura Y; Imano M; Yasuda T
    Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus 33 2 2019年05月 [査読有り]
     
    Unexpected dysphagia is an important problem affecting life prognosis in patients who have undergone an esophagectomy for esophageal cancer. For nutritional support in patients suffering from dysphagia after a previous esophagectomy, a simplified percutaneous endoscopic transgastric conduit feeding jejunostomy approach was developed that can be performed regardless of the patient's condition. The feasibility of this procedure in 25 patients with esophageal cancer who underwent three-stage esophagectomy with retrosternal gastric conduit reconstruction from April 2009 to December 2016 was evaluated retrospectively. Under fluoroscopy, a percutaneous endoscopic transgastric conduit feeding jejunostomy catheter (9 French) was introduced into the jejunum in the epigastric region using the Seldinger's technique. The following patient data were analyzed retrospectively: operating time, complications, reasons for oral intake difficulty, and clinical data describing patients' nutritional status before and 1 month after percutaneous endoscopic transgastric conduit jejunostomy treatment, such as serum albumin and clinical course. Median patients' age was 68 years (range 50-76 years). Indications for the procedure were late swallowing dysfunction (n = 12), early swallowing dysfunction secondary to surgical complication (n = 8), anastomotic leakage (n = 3), and anorexia (n = 2). Causes of late swallowing dysfunction were radiation injury (n = 8), advanced age (n = 2), or cerebral infarction (n = 2). The median operating time was 29 minutes (range 14-82 minutes). Four patients developed mild erosions at the stoma secondary to bile reflux along the side of the catheter. No patient experienced severe complications such as ileus and peritonitis. Patients were treated for a median of 160 days (range 18-3106 days) with percutaneous endoscopic transgastric conduit jejunostomy. Patient's serum albumin significantly increased from 2.8 to 3.3 g/dl in 1 month. Of the eight patients with early swallowing dysfunction, six successfully regained sufficient oral nutrition after receiving enteral feeding nutritional management. Although all except one late swallowing dysfunction patient could not discontinue tube feeding, five patients were long-term survivors at the time this report was written. This jejunostomy procedure is simple, safe, and useful for patients with unexpected dysphagia and accompanying malnutrition after esophagectomy.
  • Tomoki Makino; Makoto Yamasaki; Koji Tanaka; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yukinori Kurokawa; Masaaki Motoori; Yutaka Kimura; Kiyokazu Nakajima; Masaki Mori; Yuichiro Doki
    Annals of gastroenterological surgery 3 2 169 - 180 2019年03月 [査読有り]
     
    Background: Survival of patients with cT4 esophageal cancer is dismal. Although the optimal treatment strategy remains to be established, two treatment options are available for cT4 esophageal cancers: definitive chemoradiation (dCRT) and induction treatment followed by conversion surgery (CS). However, little is known concerning the differences in clinical outcome between patients with T4 esophageal tumors treated with dCRT and those eventually treated with CS. Methods: A systematic search of the scientific literature on PubMed/MEDLINE was carried out using the keywords "T4 esophageal cancer," "invading (involving) adjacent organ," "definitive chemoradiation," "induction therapy," "salvage surgery," and "conversion surgery," obtaining 28 reports published up to July 2018. Results/Conclusion: We found that CS was superior to dCRT with respect to local disease control and short-term survival; however, CS was associated with relatively higher perioperative mortality and morbidity. Alternatively, although dCRT might often cause fistula formation, a clinical complete response to dCRT is likely to lead to a better prognosis. Recent advances in chemotherapeutic agents have led to triple induction chemotherapy, with docetaxel, cisplatin, and 5-fluorouracil (DCF), which has shown promise as an initial induction treatment for cT4 esophageal cancer. Indeed, this regimen could control both local and systemic disease, which enables curative resection without preoperative CRT. Moreover, some appropriate changes in perioperative management and intensive systemic chemotherapy might enhance patient outcome. Randomized controlled trials with a large sample size are needed to establish the standard treatment for cT4 esophageal cancer.
  • Nakano H; Furukawa H; Nakamuro M; Kondo Y; Ishikawa K; Okubo Y; Hoshimoto M; Oota Y; Sato T; Kimura Y; Imano M; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 46 3 505 - 507 2019年03月 [査読有り]
     
    We experienced a case of early gastric cancer. A 69-year-old woman with a thick gastric wall, thickened folds, and undifferentiated cancer cells in biopsy was diagnosed with scirrhous gastric cancer. The patient underwent total gastrectomy for scirrhous gastric cancer and was found to have only an early gastric cancer lesion located on the upper gastric wall. The thick wall diagnosed before surgery was diagnosed as angiodysplasia occupying the submucosal layer.
  • ASCO、ESMO、DDW update 根治切除可能な大型3型・4型胃癌に対する術前TS-1+CDDP併用療法による第3相試験(ASCO, ESMO, DDW update Randomized phase III trial of gastrectomy with or without neoadjuvant S-1 plus cisplatin for type 4 or large type 3 gastric cancer: Japan Clinical Oncology Group study(JCOG0501))
    仁和 浩貴; 岩崎 善敬; 平林 直樹; 加治 正英; 平尾 素宏; 薮崎 裕; 栗田 啓; 伊藤 友一; 後藤 昌弘; 木村 豊; 山田 誠; 佐藤 雄哉; 片井 均; 寺島 雅典; 笹子 三津留
    日本胃癌学会総会記事 91回 247 - 247 2019年02月
  • 胃がんに対する多職種チーム医療の役割 高齢者胃切除における嚥下リハビリ介入の有用性(The role of multidisciplinary team medical treatment for gastric cancer Perioperative intervention of dysphagia rehabilitation for elderly gastric cancer patients)
    安田 篤; 木村 豊; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 安田 卓司
    日本胃癌学会総会記事 91回 233 - 233 2019年02月
  • Shunji Endo; Yukinori Kurokawa; Makio Gamoh; Yutaka Kimura; Jin Matsuyama; Hirokazu Taniguchi; Atsushi Takeno; Ryohei Kawabata; Junji Kawada; Toru Masuzawa; Kazuyoshi Yamamoto; Kouji Kobayashi; Daisuke Sakai; Toshio Shimokawa; Taroh Satoh
    Anticancer research 39 2 1059 - 1065 2019年02月 [査読有り]
     
    BACKGROUND/AIM: Trastuzumab with S-1 plus cisplatin was proved to be effective for human epidermal growth factor receptor type 2 (HER2)-positive advanced gastric cancer with measurable lesions. However, the efficacy and safety of this regimen in the absence of measurable lesions are unknown. PATIENTS AND METHODS: Patients with HER2-positive gastric cancer without measurable lesions received cisplatin plus trastuzumab intravenously on day 1 and oral S-1 on days 1-14 of a 21-day cycle. The primary end-point was overall survival, and 40 patients were planned to be enrolled. RESULTS: Fifteen patients were enrolled. The median overall survival was 14.4 months. The 1- and 3-year overall survival rates were 66.7 % and 26.7 %, respectively. Major grade 3-4 adverse events included neutropenia (47%), anemia (40%), diarrhea (20%), nausea (20%), and anorexia (20%). CONCLUSION: Trastuzumab with S-1 plus cisplatin might be effective and tolerable for HER2-positive advanced gastric cancer without measurable lesions.
  • Kimura Y; Mikami J; Makari Y; Fujii C; Hiraki Y; Imano M; Fujita J; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 46 2 245 - 249 2019年02月 [査読有り]
     
    BACKGROUND: Ramucirumab, an antiangiogenic agent, often causes proteinuria as a characteristic adverse effect. We retro- spectively evaluated proteinuria and clarified the significance of the protein/creatinine ratio by using single urine samples from patients with advanced gastric cancer who were treated with ramucirumab. METHODS: Twenty-three patients who received ramucirumabb etween June 2015 and April 2016 were enrolled. A total of 199 urinalysis specimens were qualitatively analyzed to obtain urine protein levels and the protein/creatinine ratio, and the values were compared. RESULTS: Frequency of proteinu- ria was 43.5%(grade 1: 26.1%, grade 2: 8.7%, and grade 3: 8.7%). The protein/creatinine ratio was less than 2 in -, ±, and 1+ based on the urine protein qualitative examination; 12.5% of 2+ and 71.4% of 3+ or 4+ had a protein/creatinine ratio over 2. CONCLUSIONS: In patients with gastric cancer, treated with ramucirumab, the protein/creatinine ratio should be examined in cases of 2+, 3+ or 4+ via a qualitative examination.
  • Kentaro Inoue; Sawako Yoshiuchi; Mika Yoshida; Natsuko Nakamura; Sachiko Nakajima; Akiko Kitamura; Keiko Mouri; Taku Michiura; Hiromi Mukaide; Takashi Ozaki; Hirokazu Miki; Hiroaki Yanagimoto; Sohei Satoi; Masaki Kaibori; Madoka Hamada; Yutaka Kimura; Masanori Kon
    Asian journal of endoscopic surgery 12 1 43 - 50 2019年01月 [査読有り]
     
    INTRODUCTION: The increased visceral fat in patients with obesity can increase the technical difficulty of surgery. This study was performed to evaluate a preoperative 20-day very low-calorie diet for obesity before laparoscopic gastrectomy for gastric cancer. METHODS: This prospective single-center study involved patients with obesity who were planning to undergo laparoscopic gastrectomy for gastric cancer. Obesity was defined according to the Japanese criteria: BMI ≥25 kg/m2 or waist circumference ≥85 cm in men and ≥90 cm in women. The patients underwent a preoperative 20-day very low-calorie diet and received nutritional counseling. Weight loss, body composition, visceral fat mass, and operative outcomes were evaluated. RESULTS: Thirty-three patients were enrolled from September 2013 to August 2015. Their median age was 71 years, and 78.8% were men. Their median bodyweight and BMI were 72.3 kg (range, 53.8-82.5 kg) and 26.0 kg/m2 (range, 23.5-31.0 kg/m2 ), respectively. The patients achieved a mean weight loss of 4.5% (95% confidence interval [CI]: 3.8-5.1), corresponding to 3.2 kg (95%CI: 2.7-3.7 kg). Body fat mass was significantly decreased by a mean of 2.5 kg (95%CI: 1.9-3.1), whereas skeletal muscle mass was unaffected (mean: -0.20 kg [95%CI: -0.55-0.15]). The visceral fat mass reduction rate was high as 16.8% (range, 11.6%-22.0%). All patients underwent laparoscopic gastrectomy as planned. Severe postoperative morbidity (Clavien-Dindo grade ≥III) was seen in only one patient (3.0%). CONCLUSION: The preoperative 20-day very low-calorie diet weight loss program is promising for the treatment of obesity before laparoscopic gastrectomy for gastric cancer.
  • Yanishi M; Kinoshita H; Tsukaguchi H; Kimura Y; Koito Y; Sugi M; Matsuda T
    International urology and nephrology 51 1 79 - 83 2019年01月 [査読有り]
     
    INTRODUCTION: Measuring muscle mass is an important step in detecting sarcopenia. The evaluation of sarcopenia is also important for kidney transplant recipients. Methods for estimating muscle mass have been established using computed tomography or magnetic resonance imaging, which are considered the gold standards. But these methods are invasive and costly, and there is a need for a more practical and simple method using blood samples from kidney transplant recipients. METHODS: The study population was 62 patients who underwent kidney transplantation at Kansai Medical University Hospital, and were evaluated from August to October 2017. Muscle mass was measured using dual-energy X-ray absorptiometry. Serum creatinine and cystatin C levels were measured by immunoassay. RESULTS: We analyzed 62 transplant recipients who met the inclusion criteria (20 females and 42 males, mean age of 45.6 ± 12.7 years). The creatinine/cystatin C ratio in the male group was > 1, whereas the creatinine/cystatin C ratio in the female group was < 1. Muscle mass was significantly larger in the male group than the female group. There was a significant positive correlation between the skeletal muscle index and creatinine/cystatin C ratio in the male (r = 0.553; p < 0.001) and female groups (r = 0.675; p < 0.001). CONCLUSION: The creatinine/cystatin C ratio is appropriate for evaluating muscle mass in kidney transplant recipients.
  • Shinkai M; Imano M; Chiba Y; Iwama M; Shiraisi O; Yasuda A; Tsubaki M; Nishida S; Kimura Y; Yasuda T
    Journal of surgical oncology 119 1 56 - 63 2019年01月 [査読有り]
     
    BACKGROUND: We carried out a phase II trial to evaluate the feasibility and efficacy of neoadjuvant chemotherapy comprising a single intraperitoneal administration of paclitaxel, followed by intravenous administrations of paclitaxel and cisplatin with S-1 for clinical stage III gastric cancer. METHODS: Patients with potentially resectable gastric cancer were eligible. A laparoscopic survey was performed to confirm CY0 and P0. Intraperitoneal paclitaxel (60 mg/m 2 ) was administered, followed by systemic chemotherapy. Surgery was performed after two cycles of chemotherapy. The primary endpoint was the response rate of chemotherapy. Secondary endpoints were adverse events, pathological response rate, and overall survival rate. RESULTS: Twenty patients were enrolled. Planned cycles were completed in all patients. Grade 3/4 leukopenia and grade 3/4 neutropenia were observed in four (20%) and seven (35%) patients, respectively. The overall response rate was 70% (partial response: 14, stable disease: 5, progressive disease: 1). All patients underwent R0 gastrectomy with D2 lymph-node dissection, with no surgery-related deaths. The pathological response rate was 65% (13 of 20). The 3- and 5-year overall survival rates were 90.0% and 77.1%, respectively. CONCLUSIONS: Neoadjuvant chemotherapy including intraperitoneal paclitaxel followed by sequential intravenous paclitaxel and cisplatin with S-1 for resectable advanced gastric cancer is feasible and effective.
  • Kaibori M; Matsui K; Yoshii K; Ishizaki M; Iwasaka J; Miyauchi T; Kimura Y
    PloS one 14 8 e0221079  2019年 [査読有り]
     
    Dynamic assessment of preoperative exercise capacity may be a useful predictor of postoperative prognosis. We aimed to clarify whether perioperative exercise capacity was related to long-term survival in hepatocellular carcinoma patients with chronic liver injury undergoing hepatectomy. One hundred-six patients with hepatocellular carcinoma underwent pre- and postoperative cardiopulmonary exercise testing to determine their anaerobic threshold, defined as the point between carbon dioxide production and oxygen consumption per unit of time. Testing involved 35 items including blood biochemistry analysis, in-vivo component analysis, dual-energy X-ray absorptiometry, and cardiopulmonary exercise testing preoperatively and 6 months postoperatively. We classified patients with anaerobic threshold ≥ 90% 6 months postoperatively compared with the preoperative level as the maintenance group (n = 78) and patients with anaerobic threshold < 90% as the decrease group (n = 28). Five-year recurrence-free survival rates were 39.9% vs. 9.9% (maintenance vs. decrease group) (hazard ratio: 1.87 [95% confidence interval: 1.12-3.13]; P = 0.018). Five-year overall survival rates were maintenance: 81.9%, and decrease: 61.7% (hazard ratio: 2.95 [95% confidence interval: 1.37-6.33]; P = 0.006). Multivariable Cox proportional hazards models showed that perioperative maintenance of anaerobic threshold was an independent prognostic indicator for both recurrence-free- and overall survival. Although the mean anaerobic threshold from preoperative to postoperative month 6 decreased in the exercise-not-implemented group, the exercise-implemented group experienced increased anaerobic threshold, on average, at postoperative month 6. The significant prognostic factor affecting postoperative survival for chronic liver injury patients with HCC undergoing hepatectomy was maintenance of anaerobic threshold up to 6 months postoperatively.
  • 完全鏡視下による簡便な手術食道残胃吻合法(Overlap変法を加えた偽穹窿部食道裂孔挿入法)
    安田 篤; 木村 豊; 加藤 寛章; 平木 洋子; 岩間 密; 白石 治; 新海 政幸; 安田 卓司
    日本内視鏡外科学会雑誌 23 7 OS201 - 1 (一社)日本内視鏡外科学会 2018年12月
  • 逆流防止を考慮した安全で簡便な食道残胃吻合再建(偽穹窿部食道裂孔挿入法)の治療成績
    木村 豊; 安田 篤; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今本 治彦; 安田 卓司
    日本内視鏡外科学会雑誌 23 7 OS203 - 6 (一社)日本内視鏡外科学会 2018年12月
  • Yanishi M; Kinoshita H; Tsukaguchi H; Kimura Y; Koito Y; Sugi M; Matsuda T
    Transplantation proceedings 50 10 3371 - 3375 2018年12月 [査読有り]
  • Kawakami H; Takeno A; Endo S; Makari Y; Kawada J; Taniguchi H; Tamura S; Sugimoto N; Kimura Y; Tamura T; Fujitani K; Sakai D; Shimokawa T; Kurokawa Y; Satoh T
    The oncologist 23 12 1411-e147 - e147 2018年12月 [査読有り]
     
    LESSONS LEARNED: Evidence has suggested that capecitabine-cisplatin is similar or possibly superior to S-1-cisplatin in terms of safety and efficacy for Japanese patients with advanced gastric cancer (AGC).As far as we are aware, our study is the first randomized trial of two regimens consisting of an oral fluoropyrimidine plus cisplatin in human epidermal growth receptor 2-negative AGC patients with measurable lesions. BACKGROUND: We performed a phase II study to evaluate the safety and efficacy of capecitabine plus cisplatin in comparison with S-1 plus cisplatin for first-line treatment of human epidermal growth receptor 2 (HER2)-negative advanced gastric cancer in Japan. METHODS: Eligible patients were randomly assigned to receive either capecitabine at 1,000 mg/m2 twice daily for 14 days plus cisplatin at 80 mg/m2 on day 1 every 3 weeks (n = 43) or S-1 at 40-60 mg twice daily for 21 days plus cisplatin at 60 mg/m2 on day 8 every 5 weeks (n = 41). The primary endpoint of the study was response rate. RESULTS: Response rate did not differ significantly between the capecitabine-cisplatin and S-1-cisplatin groups (53.5% vs. 51.2%, respectively, p > .999). S-1-cisplatin tended to confer a better progression-free survival (PFS; median of 5.9 vs. 4.1 months, p = .284), overall survival (OS; median of 13.5 vs. 10.0 months, p = .290), and time to treatment failure (TTF; median of 4.5 vs. 3.1 months, p = .052) compared with capecitabine-cisplatin. Common hematologic toxicities of grade 3 or 4 included anemia and neutropenia in both groups. However, anorexia, fatigue, and hyponatremia of grade 3 or 4 occurred more frequently in the capecitabine-cisplatin group. CONCLUSION: Capecitabine-cisplatin failed to demonstrate superior efficacy compared with S-1-cisplatin. The higher incidence of severe adverse events with capecitabine-cisplatin suggests that S-1-cisplatin should remain the standard first-line chemotherapy for HER2-negative advanced gastric cancer in Japan.
  • Kimura Y; Shiraishi O; Kawakami H; Ueda H; Okuno T; Hiraki Y; Kato H; Iwama M; Yasuda A; Shinkai M; Chikugo T; Imano M; Imamoto H; Nakagawa K; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 45 13 1812 - 1814 2018年12月 [査読有り]
     
    A 71-year-old man with a history of hypertension, diabetes mellitus, and cerebral infarction was admitted to our hospital with dysphagia. Gastroduodenoscopy, thoracoabdominal CT, and PET-CT findings showed type 2 advanced esophageal cancer( squamous cell carcinoma)with upper mediastinal and cervical lymph node(LN)metastasis: cT3N2M1(LYM #104L), cStage Ⅳ. Two courses of neoadjuvant UDONchemotherapy containing 5-FU(640mg/m / 2, days 1-5), docetaxel(28mg/m2, days 1 and 15), and nedaplatin(72mg/m2, day 1)were administered every 4 weeks. UDONtherapy caused grade(Gr)3 febrile neutropenia, Gr 2 diarrhea, and Gr 1 thrombopenia; the tumor and LNs partially responded to the therapy. After 2 courses of UDONtherapy, esophagectomy with right thoracotomy, 3-field LNdissection, and reconstruction of the gastric tube were performed. The postoperative course was almost uneventful besides recurrent nerve palsy, aspiration, pneumonia, and delirium, and the patient was discharged 60 days after surgery. The pathological diagnosis was ypT0N0M0, ypStage 0, and the histological response of the primary tumor and LNs were evaluated as Gr 3. Neoadjuvant UDON therapy is feasible for elderly patients with advanced esophageal cancer and renal failure or comorbidities, for whom CDDP could not be administered. We are planning a clinical trial to assess the effectiveness of neoadjuvant UDONtherapy.
  • Hiraki Y; Kimura Y; Imano M; Yasuda A; Kato H; Iwama M; Shiraishi O; Shinkai M; Imamoto H; Furukawa H; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 45 13 2381 - 2383 2018年12月 [査読有り]
     
    The usefulness of intraperitoneal(IP)chemotherapy for gastric cancer with intraperitoneal metastasis has been examined in some clinical trials. We report a case of intestinal perforation caused by a catheter for IP ports. A 75-year-old man had undergone IP therapy for type 4 gastric cancer. After IP therapy, he underwent total gastrectomy. He had no recurrence for 3 years. He complained of high fever and abdominal pain more than 1 week ago. Based on contrast-enhanced CT, we diagnosed him with peritonitis by intestinal perforation due to the catheter, and on the same day, we removed the catheter and performed intraperitoneal drainage by emergent laparotomy. The tube penetrated the ileum 20 cm from the ileocecal portion. We resected the ileocecal area and damaged intestinal tract and removed the subcutaneous IP port. He was discharged on the 25th postoperative day. IP ports should be removed after the completion of IP chemotherapy because the incidence of perforation by IP ports was reported as 0 to 3.5%in a previous report.
  • 進行食道癌における気管前106pre LN郭清手技のコツと安全性
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博
    日本消化器外科学会雑誌 51 Suppl.2 142 - 142 (一社)日本消化器外科学会 2018年11月
  • 高用量CDDPの使用が困難な進行食道癌患者に対する術前化学療法の検討
    木村 豊; 白石 治; 川上 尚人; 植田 勲人; 奥野 達哉; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 中川 和彦; 安田 卓司
    日本消化器外科学会雑誌 51 Suppl.2 268 - 268 (一社)日本消化器外科学会 2018年11月
  • FDG PET/CTによる食道癌術前化学療法の予後解析
    甲斐田 勇人; 白石 治; 岩間 密; 加藤 寛章; 木村 豊; 花岡 宏平; 山田 穣; 北島 一宏; 細野 眞; 安田 卓司; 石井 一成
    核医学 55 Suppl. S200 - S200 2018年11月 [査読有り]
  • Shinkai M; Imano M; Chiba Y; Hiraki Y; Kato H; Iwama M; Shiraisi O; Yasuda A; Tsubaki M; Nishida S; Kimura Y; Yasuda T
    Anticancer research 38 10 5969 - 5974 2018年10月 [査読有り]
     
    BACKGROUND/AIM: A preliminary study evaluating the feasibility of single intraperitoneal (IP) administration of paclitaxel followed by paclitaxel and cisplatin with S-1 (PCS) systemic chemotherapy for cytology-positive (CY1) gastric cancer. PATIENTS AND METHODS: Staging laparoscopy was performed to confirm CY1 and P0 status. Initially, patients received IP paclitaxel. Beginning 7 days later PCS was given every 3 weeks followed by second-look laparoscopy. RESULTS: Nine patients were enrolled. The toxic effects of IP and systemic chemotherapy were acceptable. After chemotherapy, 8 patients converted from CY1P0 to CY0P0 and 1 patient from CY1P0 to CY1P1. Gastrectomy was performed on 8 patients except for the CY1P1 patient. Four patients were alive without recurrence. The 2-year overall and progression-free survival rates were 76% and 65%, respectively. CONCLUSION: Combination chemotherapy with IP paclitaxel and sequential PCS is safe and may be effective for CY1 gastric cancer.
  • Shinkai M; Imano M; Chiba Y; Hiraki Y; Kato H; Iwama M; Shiraishi O; Yasuda A; Tsubaki M; Nishida S; Kimura Y; Yasuda T
    Anticancer research 38 10 5975 - 5981 2018年10月 [査読有り]
     
    AIM: To conduct a phase II study of single intraperitoneal (i.p.) administration of paclitaxel followed by paclitaxel, cisplatin, and S-1 (PCS) chemotherapy for patients with gastric cancer with peritoneal metastasis (PM). PATIENTS AND METHODS: Staging laparotomy was performed to confirm PM. Initially, patients received i.p. paclitaxel. Beginning 7 days later, PCS was given every 3 weeks followed by second-look laparoscopy. Primary and secondary endpoints were the overall survival (OS) rate, and response rate and patient safety, respectively. RESULTS: Seventeen patients were enrolled. The overall response rate was 70.5% (12/17). Grade 3/4 toxic effects included neutropenia and leukopenia. After chemotherapy, PM disappearance was confirmed in 11 patients. Gastrectomy was eventually performed in 11 patients. The 1-year OS rate was 82.4% and the median survival time was 23.9 months considering the overall cohort. CONCLUSION: Combination chemotherapy with i.p. paclitaxel and PCS is well tolerated and effective in patients with gastric cancer with PM.
  • Kazuhiro Nishikawa; Akira Tsuburaya; Takaki Yoshikawa; Masazumi Takahashi; Kazuaki Tanabe; Kensei Yamaguchi; Shigefumi Yoshino; Tsutomu Namikawa; Toru Aoyama; Yasushi Rino; Junji Kawada; Akihito Tsuji; Koichi Taira; Yutaka Kimura; Yasuhiro Kodera; Yoshinori Hirashima; Hiroshi Yabusaki; Naoki Hirabayashi; Kazumasa Fujitani; Yumi Miyashita; Satoshi Morita; Junichi Sakamoto
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 21 5 811 - 818 2018年09月 [査読有り]
     
    BACKGROUNDS: In Japan, standard regimens for advanced gastric cancer (AGC) include S-1 chemotherapy. The standard treatment for early relapse after adjuvant chemotherapy with fluoropyrimidine alone is platinum-based chemotherapy, while the standard treatment for early relapse after adjuvant chemotherapy with fluoropyrimidine plus platinum is second-line chemotherapy. To evaluate the efficacy and safety of capecitabine plus cisplatin (XP) treatment for AGC patients who relapse within 6 months after S-1-based therapy, we conducted a multicenter phase II trial (NCT01412294). METHODS: HER2-negative gastric cancer patients treated with adjuvant chemotherapy including S-1 for more than 12 weeks and relapsed within 6 months were treated with capecitabine 1000 mg/m2 bid for 14 days plus cisplatin 80 mg/m2 on day 1 of a 3-week cycle. The primary endpoint was PFS; secondary endpoints were OS, time to treatment failure, overall response rate (ORR) and safety. RESULTS: Forty patients (median age 64) were enrolled; of those, 37 (92.5%) received adjuvant S-1 monotherapy. Median PFS was 4.4 months (95% CI 3.6-5.1), which was longer than the 2-month protocol-specified threshold (p < 0.001). Median OS was 13.7 months (95% CI 9.0-17.7) and ORR was 8/30 (26.7%) (95% CI 14.2-44.4). Most common grade ≥ 3 adverse events were neutropenia (23%), anemia (18%), elevated serum creatinine (18%), fatigue (13%), diarrhea (7.5%), and anorexia (7.5%). CONCLUSIONS: XP was safe and effective in patients with early relapse after S-1 adjuvant chemotherapy for curatively resected gastric cancers. XP may be a good option for the treatment of patients after early failure after adjuvant S-1. TRIAL REGISTRATION: NCT01412294.
  • 開腹手技の継承により鏡視下手術への導入を容易にする改良型食道残胃吻合法
    安田 篤; 木村 豊; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 73回 469 - 469 (一社)日本消化器外科学会 2018年07月
  • 胸部食道癌に対する縦隔側からの101-106recリンパ節徹底郭清
    白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 73回 657 - 657 (一社)日本消化器外科学会 2018年07月
  • 胃癌腹膜播種症例に対するconversion surgeryの意義
    今野 元博; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今本 治彦; 古河 洋; 安田 卓司
    日本消化器外科学会総会 73回 796 - 796 (一社)日本消化器外科学会 2018年07月
  • 胃癌腹膜播種に対するPTX腹腔内投与+PCS全身化学療法による集学的治療の可能性
    新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 73回 1005 - 1005 (一社)日本消化器外科学会 2018年07月
  • 胃癌腹膜転移に対する腹腔内化学療法における腹腔内アクセスポート関連合併症の報告
    平木 洋子; 今野 元博; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 73回 1041 - 1041 (一社)日本消化器外科学会 2018年07月
  • Yukinori Kurokawa; Yuichiro Doki; Junki Mizusawa; Masanori Terashima; Hitoshi Katai; Takaki Yoshikawa; Yutaka Kimura; Shuji Takiguchi; Yasunori Nishida; Norimasa Fukushima; Yoshiaki Iwasaki; Masahide Kaji; Motohiro Hirao; Hiroshi Katayama; Mitsuru Sasako
    The lancet. Gastroenterology & hepatology 3 7 460 - 468 2018年07月 [査読有り]
     
    BACKGROUND: The role of bursectomy, in which the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon are dissected, has long been controversial for preventing peritoneal metastasis. We investigated the survival benefit of bursectomy in patients with resectable gastric cancer. METHODS: This phase 3, open-label, randomised controlled trial was done at 57 hospitals in Japan. Patients aged 20-80 years who had cT3(SS)-cT4a(SE) histologically proven gastric adenocarcinoma with an Eastern Cooperative Oncology Group performance status of 0 or 1 and body-mass index less than 30 kg/m2 and who did not have distant metastasis or bulky lymph nodes were randomly assigned (1:1) during surgery to receive omentectomy alone (non-bursectomy) or bursectomy. Randomisation was done by telephone or website to the Japan Clinical Oncology Group Data Center and used a minimisation method with a random component to adjust for institution, cT status (T3 vs T4a), and type of gastrectomy (distal vs total). Both groups had total or distal gastrectomy with D2 lymphadenectomy. The primary endpoint was overall survival, analysed in the intention-to-treat population. The study is registered with UMIN-CTR, number UMIN000003688. FINDINGS: Between June 1, 2010, and March 30, 2015, 1503 patients were enrolled based on preoperative inclusion and exclusion criteria. Intraoperative inclusion and exclusion criteria were met in 1204 patients, of which 602 were allocated to the non-bursectomy group and 602 were allocated to the bursectomy group. At the planned second interim analysis on Sept 17, 2016, the JCOG Data and Safety Monitoring Committee independently reviewed the results and recommended their early publication on the basis of futility because overall survival was lower in the bursectomy group than the non-bursectomy group, and because the predictive probability of overall survival being significantly higher in bursectomy than non-bursectomy patients at the final analysis was only 12·7%. 5-year overall survival was 76·7% (95% CI 72·0-80·6) in the non-bursectomy group and 76·9% (72·6-80·7) in the bursectomy group (hazard ratio 1·05, 95% CI 0·81-1·37, one-sided p=0·65). 64 (11%) of 601 in the non-bursectomy group and 77 (13%) of 600 patients in the bursectomy group had grade 3-4 operative morbidity. Pancreatic fistula was significantly more common in the bursectomy group than in the non-bursectomy group (29 [5%] vs 15 [2%]; p=0·032). Six deaths occurred either in hospital or within 1 month of surgery: five in the non-bursectomy group and one in the bursectomy group. INTERPRETATION: Bursectomy did not provide a survival advantage over non-bursectomy. D2 dissection with omentectomy alone should be done as a standard surgery for resectable cT3-T4a gastric cancer. FUNDING: Japan Agency for Medical Research and Development, the Ministry of Health, Labour and Welfare of Japan, and the National Cancer Centre Research and Development Fund.
  • Yutaka Kimura; Chizu Fujimura; Yumiko Ito; Toshiya Takahashi; Hitoshi Terui; Setsuya Aiba
    Archives of Toxicology 92 6 2043 - 2054 2018年06月 [査読有り]
     
    We established a luciferase reporter assay system, the Multi-ImmunoTox Assay (MITA), which can evaluate the effects of chemicals on the promoter activities of four cytokines: IL-2, IFN-γ, IL-1β, and IL-8. We previously reported that MITA correctly reflected the change in mRNA of human whole-blood cells treated with dexamethasone, cyclosporine, FK506, or several other immunosuppressive drugs. In this study, we combined MITA with the IL-8 Luc assay to detect skin sensitization chemicals (OECD 442E) (modified MITA: mMITA) and established a data set of 60 chemicals examined by mMITA. Using the mMITA results, chemicals can be classified based on the lowest observed effect level (LOEL) of chemicals in suppressing or augmenting the promoter activities of the four cytokines. Moreover, we demonstrated that K-means clustering and hierarchical clustering of the 60 chemicals based on the LOEL for their effects on IL-2 and IL-8 promoter activities and the judgment by the IL-8 Luc assay resulted in the same 6-cluster solution: cluster 1 with preferential suppression of IL-8, cluster 2 with suppression of IL-2 and a positive IL-8 Luc assay result, cluster 3 with suppression of both IL-2 and IL-8, cluster 4 with no effects on IL-2 or IL-8 and a negative IL-8 Luc assay result, cluster 5 with suppression of both IL-2 and IL-8 and a negative IL-8 Luc assay result, and cluster 6 with preferential suppression of IL-8. These data suggest that mMITA is a promising novel high-throughput approach for detecting unrecognized immunological effects of chemicals and for profiling their immunotoxic effects.
  • Atsuo Takashima; Kohei Shitara; Kazumasa Fujitani; Keisuke Koeda; Hiroki Hara; Norisuke Nakayama; Shuichi Hironaka; Kazuhiro Nishikawa; Yutaka Kimura; Kenji Amagai; Hirofumi Fujii; Kei Muro; Taito Esaki; Yasuhiro Choda; Toshimi Takano; Keisho Chin; Atsushi Sato; Masahiro Goto; Norimasa Fukushima; Takuo Hara; Nozomu Machida; Manabu Ohta; Narikazu Boku; Masashi Shimura; Satoshi Morita; Wasaburo Koizumi
    Gastric Cancer 22 1 1 - 9 2018年05月 [査読有り]
     
    Background: In the ABSOLUTE trial, weekly nanoparticle albumin-bound paclitaxel (w-nab-PTX) showed non-inferiority to weekly solvent-based paclitaxel (w-sb-PTX) for overall survival (OS). Thus, w-nab-PTX might be an option for second-line chemotherapy in advanced gastric cancer (AGC). However, predictive factors for efficacies of these agents have not been evaluated. Methods: Patients previously enrolled in the ABSOLUTE trial were divided into apparent peritoneal metastasis group (PM group) and no apparent peritoneal metastasis group (no PM group) based on baseline imaging evaluated by RECIST ver. 1.1 criteria and amount of ascites. OS, progression-free survival, and overall response rate were compared between two arms in each group. Results: This study included 240 and 243 patients in the w-nab-PTX and w-sb-PTX arms, respectively. In the PM group, the w-nab-PTX arm (n = 88) had longer OS than the w-sb-PTX arm (n = 103), and median survival time (MST) of 9.9 and 8.7 months [hazard ratio (HR) 0.63 95% CI 0.45–0.88 P = 0.0060], respectively. In the no PM group, the w-nab-PTX arm (n = 140) had shorter OS than the w-sb-PTX arm (n = 152), and MST of 11.6 and 15.7 months (HR 1.40 95% CI 1.06–1.86 P = 0.0180), respectively. After adjusting for prognostic factors, the HR for OS in the w-nab-PTX arm versus the w-sb-PTX arm was 0.59 (95% CI 0.42–0.83 P = 0.0023 PM group) and 1.34 (95% CI 1.01–1.78 P = 0.0414 no PM group), with significant interaction between treatment efficacy and presence of peritoneal metastasis (P = 0.0003). Conclusions: The presence of apparent peritoneal metastasis might be a predictive factor for selecting w-nab-PTX for pretreated AGC patients. Trial registration number: JapicCTI-132059.
  • Yutaka Kimura; Masashi Fujii; Toshiki Masuishi; Kazuhiro Nishikawa; Chikara Kunisaki; Satoshi Matsusaka; Yoshihiko Segawa; Masato Nakamura; Kinro Sasaki; Narutoshi Nagao; Yukimasa Hatachi; Yasuhiro Yuasa; Shinya Asami; Masahiro Takeuchi; Hiroshi Furukawa; Toshifusa Nakajima; Tomono Kawase; Ryohei Kawabata; Tetsuya Etou; Hirochika Makino; Hidetaka Ono; Yusuke Izumisawa; Junji Kawada; Ken Shimada; Yu Sunakawa; Hitoshi Satomura; Katsuyuki Kunieda; Akihito Tsuji; Hironaga Satake; Hisashi Ishikura; Hiroshi Okitsu; Takahiro Ito; Kentaro Moriichi; Masazumi Takahashi; Yasutaka Takinishi; Takashi Sekikawa; Naoki Okumura; Shigemitsu Ueyama; Noriyuki Yamamura; Dai Manaka; Sachiko Oouchi; Ryuichiro Ohashi; Tomohiko Mannami; Kazuaki Tanabe; Takeshi Shiraishi; on behalf of the JACCRO GC-06 Study Group
    Gastric Cancer 21 3 421 - 427 2018年05月 [査読有り]
     
    Background: S-1 plus cisplatin is a standard regimen for advanced gastric cancer (AGC) in Asia. The ToGA trial established a fluoropyrimidine plus cisplatin and trastuzumab as a standard treatment for human epidermal growth factor receptor 2 (HER2)-positive AGC. In the HERBIS-1 trial, trastuzumab combined with S-1 plus cisplatin showed promising antitumor activity in patients with HER2-positive AGC. However, cisplatin has several important drawbacks, including vomiting and renal toxicity. These disadvantages of cisplatin are prominent in elderly patients. Therefore, we conducted a prospective phase II study of trastuzumab plus S-1 without cisplatin in elderly patients with HER2-positive AGC. Methods: Patients 65 years or older who had HER2-positive AGC received S-1 orally on days 1–28 of a 42-day cycle and trastuzumab intravenously on day 1 of a 21-day cycle. Results: A total of 51 patients were enrolled. Two patients were ineligible. The full analysis set thus comprised 49 patients. The median age was 71 years (range 65–85). The confirmed response rate was 40.8% (95% CI 27.1–54.6%), and the null hypothesis was rejected. The median follow-up period was 10.6 months. Median overall survival was 15.8 months. Median progression-free survival was 5.1 months, and time to treatment failure was 4.0 months. Major grade 3 or 4 adverse events included neutropenia (12.0%), anemia (24.0%), diarrhea (10.0%), and anorexia (12.0%). There was one treatment-related death. Conclusions: Trastuzumab in combination with S-1 alone demonstrated promising antitumor activity and manageable toxic effects as well as promising survival results in elderly patients with HER2-positive AGC. Clinical trials registration: UMIN000007368.
  • 切除可能食道癌に対する術前化学療法としてのDCFとACF療法の多施設共同ランダム化比較試験 Annals of Oncology
    山崎 誠; 安田 卓司; 矢野 雅彦; 平尾 素宏; 小林 研二; 藤谷 和正; 田村 茂行; 木村 豊; 宮田 博志; 本告 正明; 白石 治; 牧野 知紀; 佐藤 太郎; 森 正樹; 土岐 祐一郎
    日本外科学会定期学術集会抄録集 118回 785 - 785 2018年04月
  • Akiko Watabe; Kenshi Yamasaki; Masayuki Asano; Yumi Kanbayashi; Mei Nasu-Tamabuchi; Hitoshi Terui; Sadanori Furudate; Aya Kakizaki; Kenichiro Tsuchiyama; Yutaka Kimura; Yumiko Ito; Katsuko Kikuchi; Setsuya Aiba
    Journal of Dermatology 45 4 456 - 462 2018年04月 [査読有り]
     
    Rhododendrol (RD), 4-(4-hydroxyphenyl)-2-butanol, inhibits melanin synthesis and has been used for skin-whitening cosmetic products. RD has been very effective in lightening skin pigmentation, but some persons have developed so-called RD vitiligo, in which vitiligo starts on the face, neck and hands where topical RD has been applied and even extended over skin areas where RD has not been applied. RD vitiligo lesions in some patients have lasted for years and have been resistant to conventional vitiligo treatments. We examined the effects of cholecalciferol on RD vitiligo in a blinded randomized clinical trial. Forty-eight female RD vitiligo patients were recruited for the trial and were randomized into two groups: the vitamin D (VD)-intervention group that received daily 5000 IU cholecalciferol for 5 months and the control group. Three blinded investigators scored vitiligo improvement by comparing photographic images of baseline and at 5-month observation. Serum 25(OH)D3 of RD vitiligo patients was not significantly different from age-matched healthy volunteers. Twenty-two in the VD-intervention group and 23 in the control group completed the 5-month observation. Serum 25(OH)D3 levels were significantly increased after the 5-month VD intervention, while the control group did not change. The improvement scores were significantly higher in the VD-intervention group than the control group. The improvement scores were positively correlated with the serum 25(OH)D3 levels after the 5-month intervention period but not before the treatment. This blinded randomized clinical trial showed favor in administrating 5000 IU cholecalciferol daily to RD vitiligo patients.
  • 腹腔鏡下胃全摘と比較した腹腔鏡下噴門側胃切除(食道残胃吻合)のメリット(残胃を残す意義)(Advantage of proximal gastrectomy compared with total gastrectomy in laparoscopic surgery)
    安田 篤; 木村 豊; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦; 古河 洋; 安田 卓司
    日本胃癌学会総会記事 90回 283 - 283 2018年03月
  • スキルス胃がんが疑われた早期胃癌の切除例
    中野博史; 古河洋; 中室誠; 近藤禎晃; 大久保遊平; 星本真弘; 太田善夫; 佐藤隆夫; 木村豊; 今野元博; 安田卓司
    癌と化学療法 45 12 2018年 [査読有り]
  • Sachiko Makabe; Yanika Kowitlawakul; Mohd Said Nurumal; Junko Takagai; Orn-Anong Wichaikhum; Neyzang Wangmo; Suk Foon Yap; Wipada Kunaviktikul; Junko Komatsu; Hideko Shirakawa; Yutaka Kimura; Yoshihiro Asanuma
    Industrial Health 56 3 212 - 219 2018年 [査読有り]
     
    The study aimed to compare nurses’ quality of life and investigate key determinants among Asian countries with different economic status. A cross-sectional survey was conducted across five Asian countries (Japan, Singapore, Malaysia, Thailand, and Bhutan). Quality of life (WHOQOL-BREF), job stress (National Institute of Occupational Safety and Health questionnaire), and demographic data were assessed. Stepwise multivariate linear regression analysis was performed to identify the key determinants of quality of life. Participants were 3,829 nurses (response rate: 82%) with a mean age of 33 ± 10 yr and majority were women (92%). Regarding quality of life, Bhutan yielded the highest scores, followed by Malaysia, Thailand, Singapore, and Japan, and these results were statistically significant. The key determinants that were significantly related to quality of life were “stress coping ability,” “life satisfaction,” “Japan,” “social support,” “job stress,” and “Singapore” (adjusted R2=0.46). In conclusion, nurses’ quality of life differs across Asian countries and is not linked to the country’s economic development. To maintain a good quality of life for nurses, an international exchange program like international nursing conferences for work environment and staff coping strategies is recommended to broaden institution’ minds and share experiences and exchange views to be able to realize their own problems and discover global solutions to them.
  • Takushi Yasuda; Osamu Shiraishi; Mitsuru Iwama; Tomoki Makino; Hiroaki Kato; Yutaka Kimura
    Journal of Thoracic and Cardiovascular Surgery 156 2 859 - 866 2018年 [査読有り]
     
    Background: The incidence of metachronous esophageal squamous cell cancer (ESCC) after head and neck cancer (HNC) and in elderly patients has increased. Both elderly ESCC patients and ESCC patients after HNC surgery are at potential risk for dysphagia, and for the latter, surgery in the neck is difficult. An intrathoracic anastomosis that bypasses the cervical procedure is preferable to preserve swallowing function and reduce surgical risk. In gastrectomized patients, because the stomach cannot be used as a substitute, securing graft blood supply is critical, but microvascular anastomosis cannot be easily added in procedures for intrathoracic posterior mediastinal reconstruction. Thus, we have developed a novel technique for esophageal reconstruction in gastrectomized patients who are elderly or who had undergone HNC surgery, enabling concomitant intrathoracic anastomosis and microvascular anastomosis. The purpose of this study was to evaluate the usefulness and safety of this technique. Methods: The jejunal or ileocolic graft is first pulled up through the anterior mediastinum and is then passed into the right thoracic cavity via a small hole made in the anterior mediastinal pleura. The graft is finally anastomosed with the remnant esophagus in the upper posterior mediastinum. Thereafter, microvascular anastomosis is performed in the retrosternal space. Results: Four patients underwent this new reconstruction procedure with no significant postoperative complications, good swallowing function postoperatively, and no retention of food in the graft. Conclusions: This novel transmediastinal reconstruction technique is a possible option for highly selected patients to enable intrathoracic anastomosis and the addition of microvascular anastomosis.
  • Kimura Y; Watanabe M; Suzuki N; Iwaki T; Yamakage K; Saito K; Nakajima Y; Fujimura C; Ohmiya Y; Omori T; Kojima H; Aiba S
    The Journal of toxicological sciences 43 12 741 - 749 2018年 [査読有り]
     
    In all current in vitro skin sensitisation assays, DMSO is used to dissolve water-insoluble chemicals. However, our previous study suggested the superiority of the modified IL-8 Luc assay (mIL-8 Luc), in which X-VIVOTM 15 is used to dissolve chemicals, over the original assay using DMSO (oIL-8 Luc). In this study, to confirm the superiority of the mIL-8 Luc, we first increased the number of chemicals examined and demonstrated the superiority of the mIL-8 Luc, in which the mIL-8 Luc provided 87.6% of sensitivity, 74.2% of specificity, and 84.6% of accuracy. Next, to clarify the cause of false negative judgment by the mIL-8 Luc, we examined the effects of physical properties of chemicals on judgment. The results demonstrated that high molecular weight, high LogKo/w, or poor water solubility, did not cause false negative judgment. When it was accepted as an OECD test guideline, the criteria of the mIL-8 Luc to determine sensitisers were modified to further decrease false negative judgment by poor solubility. By applying the new criteria, the test guideline IL-8 Luc assay (tgIL-8 Luc) improved sensitivity but decreased specificity and increased the number of chemicals that cannot be judged. To overcome this problem, we examined a simple combination of the tgIL-8 Luc with direct peptide reactive assay (DPRA), which could improve specificity and decrease the number of the chemicals that cannot be judged. These data suggest that the tgIL-8 Luc is a promising in vitro skin sensitisation assay in combination with other in vitro or in chemico methods.
  • Takeo Fukagawa; Hitoshi Katai; Junki Mizusawa; Kenichi Nakamura; Takeshi Sano; Masanori Terashima; Seiji Ito; Takaki Yoshikawa; Norimasa Fukushima; Yasuyuki Kawachi; Takahiro Kinoshita; Yutaka Kimura; Hiroshi Yabusaki; Yasunori Nishida; Yoshiaki Iwasaki; Sang-Woong Lee; Takashi Yasuda; Mitsuru Sasako; on behalf of the Stomach Cancer Study Group of the Japan Clinical Oncology Group
    Gastric Cancer 21 1 68 - 73 2018年01月 [査読有り]
     
    Background: Neoadjuvant chemotherapy (NAC) followed by radical surgery is a promising strategy to improve survival of patients with stage III gastric cancer, but is associated with the risk of preoperative overdiagnosis by which patients with early disease may receive unnecessary intensive chemotherapy. Methods: We assessed the validity of a preoperative diagnostic criterion in a prospective multicenter study. Patients with gastric cancer with a clinical diagnosis of T2/T3/T4, M0, except for diffuse large tumors and extensive bulky nodal disease, were eligible. Prospectively recorded clinical diagnoses (cT category, cN category) were compared with postoperative pathological diagnoses (pT category, pN category, and pathological stage). The primary endpoint was the proportion of pathological stage I tumors among those diagnosed as cT3/T4, which we expected to be 5% or less. Results: Data from 1260 patients enrolled from 53 institutions were analyzed. The proportion of pathological stage I tumors in those with a diagnosis of cT3/T4 (primary endpoint) was 12.3%, which was much higher than the prespecified value. The positive predictive value and the sensitivity for pathological stage III tumors were 43.6% and 87.8% respectively. The sensitivity and specificity of contrast-enhanced CT for lymph node metastasis were 62.5% and 65.7% respectively. After exploring several diagnostic criteria, we propose, for future NAC trials in Japan, a diagnosis of “cT3/T4 with cN1/N2/N3,” by which inclusion of pathological stage I tumors was reduced to 6.5%, although its sensitivity for pathological stage III tumors decreased to 64.5%. Conclusion: Clinical diagnosis of T3/T4 tumors was not an optimal criterion to select patients for intensive NAC trials because more than 10% of patients with pathological stage I disease were included. We propose the criterion “cT3/T4 and cN1/N2/N3” instead.
  • 臓器把持用クリップを活用した肥満患者に対する腹腔鏡下胃切除術の工夫
    木村 豊; 安田 篤; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今本 治彦; 安田 卓司
    日本内視鏡外科学会雑誌 22 7 EP191 - 07 (一社)日本内視鏡外科学会 2017年12月
  • Yasuda A; Yasuda T; Kato H; Iwama M; Shiraishi O; Hiraki Y; Tanaka Y; Shinkai M; Imano M; Kimura Y; Imamoto H
    Surgical case reports 3 1 79 - 79 2017年12月 [査読有り]
     
    BACKGROUND: An incisional hernia in a case of antethoracic pedicled jejunal flap esophageal reconstruction after esophagectomy is a very rare occurrence, and this hernia was distinctive in that the reconstructed jejunum had passed through the hernial orifice; a standard surgical treatment for such a presentation has not been established. Herein, we describe a case of repair using mesh prosthesis for an atypical and distinctive incisional hernia after antethoracic pedicled jejunal flap esophageal reconstruction. CASE PRESENTATION: A 77-year-old woman with a history of subtotal esophagectomy who had undergone antethoracic pedicled jejunal flap reconstruction complained of epigastric prominence and discomfort without pain. On examination, she had an abdominal protrusion between the xiphoid process and the umbilicus that contained the small bowel. Computed tomography showed that the fenestration of the abdominal wall that was intentionally created for jejunum pull-up was dehisced in a region measuring 9 × 15 cm and the small intestine protruded through it into the subcutaneous space without strangulation. Because the hernial orifice was too large and the reconstructed jejunum was passing through the hernial orifice in this case, we applied a parastomal hernia repair method that was modified from the inguinal hernia repair using the Lichtenstein technique. After 3 years and 5 months following surgery, the patient has recovered without hernia recurrence or other complications. CONCLUSION: We consider this to be the first case of repair using Composix mesh prosthesis for repair of an atypical and distinctive incisional hernia after an antethoracic pedicled jejunal flap reconstruction. This method seems to be useful and could potentially be widely adopted as the surgical treatment for this condition.
  • 古河 洋; 中室 誠; 中野 博史; 近藤 禎晃; 石川 和男; 大久保 遊平; 今野 元博; 安田 卓司; 木村 豊; 今本 治彦; 新海 政幸; 安田 篤; 白石 治; 岩間 密; 加藤 寛章
    癌と化学療法 44 12 1077 - 1079 (株)癌と化学療法社 2017年11月 
    4型胃がん(スキルス胃がん)のなかに、「診断困難な症例」が少なからず存在する。内視鏡検査で粘膜面から異常が指摘できないもの、内視鏡では"太い襞"がありスキルス胃がんであるが、生検でがん組織が得られない場合である。患者は85歳、男性。太い雛壁がありスキルス胃がんと診断されたが、生検でがん組織が得られず当院に紹介された。狭窄があるため、開腹による精査と治療を説明し実施した。開腹により適切な診断ができ、本人の希望どおりに手術(胃全摘)を行った。術後化学療法なしに1年生存中である。スキルス胃がんは内視鏡生検の結果だけに頼らず試験開腹まで行って早期に診断を付け、治療を開始すべきである。(著者抄録)
  • 木村 豊; 間狩 洋一; 三上 城太; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 藤田 淳也; 古河 洋; 安田 卓司
    癌と化学療法 44 12 1080 - 1082 (株)癌と化学療法社 2017年11月 
    はじめに:進行再発胃癌の二次治療として推奨されているramucirumab(RAM)+paclitaxel(PTX)療法の特徴的な有害事象(AE)として蛋白尿があげられる。今回、RAM+PTX療法によりgrade(gr)3の蛋白尿を来したためRAMを中止し、PTX単剤を続行し、奏効を得た高齢の再発胃癌の1例を経験した。症例:77歳、女性。76歳時に胃癌のため幽門側胃切除術、D2郭清を施行され、粘液癌、T4aN3H0P0CY0M0、fStage IIICであった。S-1による1年間の補助化学療法後、術後1年4ヵ月目に腹膜転移再発を来した。二次治療としてRAM(8mg/kg:第1、15日)+PTX(80mg/m2:第1、8、15日)を開始した。2コース目にgr3の尿蛋白(定性3+、尿中蛋白/Cr比8.30)を認めたためRAMを中止し、以後はPTX単剤の投与を施行した。RAM中止後に蛋白尿は速やかに改善し、2コース後のCT検査で腹水は減少、4コース後には腹水は消失した。考察:RAMの適正使用ガイドでは、投与前には尿蛋白定性検査を行い、2+以上では尿蛋白定量検査を行い、3g以上では投与の中止が推奨されている。本症例では、適正使用ガイドに則りPTX単剤を続行することによって奏効を得た。(著者抄録)
  • 新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 古河 洋; 安田 卓司
    癌と化学療法 44 12 1355 - 1357 (株)癌と化学療法社 2017年11月 
    背景と目的:CY1P0胃癌の予後を改善する目的にpaclitaxel(PTX)腹腔内投与とPTX、cisplatin(CDDP)、S-1(PCS)3剤による全身化学療法を施行したので報告する。対象と方法:審査腹腔鏡によりCY1P0と診断した症例に対し、PTX腹腔内投与、逐次化学療法としてPCS療法を施行。2コース施行時にRECIST評価法にてPDでなければ、再度審査腹腔鏡を施行した。結果:症例は4例、腹腔内投与および全身化学療法によるGrade3以上の有害事象として1例に白血球減少、好中球減少を認めた。奏効度はPR1例、SD3例。全例に再度審査腹腔鏡を施行した。4例ともCY0P0にdown stageしていたため、D2郭清を伴う胃切除術を施行した。術後合併症は食道空腸吻合部の縫合不全1例と膵液瘻1例を認めた。組織学的治療効果判定はGrade 1a 3例、Grade 1b 1例。長期成績:肝再発1例、#16リンパ節再発を1例に認め原病死するも腹膜再発はなく、残り2例は無再発生存中である。結語:P0CY1胃癌に対する本治療法の有害事象は認容範囲であり、長期生存例も認めた。(著者抄録)
  • 岩間 密; 木村 豊; 白石 治; 加藤 寛章; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    癌と化学療法 44 12 1720 - 1722 (株)癌と化学療法社 2017年11月 
    気管に浸潤したT4食道癌に対し化学放射線療法(CRT)と化学療法による集学的治療により、R0切除し得た症例を経験したので報告する。症例は75歳、男性。嗄声を自覚し、上部消化管内視鏡検査で胸部上部(Ut)に3型腫瘍を認め、CT検査でNo.106recRリンパ節(LN)の胸膜・気管浸潤を認めたため、食道扁平上皮癌、Ut、cT4b(No.106recR-気管)N1M0、cStage IIIC(UICC 7th)と診断した。5-FU+CDDP(CF)療法を併用したCRT(60Gy)を施行したがT4解除には至らず、docetaxel+CF(DCF)療法を2コース追加した。内視鏡上はほぼCRで、No.106recR LNも著明に縮小してFDG-PETの集積も消失したためT4解除と判断し、サルベージ手術を行った。Utの腫瘍からNo.106recR LNにかけては高度の瘢痕化を呈するも気管や反回神経の剥離は可能で、合併切除せずともR0切除が可能であった。T4局所進行食道癌に対しては、CRTにDCF療法を加えた集学的治療でT4解除が得られた後に手術を行うことで、安全かつ臓器機能の温存や予後の改善が期待できると考えられた。(著者抄録)
  • 平木 洋子; 加藤 寛章; 白石 治; 田中 裕美子; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    癌と化学療法 44 12 1723 - 1725 (株)癌と化学療法社 2017年11月 
    播種や他臓器浸潤が疑われる巨大胃gastrointestinal stromal tumor(GIST)に対して、イマチニブによる術前化学療法後に腫瘍切除を行った症例を経験したので報告する。症例は69歳、男性。急速に増大する腹部膨満感を主訴に受診した。CT検査にて壁外結節を伴い膵臓、脾臓と広範囲に接する巨大な胃原発を疑う嚢胞性腫瘤を認め、超音波内視鏡下穿刺吸引細胞診にてGISTと診断された。前治療なしでの手術では、術中の偽被膜破損や他臓器合併切除のリスクがあると判断し、術前化学療法としてイマチニブ400mg/日を6ヵ月間内服した。腫瘍活性が低下したが嚢胞部分の大きさが変化せず、腹部膨満の訴えが強いため手術を行った。イマチニブは術前1週間前に休薬し、合併切除や偽被膜破損なく腫瘍摘出術を行うことができ、術後2週目からイマチニブを再開した。術後経過は順調で、術後1年8ヵ月経過して無再発生存中である。(著者抄録)
  • 安田 篤; 安田 卓司; 木村 豊; 加藤 寛章; 平木 洋子; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦
    癌と化学療法 44 12 1943 - 1945 (株)癌と化学療法社 2017年11月 
    cStage II/III食道癌に対する治療戦略は術前化学療法(neoadjuvant chemotherapy:NAC)+根治手術が標準であるが、深い潰瘍症例などでは腫瘍穿通が生じて治療戦略を変更せざるを得ない状況に陥ることも経験される。今回、進行食道癌症例に対してNACを施行し、腫瘍壊死のため大動脈穿通のリスクを来したため緊急手術を施行して危険を回避し得た1症例を報告する。症例は62歳、女性。胸部つまり感と吐血を認め、内視鏡検査にて胸部食道癌(扁平上皮癌、cT4N2M0)と診断された。docetaxel+CDDP+5-FU(DCF)によるNACを施行したが2コース終了後に腫瘍が大動脈へ穿通寸前であることが判明し、緊急手術にて右開胸食道亜全摘、胸骨後経路細径胃管再建を行った。本症例は腫瘍がBotallo靱帯へ浸潤して根治切除はできなかったが、胸腔内穿通による縦隔炎や大動脈穿通などの危機的状態を回避することができた。進行癌の集学的治療では、常にoncologic emergencyに対する緊急対応を想定し、発症時には迅速に対処することが肝要と考えられた。(著者抄録)
  • 白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    癌と化学療法 44 12 1844 - 1846 (株)癌と化学療法社 2017年11月 
    食道入口部に及ぶ頸部食道癌を化学放射線療法(CRT)と術式の工夫によって、quality of life(QOL)と根治性を両立し得た喉頭温存手術の1例を報告する。症例は58歳、男性。腫瘍は食道入口部から胸骨切痕の高さまで及ぶT3頸部食道癌で、左右101リンパ節に転移を認めた。まずCRT(5-FU+CDDP+30Gy)で腫瘍を縮小させ、切離断端の腫瘍陰性を確保した。手術においては切離断端距離を最大限確保するため、両側輪状咽頭筋、下咽頭収縮筋下端を切離し、輪状軟骨上縁の高さでの食道を切離した。また、術後の誤嚥対策として、術後に瘢痕拘縮して喉頭挙上運動に拮抗作用を呈する舌骨下筋群を胸骨付着部で切離した。再建は遊離空腸で行った。病理結果は扁平上皮癌、ypT2、INFb、ly0、v0、PM0(10mm)、ypN0、ypStage IIAであった。術後4日目に抜管し、右反回神経麻痺を認めたが誤嚥はなく経過し、嚥下リハビリに時間を要したものの経口摂取は良好で、術後71日目に退院した。その後は社会復帰し、術後5年間再発なく経過した。(著者抄録)
  • Hiroshi Furukawa; Makoto Nakamuro; Hiroshi Nakano; Yoshiaki Kondo; Kazuo Ishikawa; Yuhei Okubo; Motohiro Imano; Takushi Yasuda; Yutaka Kimura; Haruhiko Imamoto; Masayuki Shinkai; Atsushi Yasuda; Osamu Shiraishi; Mitsuru Iwama; Hiroaki Kato
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1077 - 1079 2017年11月 
    Some of scirrhous gastric cancer are difficult to diagnose on the surface view or to take correct biopsy specimen.A 85-yearold man with dysphagia was diagnosed scirrhous gastric cancer endoscopically, but could not be taken a biopsy specimen showing cancer.We informed cases of scirrhous gastric cancer difficult to take correct biopsy specimen and recommended surgical operation to take correct specimen and to start a treatment.Patient underwent total gastrectomy after cancer diagnosis( P0CY0cT4aN0).He can eat more food and survive longer than 1 year without any chemotherapies.Scirrhous gastric cancer needs early diagnosis and treatment to improve patient prognosis.
  • Mitsuru Iwama; Yutaka Kimura; Osamu Shiraishi; Hiroaki Kato; Yoko Hiraki; Yumiko Tanaka; Atsushi Yasuda; Masayuki Shinkai; Motohiro Imano; Haruhiko Imamoto; Takushi Yasuda
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1720 - 1722 2017年11月 
    Prognosis of locally advanced esophageal cancer is poor. The greatest prognostic factor of locally advanced esophageal cancer is a local control. We experienced a case of T4 locally advanced thoracic esophageal cancer who was successfully resected without any combined resection after multimodality therapy. A male in 75-year-old. was diagnosed with type 3 locally advanced upper thoracic esophageal cancer whose metastatic right recurrent laryngeal lymph node invaded into the trachea. Definitive chemoradiation therapy(CRT)was performed, leading to a significant shrinkage of the main tumor, but T4 lesion remained. Next, adding DCF therapy(docetaxel, CDDP and 5-FU), a relief of T4 was finally obtained. Then, salvage surgery with subtotalesophagectomy and retrosternalesophagealreconstruction with gastric tube was performed, resulting in R0 resection without any combined resection. The postoperative course was uneventful, and the patient has been alive without recurrence for 1 year after surgery. In locally advanced cancer, focusing on T4 downstaging, it is significantly important in terms of safety, curativity and organ preservation to perform surgery after a sure sign of T4 relief by multimodality therapy.
  • 幕谷 悠介; 白石 治; 岩間 密; 平木 洋子; 加藤 寛章; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    癌と化学療法 44 12 1577 - 1579 (株)癌と化学療法社 2017年11月 [査読有り]
     
    症例は76歳、男性。69歳時に胸部食道癌に対し右開胸食道亜全摘術、胸骨後経路胃管再建術を施行され、術中に心室細動から心停止を来した既往があった。今回、上部消化管内視鏡検査にて再建胃管幽門前庭部小彎の3型胃管癌(中分化型腺癌、cT2N0M0、cStage IIA)と診断された。高度のるい痩(BMI 15kg/m2)があり、間質性肺炎に対するステロイドの長期間の内服、前回手術時の心停止の既往があり、胸骨縦切開胃管全摘術を行うにはリスクが極めて高いと判断した。そのため胃管幽門側部分切除術とし、#4d、#6リンパ節は右胃大網動静脈をすだれ状に郭清し口側胃管への血流を温存、右胃動脈は切離し、#5リンパ節を郭清して病巣を摘出した。周術期に合併症はなく、術後40日目に退院となった。予備力の非常に乏しい患者には、根治性と安全性のバランスを考慮した本術式の選択が有用であったと考えられる。(著者抄録)
  • Yusuke Makutani; Osamu Shiraishi; Mitsuru Iwama; Yoko Hiraki; Hiroaki Kato; Atsushi Yasuda; Masayuki Shinkai; Motohiro Imano; Yutaka Kimura; Haruhiko Imamoto; Takushi Yasuda
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1577 - 1579 2017年11月 [査読有り]
     
    A 76-year-old man was admitted to our hospital for treatment of gastric tube cancer(cT2N0M0, cStage II A)detected by a screening upper gastrointestinal endoscopy. Seven years previously, he had undergone subtotal esophagectomy for esophageal cancer with gastric pull-up via the retrosternal route. At that time, he experienced cardiopulmonary arrest due to ventric- ular tachycardia. He was in a state of poor nutrition(BMI 15 kg/m2). Therefore, reducing operative stress as much as possible, minimizing complications after surgery, and aiming for a satisfactory postoperative course are all important goals. Based on his past history, we performed distal gastrectomy(resection of the distal part of the gastric tube)without excision of the right gastroepiploic artery. The postoperative course was uneventful. He was discharged 40 days after surgery. By considering the risks of surgery due to cardiac dysfunction and malnutrition, we were able to provide effective and safe therapy for the patient.
  • Hiraki Y; Kato H; Shiraishi O; Tanaka Y; Iwama M; Yasuda A; Shinkai M; Kimura Y; Imano M; Imamoto H; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1723 - 1725 2017年11月 [査読有り]
     
    The usefulness and safety of imatinibfor neoadjuvant chemotherapy for resectable gastrointestinal stromal tumor(GIST) has not been established. We reported a case of a huge GIST of the stomach that was safely resected following preoperative imatinibtherapy. A 69-year-old man was hospitalized with abdominal fullness which increased rapidly from a month ago. A CT scan showed a huge tumor containing solid and cystic component which was accompanied by an extra-wall nodule. The tumor was strongly suspected to be originated from the stomach and EUS-FNA revealed GIST. We diagnosed GIST of the stomach and initiated preoperative adjuvant chemotherapy with imatinib because there was a risk for the break of tumor capsule and composite resection of the other organs without prior chemotherapy. After the administration of imatinib4 00 mg/day for 6months, the solid component was decreased in size and its' activity by PET-CT had declined, but the size of the cystic component was not changed and the patient's complaint of fullness was not reduced. Then, after a week cessation of imatinib, we performed surgical removal of the tumor with partial gastrectomy without surgical complication during and after the operation. Imatinibwas resumed 2 weeks later postoperatively and 1 year and 8 months has passed since the operation without recurrence. Neoadjuvant chemotherapy with imatinibhas the potential to become an important therapeutic option for the treatment of huge GISTs.
  • Shiraishi O; Kato H; Iwama M; Hiraki Y; Yasuda A; Shinkai M; Imano M; Kimura Y; Imamoto H; Yasuda T
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1844 - 1846 2017年11月 [査読有り]
     
    The patient was a 58-year-old man suffering from dysphagia. He was diagnosed with T3 cervicalesophagealcancer that invaded the posterior hypopharyngealwal lwith lymph node metastasis. The patient received neoadjuvant chemoradiotherapy (30 Gy with CDDP/5-FU), followed by larynx-preserving surgery(LPS)for cervicalesophagealcancer. Two techniques for successfulLPS consist of the dissections of cricopharyngealmuscl e and the inferior pharyngealsphincter, and the complete division of the bilateral infrahyoid muscles attached to the sternum(CDBIMS). The former technique of releasing the esophagus from the trachea at the cricoid cartilage level results in the extension of the oral surgical margin. The latter technique is expected to prevent postoperative aspiration pneumonia, as the lack of flexibility of scarred infrahyoid muscles is regarded as one of the major causes of dysfunction in swallowing. Free jejunum was transferred for cervical reconstruction. Pathological examination indicated degenerated squamous cell carcinoma(ypT2, INF b, ly0, v0, PM0, ypN0, ypStage II A). Although the patient had recurrent nerve palsy, he could eat meals without aspiration. He returned to normal life after discharge from the hospital. Five years after surgery, no recurrence had been observed.
  • Yasuda A; Yasuda T; Kimura Y; Kato H; Hiraki Y; Iwama M; Shiraishi O; Shinkai M; Imano M; Imamoto H
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1943 - 1945 2017年11月 [査読有り]
     
    According to the Guidelines for Diagnosis and Treatment of Carcinoma of the Esophagus in Japan, the standard treatment of esophageal cancer with cStage II / III is preoperative chemotherapy and radical resection. But when the tumor has deep ulcer, the perforation of it is sometimes occurred due of the anti-tumor effect and we are forced to change the standard treatment. In this time, we report a case of emergency resection of esophageal cancer which is on the brink of perforation after neoadjuvant chemotherapy. A 62-year-old woman had locally advanced esophageal cancer(cT4N2M0)and performed neoadjuvant chemotherapy(NAC). After 2 courses of NAC, the patient got into critical condition that the esophageal cancer was on the brink of perforation, thus we immediately performed emergency resection of the tumor. Unfortunately, the tumor was not completely resected because of invasion to the Botallo ligament, but we were able to avoid a critical state such as mediastinitis or penetration to the aorta. In multimodality therapy for locally advanced tumor, immediate response to oncologic emergency is significantly required, impacting on the prognosis and quality of life.
  • 胃切除後症候群の予防と治療 胃切除術後症候群に対する膵酵素補充剤の有用性に関する検討
    木村 豊; 三上 城太; 間狩 洋一; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 78 増刊 390 - 390 日本臨床外科学会 2017年10月
  • 外科手術での補助器具開発 左側臥位食道切除術における安定した術野確保のための肺圧排固定器具の開発
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    日本臨床外科学会雑誌 78 増刊 404 - 404 日本臨床外科学会 2017年10月
  • 木村 豊; 岩間 緑; 白石 治; 平木 洋子; 加藤 寛章; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本外科感染症学会雑誌 14 5 647 - 647 (一社)日本外科感染症学会 2017年10月
  • 「それぞれの癌」最善の治療とは?食道癌 内科と外科の立場から cT4食道癌の外科治療の限界と成績
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 宮田 博志; 新海 政幸; 今野 元博; 木村 豊; 矢野 雅彦; 今本 治彦
    日本癌治療学会学術集会抄録集 55回 PD9 - 5 (一社)日本癌治療学会 2017年10月
  • 食道癌特異的ペプチドワクチンの術後補助療法としての有用性と腫瘍微小環境との関連
    安田 卓司; 錦 耕平; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 奥野 清隆; 中村 祐輔
    日本癌治療学会学術集会抄録集 55回 P128 - 2 (一社)日本癌治療学会 2017年10月
  • 既治療に耐性の進行再発胃癌に対するramucirumab療法における蛋白尿に関する検討
    木村 豊; 間狩 洋一; 三上 城太; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 古河 洋; 藤田 淳也; 安田 卓司
    日本癌治療学会学術集会抄録集 55回 P170 - 4 (一社)日本癌治療学会 2017年10月
  • 良性潰瘍に対する胃切既往のある胸部食道癌における、腹部リンパ節転移状況の検討
    加藤 寛章; 白石 治; 岩間 密; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会雑誌 50 Suppl.2 182 - 182 (一社)日本消化器外科学会 2017年10月
  • 進行再発胃癌に対するramucirumab使用例における蛋白尿の検討
    木村 豊; 間狩 洋一; 三上 城太; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 古河 洋; 藤田 淳也; 安田 卓司
    日本消化器外科学会雑誌 50 Suppl.2 260 - 260 (一社)日本消化器外科学会 2017年10月
  • 食道癌術後気管切開における甲状腺上アプローチの有用性
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    日本消化器外科学会雑誌 50 Suppl.2 456 - 456 (一社)日本消化器外科学会 2017年10月
  • Kotaro Yamashita; Yasuhiro Miyazaki; Tsuyoshi Takahashi; Yasunori Masuike; Masaaki Motoori; Yutaka Kimura; Yukinori Kurokawa; Tomoki Makino; Makoto Yamasaki; Kiyokazu Nakajima; Shuji Takiguchi; Masaki Mori; Yuichiro Doki
    Surgery today 47 10 1274 - 1281 2017年10月 [査読有り]
     
    PURPOSE: To assess the safety and feasibility of laparoscopic gastrectomy (LG) for gastric cancer patients with a history of abdominal surgery (HAS). METHODS: This retrospective study analyzed data collected from gastric cancer patients with HAS, who underwent LG between 2004 and 2015. We compared the clinicopathological features that correlated with conversion to open surgery and the development of severe postoperative complications (Clavien-Dindo classification of grade III or higher). RESULTS: Of the 41 patients identified, 6 (14.6%) required conversion to open surgery. The incidence of conversion to open surgery was associated with a history of lower gastrointestinal tract surgery (p = 0.009), attempted laparoscopic total gastrectomy (p = 0.002), and excessive blood loss (p < 0.001). Severe postoperative complications developed in six patients (14.6%). Although the development of complications was associated with high postoperative serum C-reactive protein, the type of past abdominal surgery was not significantly correlated with severe complications. CONCLUSIONS: LG was feasible for gastric cancer patients with a HAS, but for those with a history of lower abdominal surgery or those who require total gastrectomy, surgeons should carefully consider the indications for LG.
  • 白石 治; 加藤 寛章; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    消化器内視鏡 29 9 1757 - 1764 (株)東京医学社 2017年09月 
    食道胃接合部癌はこれまでは食道癌、胃癌としておのおの扱われてきたため、その手術治療方針は確立されていない。術式決定の鍵となるのは開胸に関わる縦隔リンパ節、胃全摘に関わる胃大彎側のリンパ節、転移率の高い傍大動脈リンパ節(#16a2lat)の郭清の要否である。これまでの報告と自験例を合わせて検討すると、縦隔リンパ節転移は食道浸潤位置と関連があり、胃大彎リンパ節(#4d)は転移頻度が低く、進行癌では大動脈周囲リンパ節(#16a2lat)は転移をきたしやすい。現在、本邦では西分類食道胃接合部癌に対して、扁平上皮癌および食道浸潤長30mmを超える腺癌は"右開胸食道亜全摘+上中下縦隔リンパ節郭清"、30mmを超えない腺癌は"経裂孔的下部食道切除+下縦隔リンパ節郭清"、16a2latリンパ節の追加郭清、胃全摘は規定しない方針で前向き介入臨床試験が進んでおり、結果が待たれるところである。(著者抄録)
  • Yutaka Kimura; Hiroshi Yano; Takashi Iwazawa; Junya Fujita; Shoichiro Fujita; Kazuyoshi Yamamoto; Takushi Yasuda
    SURGERY TODAY 47 9 1080 - 1085 2017年09月 [査読有り]
     
    Purpose Many surgeons in Japan use 1-day nasogastric tube (NGT) decompression after gastrectomy as a standard procedure. This prospective randomized study aimed to define whether 1-day NGT decompression is necessary after distal gastrectomy. Methods The subjects were 233 patients with gastric cancer, randomized into two groups immediately after distal gastrectomy: one group received 1-day NGT decompression (NGT group, n = 119) and the other did not (no-NGT group, n = 114). The primary outcome measure was postoperative surgery-related and respiratory complications, whereas secondary measures were the postoperative course to recovery and patient complaints. Results The incidence of surgery-related complications did not differ significantly between the NGT and no-NGT groups (21.0 and 19.2%, respectively; p = 0.87). The rate of respiratory complications was 6.7% in the NGT group and 7.0% in the no-NGT group (p > 0.99). The time to passage of first flatus and the postoperative hospital stay did not differ between the groups. Twenty-five patients in the NGT group and none in the no-NGT group complained of nasopharyngeal discomfort ( p < 0.0001). Conclusion Considering the physical discomfort caused by the NGT, we believe that routine 1-day NGT decompression is unnecessary after distal gastrectomy.
  • Aoyama T; Nishikawa K; Fujitani K; Tanabe K; Ito S; Matsui T; Miki A; Nemoto H; Sakamaki K; Fukunaga T; Kimura Y; Hirabayashi N; Yoshikawa T
    Ann Oncol 28 8 1876 - 1881 2017年08月 [査読有り]
     
    Background: Neoadjuvant chemotherapy (NAC) is a promising method of improving the survival of resectable gastric cancer. Cisplatin/S-1 (CS) and docetaxel/cisplatin/S-1 (DCS) are both effective against metastatic gastric cancer. This report clarified the impact of these regimens on early endpoints, including the pathological responses, chemotherapy-related toxicities, and surgical results. Methods: Patients with M0 and either T4 or T3 in case of junctional cancer or scirrhous type received two or four courses of cisplatin (60 mg/m(2) at day 8)/S-1 (80 mg/m(2) for 21 days with 1 week rest) or docetaxel (40 mg/m(2) at day 1)/cisplatin (60 mg/m(2) at day 1)/S-1 (80 mg/m(2) for 14 days with 2 weeks rest) as NAC. Patients then underwent D2 gastrectomy and adjuvant S-1 chemotherapy for 1 year. The primary endpoint was the 3-year overall survival. Results: Between October 2011 and September 2014, 132 patients were assigned to receive CS (n = 66; 33 in 2 courses and 33 in 4 courses) or DCS (n = 66; 33 in 2 courses and 33 in 4 courses). The respective major grade 3 or 4 hematological toxicities (CS/DCS) were leukocytopenia (14.1%/26.2%), neutropenia (29.7%/47.7%), anemia (14.1%/12.3%), and platelet reduction (3.1%/1.5%). The rate of pathological response, defined as a complete response or< 10% residual cancer remaining, was 19.4% in the CS group and 15.4% in the DCS group, and 15.6% in the two-course group and 19.0% in the 4-course group. The R0 resection rate was 72.7% in the CS group and 81.8% in the DCS group and 80.3% in the two-course group and the 74.2% in the four-course group. No treatment-related deaths were observed. Conclusions: Our results do not support three-drug therapy with a taxane over two-drug therapy, or any further treatment beyond two cycles as an attractive candidate for the test arm of NAC.
  • 85歳以上の超高齢胃癌患者におけるNCDリスクカリキュレーター予測死亡率と実際の手術成績との比較
    山本 和義; 藤田 正一郎; 藤田 淳也; 木村 豊; 安達 慧; 高 正浩; 野中 亮児; 藤江 裕二郎; 橋本 和彦; 大西 直
    日本消化器外科学会総会 72回 PH4 - 7 (一社)日本消化器外科学会 2017年07月 [査読有り]
  • 岩間 密; 安田 卓司; 白石 治; 加藤 寛章; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    胸部外科 70 8 720 - 727 (株)南江堂 2017年07月
  • 食道胃接合部腺癌の至適リンパ節郭清と術式選択 リンパ節転移状況に基づく進行EGJ腺癌に対するNAC+胸腹連続郭清
    白石 治; 平木 洋子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 O1 - 3 (一社)日本消化器外科学会 2017年07月
  • CY(+)進行胃癌に対するPTX腹腔内投与+PCS全身化学療法の有用性の検討
    新海 政幸; 今野 元博; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 PG6 - 4 (一社)日本消化器外科学会 2017年07月
  • 胃切既往のある胸部食道癌の腹部リンパ節転移の検討 残胃全摘の省略は許容されるか
    加藤 寛章; 白石 治; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 PK7 - 3 (一社)日本消化器外科学会 2017年07月
  • 食道癌に対する縦隔リンパ節郭清の手術手技 安定した術野確保のための右肺圧排固定器具の開発と胸腔鏡拡大画像に基づく左側臥位縦隔リンパ節郭清手技
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 羊子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    日本消化器外科学会総会 72回 O2 - 2 (一社)日本消化器外科学会 2017年07月
  • 胃上部癌に対する腹腔鏡下手術の郭清・再建手技の定型化 菱形残胃作成と食道裂孔挿入を付加した噴門側胃切除・食道残胃吻合法
    安田 篤; 新海 政幸; 加藤 寛章; 平木 洋子; 岩間 密; 白石 治; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 O2 - 4 (一社)日本消化器外科学会 2017年07月
  • cT4局所進行食道癌に対するSalvage手術を前提とした導入化学放射線療法による治療戦略
    岩間 密; 白石 治; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 RS3 - 2 (一社)日本消化器外科学会 2017年07月
  • 高齢・胃切後胸部食道癌に対する嚥下機能温存と血行付加を考慮した新規縦隔横断胸骨後経路高位胸腔内吻合
    平木 洋子; 白石 治; 岩間 密; 加藤 寛章; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本消化器外科学会総会 72回 PK17 - 7 (一社)日本消化器外科学会 2017年07月
  • Mitsuru Iwama; Takushi Yasuda; Osamu Shiraishi; Hiroaki Kato; Yoko Hiraki; Yumiko Tanaka; Atsushi Yasuda; Masayuki Shinkai; Motohiro Imano; Yutaka Kimura; Haruhiko Imamoto
    Kyobu geka. The Japanese journal of thoracic surgery 70 8 720 - 727 2017年07月 
    Patients with esophageal cancer are often treated with definitive chemoradiotherapy (dCRT). Regardless of arrival at dCRT, the risk of local/regional recurrence during follow-up is significant. Many patient are faced with limited options for therapy once dCRT has failed. Salvage surgery is the only way for complete cure of patients with local/regional recurrent esophageal cancer after dCRT. However, salvage surgery has a significant high risk of fatal complications. We examine our preventive measures to reduce the incidence of postoperative complications after salvage surgery for thoracic esophageal cancer. The points of our preventive measures are them; I. the ingenuity of surgery, II. the securement of blood supply for the respiratory tract, III. standard lymphadenectomy, IV. countermeasures of anastomotic failure, V. countermeasures of dead space, VI. countermeasures of respiratory complications, VII. perioperative managements. Salvage surgery is a reasonable option to treat patients with local/regional recurrence after failed dCRT. Our preventive mesures are effective, therefore, we have to make the further technological developments and the safety of salvage surgery.
  • 岩間 密; 安田 卓司; 白石 治; 加藤 寛章; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    胸部外科 70 8 720 - 727 (株)南江堂 2017年07月
  • サルベージ手術の成績と問題点 当科におけるSalvage手術の安全性と有効性に関する検討
    岩間 密; 白石 治; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 71回 S4 - 7 (NPO)日本食道学会 2017年06月
  • 高齢食道癌患者に対する手術における誤嚥、肺炎の発症の低減を目指した治療選択
    木村 豊; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 71回 P6 - 8 (NPO)日本食道学会 2017年06月
  • 胃癌、頭頸部癌との重複食道癌に対する治療戦略
    加藤 寛章; 白石 治; 岩間 密; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本食道学会学術集会プログラム・抄録集 71回 P67 - 3 (NPO)日本食道学会 2017年06月
  • Jeong Ho Moon; Yoshiyuki Fujiwara; Motohiro Hirao; Hiroshi Imamura; Yutaka Kimura; Kazumasa Fujitani; Junya Fujita; Shigeyuki Tamura; Shuji Takiguchi; Masahiko Yano; Masaki Mori; Yuichiro Doki
    ANTICANCER RESEARCH 37 6 3061 - 3067 2017年06月 [査読有り]
     
    Aim: This prospective randomized study compared the survival of patients with stage IB-IIIA gastric cancer treated with surgery alone or surgery followed by adjuvant chemotherapy. Patients and Methods: Patients with pathological stage IB-IIIA disease were randomly assigned to the following groups: surgery alone (n=116), or surgery followed by adjuvant chemotherapy with 5-fluorouracil, doxifluridine, or uracil-tegafur for 12 months (n=113). Results: The overall survival rate was 86.1% in the adjuvant group and 78.5% in the surgery-alone group. The overall survival rate did not significantly differ between the adjuvant-chemotherapy and surgery-only groups (p=0.163). In the subgroup analyses, patients with stage II disease and those receiving uracil-tegafur treatment in the adjuvant group showed significantly better prognosis than those in the surgery-alone group (p=0.036 and 0.005, respectively). Conclusion: This study did not find a significant survival benefit to be associated with adjuvant chemotherapy with fluoropyrimidines in patients with stage IB-IIIA gastric cancer. However, it may be effective for patients with stage II disease. Additionally, uracil-tegafur is a promising agent for adjuvant chemotherapy of gastric cancer if S-1 is not available because of its toxicity.
  • 白石 治; 田中 由美子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本気管食道科学会会報 68 2 115 - 115 (NPO)日本気管食道科学会 2017年04月
  • 再発食道癌の治療戦略 外科的介入の有用性は 胸部食道癌根治術後再発とその治療戦略 再び根治を目指して
    加藤 寛章; 白石 治; 岩間 密; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本外科学会定期学術集会抄録集 117回 WS - 4 (一社)日本外科学会 2017年04月
  • 胃癌手術における逆流防止の工夫と長期成績 噴門側胃切除・食道残胃吻合における食道胃逆流防止の工夫
    安田 篤; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 今野 元博; 今本 治彦; 木村 豊; 古河 洋; 安田 卓司; 奥野 清隆
    日本外科学会定期学術集会抄録集 117回 WS - 4 (一社)日本外科学会 2017年04月
  • 胸部食道癌手術における頸部郭清の合理化は可能か Standard or Selective Selective
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    日本外科学会定期学術集会抄録集 117回 DB - 2 (一社)日本外科学会 2017年04月
  • 切除可能進行胃癌に対する術前TS-1+Cisplatin+Paclitaxel併用療法(PCS療法)
    新海 政幸; 今野 元博; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 安田 卓司
    日本外科学会定期学術集会抄録集 117回 SF - 6 (一社)日本外科学会 2017年04月
  • 安全性を目指した胸部食道癌手術における再建術の工夫
    岩間 密; 加藤 寛章; 白石 治; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本外科学会定期学術集会抄録集 117回 PS - 1 (一社)日本外科学会 2017年04月
  • 腹腔鏡下にD2郭清を伴う腹腔鏡下胃切除術を安全に行うための工夫
    木村 豊; 三上 城太; 間狩 洋一; 藤田 淳也; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 古河 洋; 今本 治彦; 安田 卓司
    日本外科学会定期学術集会抄録集 117回 PS - 5 (一社)日本外科学会 2017年04月
  • The JCOG1001 bursectomy trial
    Kurokawa Y; Doki Y; Mizusawa J; Terashima M; Katai H; Yoshikawa T; Kimura Y; Takiguchi S; Nishida Y; Iwasaki Y; Fukushima N; Kaji M; Hirao M; Katayama H; Nakamura K; Sano T; Sasako M
    The 12th International Gastric Cancer Congress (IGCC) 2017年04月 [査読有り]
  • 高齢社会の癌治療 高齢者胸部食道癌手術におけるリスク因子と対策
    白石 治; 田中 由美子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本気管食道科学会会報 68 2 115 - 115 (NPO)日本気管食道科学会 2017年04月
  • 白石 治; 加藤 寛章; 岩間 密; 新海 政幸; 木村 豊; 安田 卓司
    手術 71 5 743 - 751 金原出版(株) 2017年04月
  • 幽門側胃切除術後の高齢者における呼吸器合併症に対する周術期の嚥下リハビリ介入についての検討
    田中 裕美子; 安田 篤; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本胃癌学会総会記事 89回 241 - 241 (一社)日本胃癌学会 2017年03月
  • 根治切除可能な大型3型/4型胃癌に対する術前化学放射線療法の実現可能性
    白石 治; 田中 裕美子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 古河 洋; 塩崎 均; 安田 卓司
    日本胃癌学会総会記事 89回 243 - 243 (一社)日本胃癌学会 2017年03月
  • 当科での幽門保存胃切除術の検討
    安田 篤; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 古河 洋; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司; 奥野 清隆
    日本胃癌学会総会記事 89回 316 - 316 (一社)日本胃癌学会 2017年03月
  • 切除可能進行胃癌に対する術前PCS療法(Neoadjuvant combination chemotherapy with S-1, CDDP and PTX for resectable advanced gastric cancer)
    新海 政幸; 今野 元博; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 安田 卓司
    日本胃癌学会総会記事 89回 329 - 329 2017年03月
  • 胃全摘術後早期の体重減少に影響を及ぼす因子に関する検討(The examination of factors affecting body weight loss in patients after total gastrectomy)
    木村 豊; 三上 城太; 間狩 洋一; 藤田 淳也; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 今本 治彦; 有田 卓司
    日本胃癌学会総会記事 89回 431 - 431 2017年03月
  • 胸部食道癌術後胃管癌に関する検討(A study about gastric tube cancer after radical esophagectomy for thoracic esophageal cancer)
    岩間 密; 白石 治; 加藤 寛章; 平木 洋子; 田中 裕美子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦; 安田 卓司
    日本胃癌学会総会記事 89回 447 - 447 2017年03月
  • 【消化器癌手術に必要な拡大視による局所微細解剖アトラス】 Esophageal Surgery 高度進行食道癌の切除可能性を見極める拡大視による局所微細解剖
    白石 治; 加藤 寛章; 岩間 密; 新海 政幸; 木村 豊; 安田 卓司
    手術 71 4 389 - 397 金原出版(株) 2017年03月
  • Yamasaki M; Yasuda T; Yano M; Hirao M; Kobayashi K; Fujitani K; Tamura S; Kimura Y; Miyata H; Motoori M; Shiraishi O; Makino T; Satoh T; Mori M; Doki Y
    Ann Oncol 28 1 116 - 120 2017年01月 [査読有り]
     
    Background: This phase II trial evaluated the efficacy of cisplatin and fluorouracil (CF)-based combination neoadjuvant chemotherapy on the outcome of patients with resectable locally advanced esophageal squamous cell carcinoma (ESCC). We compared the recurrence-free survival (RFS) associated with CF plus Adriamycin (ACF) with that associated with CF plus docetaxel (DCF) to select an alternative regimen in a new phase III trial investigating the optimal neoadjuvant treatment of patients with ESCC. Patients and methods: Patients with resectable advanced ESCC were randomly assigned to either ACF (Adriamycin 35 mg/m(2), cisplatin 70 mg/m(2) i. v. on day 1, fluorouracil 700 mg/m(2) continuous infusion for 7 days) every 4 weeks or DCF (docetaxel 70 mg/m(2), cisplatin 70 mg/m(2) i. v. on day 1, fluorouracil 700 mg/m(2) continuous infusion for 5 days) every 3 weeks. Surgery was scheduled after completion of two cycles of chemotherapy. The primary end point was RFS, analyzed by the intention-to-treat. Results: Between October 2011 and October 2013, 162 patients at 10 institutions were enrolled in the study, all of whom were eligible and randomly assigned to the two groups (81 to the ACF group and 81 to the DCF group). The R0 resection rates for the ACF and DCF groups were equivalent (95.9% versus 96.2%, P = 0.93). The 2-year RFS and overall survival rates for DCF versus ACF were 64.1% versus 42.9% (hazard ratio 0.53, 95% confidence interval 0.33-0.83, P = 0.0057) and 78.6% versus 65.4% (P = 0.08), respectively. Conclusion: Compared with ACF, DCF chemotherapy was associated with prolonged RFS for
  • Noriko Wada; Tsuyoshi Takahashi; Yukinori Kurokawa; Kiyokazu Nakajima; Toru Masuzawa; Rie Nakatsuka; Junji Kawada; Toshirou Nishida; Yutaka Kimura; Kouji Tanaka; Yasuhiro Miyazaki; Tomoki Makino; Makoto Yamasaki; Shuji Takiguchi; Masaki Mori; Yuichiro Doki
    Digestion 95 2 115 - 121 2017年 [査読有り]
     
    BACKGROUND/AIMS: Previous studies have proposed risk classifications for patients with gastrointestinal stromal tumor (GIST) after resection and have contributed to the prediction of its prognosis. However, optimal postoperative surveillance has not yet been established. METHODS: We retrospectively analyzed data from 115 GIST patients who experienced recurrence after complete resection. The relationships between clinicopathological characteristics and the first recurrence sites, or time to recurrence (TTR), were investigated. We also compared the characteristics between 2 subgroups based on a TTR of ≤5 or >5 years. RESULTS: The first recurrence occurred in the abdomen in 114 of 115 patients (99.1%); one case of esophageal GIST recurred in the lung. Gastric and small intestinal GISTs recurred most frequently in the liver or peritoneum, while the most common recurrences of colorectal GISTs were found to be local. Fourteen patients (12.2%) experienced recurrence after >5 years. Smaller tumors and those categorized as lower risk were significantly more frequent in the TTR >5 years group than in the TTR ≤5 years group. In the TTR >5 years group, local recurrence was the most frequent type of recurrence (42.9%). CONCLUSION: Based on abdominal examination, postoperative surveillance after complete resection for primary GISTs may be recommended for >5 years.
  • Jota Mikami; Yutaka Kimura; Yoichi Makari; Junya Fujita; Tomoya Kishimoto; Genta Sawada; Shin Nakahira; Ken Nakata; Masaki Tsujie; Hiroki Ohzato
    WORLD JOURNAL OF SURGICAL ONCOLOGY 15 1 8  2017年01月 [査読有り]
     
    Background: Bone metastasis due to gastric cancer is rare, and the clinical features have not been fully evaluated. We investigated the clinical features, treatment outcomes, and prognostic factors in gastric cancer patients with bone metastasis. Methods: We retrospectively collected data on 34 consecutive patients who were diagnosed radiologically with bone metastasis due to gastric cancer. We estimated the overall survival after the diagnosis of bone metastasis using the Kaplan-Meier product-limit method and evaluated which clinicopathological factors were associated with prognostic factors for survival using univariate and multivariate Cox proportional hazards regression models. Results: The treatment for the primary tumor was surgery in 16 patients (47.1%) and chemotherapy in 18 patients (52.9%). The median serum alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) levels at the time of bone metastasis were 375.5 and 249 IU/L, respectively. Ten patients (29.4%) were diagnosed with bone metastasis and gastric cancer at the same time. The 6-month survival rate after the diagnosis of bone metastasis was 63.8%, and the median survival time was 227.5 days. Multivariate analysis revealed that metachronous metastasis (p = 0.035) and extraosseous metastasis (p = 0.028) were significant risk factors for poor survival. Conclusions: The prognosis of gastric cancer with bone metastasis was poor, and metachronous metastasis and extraosseous metastasis were shown to be poor prognostic factors. Serum ALP, LDH, and tumor markers are not always high, so aggressive diagnosis using appropriate modalities such as bone scan, MRI, or PET-CT may be necessary in routine practice even in asymptomatic patients.
  • 【胃癌・食道癌のリンパ節郭清のすべて】 食道癌に対する頸部リンパ節郭清
    白石 治; 岩間 密; 加藤 寛章; 平木 洋子; 田中 裕美子; 中野 敬次; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    消化器外科 40 1 17 - 29 (株)へるす出版 2017年01月
  • Osamu Shiraishi; Makoto Yamasaki; Tomoki Makino; Masaaki Motoori; Hiroshi Miyata; Masayuki Shinkai; Yutaka Kimura; Motohiro Hirao; Kazumasa Fujitani; Shigeyuki Tamura; Kenji Kobayashi; Masahiko Yano; Yuichiro Doki; Takushi Yasuda
    ONCOLOGY 92 2 101 - 108 2017年 [査読有り]
     
    Background: Neoadjuvant chemotherapy for resectable advanced esophageal squamous cell carcinoma (ESCC) requires reassessment. We have conducted a trial aiming at the comparison between DCF and ACF concerning perioperative adverse events. Methods: Patients were randomly assigned to receive either DCF [docetaxel 70 mg/m(2), cisplatin 70 mg/m(2) on day 1, and 5-fluorouracil (5-FU) 700 mg/m(2) for 5 days] every 3 weeks or ACF (adriamycin 35 mg/m(2), cisplatin 70 mg/m(2) on day 1, and 5-FU 700 mg/m(2) for 7 days) every 4 weeks. Each group consisted of 81 patients. Two cycles of preoperative chemotherapy were planned, after which patients underwent subtotal esophagectomy via a right thoracotomy with lymphadenectomy. Chemotherapy- and surgery-related adverse effects were assessed. Results: Grade 3-4 neutropenia and febrile neutropenia occurred in 90 and 39% of patients, respectively, in the DCF group compared with 69 and 17% of patients, respectively, in the ACF group (p<0.01). Perioperative complications did not differ significantly between the groups. The overall response rates of DCF and ACF were 61 and 40%, respectively, while the histopathological complete responses were 15 and 3%, respectively (p<0.01). Conclusion: The DCF and ACF regimens were found to be equally feasible in patients with resectable advanced ESCC; however, DCF delivered an antitumor effect and therefore potentially improved the long-term outcomes. (C) 2016 S. Karger AG, Basel
  • 【消化器外科 上部消化管】こだわりの手術手技 出血はしない、させない、ひろげない 腹腔鏡下胃切除術において出血を減少させるための工夫
    木村 豊; 三上 城太; 間狩 洋一; 藤田 淳也; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 彭 英峰; 新海 政幸; 今本 治彦; 安田 卓司
    日本内視鏡外科学会雑誌 21 7 RS19 - 4 (一社)日本内視鏡外科学会 2016年12月
  • 早期胃癌に対する噴門側胃切除術のメリットとデメリット 噴門胃切除後の菱形残胃作成と偽穹窿部食道裂孔挿入による食道残胃吻合法
    安田 篤; 今本 治彦; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 新海 政幸; 木村 豊; 今野 元博; 古河 洋; 安田 卓司; 奥野 清隆
    日本内視鏡外科学会雑誌 21 7 RS41 - 4 (一社)日本内視鏡外科学会 2016年12月
  • 天野 浩司; 中田 健; 辻江 正樹; 清水 克修; 川田 真大; 蛯原 健; 薬師寺 秀明; 常俊 雄介; 臼井 章浩; 中田 康城; 池田 直樹; 木村 豊; 藤田 淳也
    癌と化学療法 43 12 1824 - 1826 (株)癌と化学療法社 2016年11月 
    腸腰筋膿瘍を伴う大腸癌に対して、一期的手術を行うかドレナージを先行させてから手術を行うかは報告により様々である。今回われわれは、ドレナージを先行させたことで腹腔鏡で安全に切除を行うことができた。膿瘍形成している炎症期には手術を避け、先にドレナージで炎症と全身状態の改善を図ってから低侵襲に手術を行うことが患者にとっての利益が大きいと考えられた。(著者抄録)
  • 蛯原 健; 山田 元彦; 清水 克修; 天野 浩司; 川田 真大; 澤田 元太; 常俊 雄介; 中田 健; 臼井 章浩; 辻江 正樹; 木村 豊; 棟方 哲; 中田 康城; 藤田 淳也
    癌と化学療法 43 12 1830 - 1832 (株)癌と化学療法社 2016年11月 
    大腸癌穿孔では腹膜炎、敗血症から重篤なショックに陥ることをしばし認め、緊急手術を行うも救命ができないことがある。一方、緊急手術時は時間的な制約とともに病態をすべて把握することは困難であり、郭清を含めた腫瘍学的な手術の完遂は難しい。そこでわれわれは、外傷学で発展したdamage control surgeryの概念を用いて大腸癌穿孔の治療を行っている。初回の緊急手術は感染コントロールのため穿孔腸管の切除、腹腔内洗浄のみ行い、吻合、人工肛門造設は行わない。open abdominal managementにて手術を終えた後、集中治療室での全身状態の安定化を図る。専門外科医、家族を含め治療方針の決定を行い、全身状態が安定したところで追加郭清、吻合、人工肛門造設を行う治療戦略である。今回、ショックを呈し救命が困難と考えられた92歳、女性の症例を提示し、われわれの治療戦略の意義を報告する。(著者抄録)
  • Nishi H; Nakata K; Hiraki Y; Yoshimura J; Sasamatsu S; Shimizu K; Inoue T; Mikami J; Sawada G; Nakahira S; Makari Y; Yamamoto T; Tsujie M; Kimura Y; Ohsato H
    Gan to kagaku ryoho. Cancer & chemotherapy 43 12 1452 - 1454 2016年11月 [査読有り]
     
    Management for obstructive cancer of the colon diverges into many ways. The aim of this study was to evaluate the treatment course of patients with malignant obstruction after ileo/coleostomy. Thirty-six patients with malignant obstruction who underwent ileo/coleostomy in our hospital from May 2012 to January 2016were enrolled in the study. Clinical outcomes were the period before treatment initiation, chemotherapy, radiotherapy, primary lesion resection, and death, and these were retrospectively analyzed. Although 9 stomal complications occurred, no case experienced a delayed treatment start. However, patients with perioperative complications, sepsis due to the tumor, pneumonia, cerebral infractions, and ileus needed a long recovery period before treatment initiation. Patients who need ileo/coleostomy must be considered for performance status and ways to decrease perioperative complications to prevent stomal complications from chemo/radiotherapy.
  • Mikami J; Kimura Y; Makari Y; Sawada G; Nakahira S; Nakata K; Yamamoto T; Tsujie M; Ohsato H
    Gan to kagaku ryoho. Cancer & chemotherapy 43 12 1899 - 1901 2016年11月 [査読有り]
  • Kimura Y; Makari Y; Mikami J; Hiraki Y; Sasamatsu S; Sawada G; Nakahira S; Yamamura J; Kamigaki S; Nakata K; Ikeda N; Tsujie M; Fujita J; Kuriu A; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 43 12 1920 - 1922 2016年11月 [査読有り]
  • Kimura Y; Makari Y; Mikami J; Yoshimura J; Inoue T; Sawada G; Nakahira S; Yamamura J; Kamigaki S; Nakata K; Yamamoto T; Ikeda N; Tsujie M; Fujita J; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 43 12 2404 - 2406 2016年11月 [査読有り]
  • Paclitaxel+Ramucirumab療法が奏効した高齢の切除不能進行胃癌の1例
    木村 豊; 間狩 洋一; 三上 城太; 吉村 旬平; 井上 稔也; 澤田 元太; 中平 伸; 山村 順; 神垣 俊二; 中田 健; 山本 為義; 池田 直樹; 辻江 正樹; 藤田 淳也; 大里 浩樹
    癌と化学療法 43 12 2404 - 2406 (株)癌と化学療法社 2016年11月 
    paclitaxel(PTX)+ramucirumab(RAM)療法が奏効した高齢の切除不能進行胃癌の1例を経験したので報告する。症例は80歳、男性。主訴は食欲低下、家族歴は特記すべきことなし、既往歴は76歳時に虫垂切除を受けていた。併存疾患として高血圧、高脂血症、高尿酸血症を認めた。2014年12月に上部消化管内視鏡検査で胃体部から前庭部の4型胃癌(por2)を認め、腹部造影CT検査で胃壁の肥厚、多数のリンパ節腫大、骨盤腹水を認めた。審査腹腔鏡で腹膜転移結節を多数認め、T4a、N3、H0、P1、M1、Stage IVと診断し、S-1による化学療法を行った。リンパ節の縮小、胃壁肥厚の軽減を認めPRとなったが、8.5ヵ月後にリンパ節が増大し腹水が出現した。2015年10月より二次治療としてPTX(70mg/m2:第1、8、15日、28日ごと)+RAM(8mg/kg:第1、15日、28日ごと)を開始した。performance status(PS)1であったが高齢のためPTXを70mg/m2で開始したところ好中球減少(grade 3)、食欲低下(grade 2)、鼻出血(grade 1)を認め、3コース目からは第1、15日の隔週でPTX+RAMの投与を行った。2コース後には胃壁肥厚の軽減、リンパ節の縮小、腹水の消失を認め、外来治療を8ヵ月継続中である。有害事象(好中球減少:grade 2)のためPTXが隔週投与となったが、8ヵ月間PRが持続している。高齢の胃癌患者に対して、PTX+RAM療法は有害事象に注意して施行すれば有用なレジメンとなり得る。(著者抄録)
  • S-1治療中の胃癌患者における眼症状に関する検討
    藤井 千賀; 木村 豊; 間狩 洋一; 三上 城太; 藤田 淳也; 神垣 俊二; 林 仁; 柳下 祐貴子; 安井 友佳子; 石坂 敏彦
    癌と化学療法 43 12 1960 - 1962 (株)癌と化学療法社 2016年11月 
    近年、S-1治療による眼症状も注意が必要な副作用として注目されている。当院において2014年1月〜2015年12月にS-1単剤での治療が開始となった胃癌患者75例を対象に、S-1治療による眼症状の発現状況と対処法について後方視的調査を行った。眼症状がみられた症例は16例(21%)。発現時期中央値は3(1〜8)ヵ月。Grade 2の症状は流涙14例、眼脂8例、結膜炎が4例にみられた。対処方法は人工涙液点眼7例、抗炎症作用を有するフルメトロン点眼1例、その両方の使用が8例であった。うち3例が眼科受診を必要とした。S-1治療の減量や休薬が必要となる症状はみられなかった。点眼剤により適切に対処すれば、胃癌患者におけるS-1と関連する眼症状はS-1化学療法に影響を与えない可能性がある。(著者抄録)
  • 化学療法施行中に出血を来した進行胃癌に対して血管塞栓術を行った3例
    木村 豊; 間狩 洋一; 三上 城太; 平木 洋子; 笹松 信吾; 澤田 元太; 中平 伸; 山村 順; 神垣 俊二; 中田 健; 池田 直樹; 辻江 正樹; 藤田 淳也; 栗生 明博; 大里 浩樹
    癌と化学療法 43 12 1920 - 1922 (株)癌と化学療法社 2016年11月 
    化学療法中の切除不能進行胃癌の出血に対して血管塞栓術(TAE)を行った3例について報告する。症例1:71歳、男性。UM、3型胃癌、T4b(Panc)、N3、H0、CY1、P0、M1、Stage IVに対するS-1+trastuzumab療法施行中の腫瘍出血に対してTAEを施行した。後胃動脈から出血に対して脾動脈本幹を金属コイルで塞栓して止血した。脾梗塞(grade 3)、左胸水(grade 2)、腹痛(grade 2)を認めたが、TAEの4週間後から二次治療paclitaxel(PTX)を開始した。症例2:76歳、男性。ML、3型胃癌、T4a、N3、H0、P1、M1、Stage IVに対するS-1+cisplatin療法施行中の腫瘍出血に対して左右の胃動脈から多孔性ゼラチンスポンジ(セレスキュー)にてTAEを施行した。止血が得られなかったため、S-1併用で31Gyの放射線照射を行い止血が得られ、nab-PTXによる化学療法を行った。症例3:74歳、男性。UML、4型胃癌、T4a、N3、H1、P0、M1、Stage IVに対する二次治療nab-PTXによる化学療法中の腫瘍出血に対して左胃動脈から多孔性ゼラチンスポンジ(セレスキュー)にてTAEを行った。退院可能となったが、PS 4のためbest supportive careを行った。まとめ:化学療法中の出血性進行胃癌3例のうち2例で止血が得られた。TAEは有用な選択肢であると考えられた。(著者抄録)
  • 大腸ステントが有用であった胃癌腹膜転移の1例
    三上 城太; 木村 豊; 間狩 洋一; 澤田 元太; 中平 伸; 中田 健; 山本 為義; 辻江 正樹; 大里 浩樹
    癌と化学療法 43 12 1899 - 1901 (株)癌と化学療法社 2016年11月 
    症例は66歳、女性。腹痛、嘔吐を主訴に当院を受診し、腹部CTにて胃前庭部の壁肥厚および結腸脾彎曲部の腫瘍による大腸閉塞を認めた。絶食にて入院加療を行い、経肛門的イレウス管を留置した4日後に自己拡張型金属ステント(SEMS)を留置した。症状は改善し、ステント留置による合併症を認めず、普通食摂取が可能となり術後12日目に退院となった。上下部消化管内視鏡検査、CT検査の結果、胃癌Type4、cT4a(SE)、N2、H0、P1、M1(LYM)、cStage IVと診断し、退院後10日目にSOX療法を開始した。8コース後の効果判定でPDとなり、nab-PTXを開始した。ステント留置に伴う晩期合併症は認めなかった。胃癌腹膜転移による大腸閉塞に対するステント留置はイレウスの改善に有用であり、比較的侵襲の少ない処置により化学療法を行うことが可能となった。(著者抄録)
  • 大腸癌穿孔に対するDamage Control Surgery
    蛯原 健; 山田 元彦; 清水 克修; 天野 浩司; 川田 真大; 澤田 元太; 常俊 雄介; 中田 健; 臼井 章浩; 辻江 正樹; 木村 豊; 棟方 哲; 中田 康城; 藤田 淳也
    癌と化学療法 43 12 1830 - 1832 (株)癌と化学療法社 2016年11月 
    大腸癌穿孔では腹膜炎、敗血症から重篤なショックに陥ることをしばし認め、緊急手術を行うも救命ができないことがある。一方、緊急手術時は時間的な制約とともに病態をすべて把握することは困難であり、郭清を含めた腫瘍学的な手術の完遂は難しい。そこでわれわれは、外傷学で発展したdamage control surgeryの概念を用いて大腸癌穿孔の治療を行っている。初回の緊急手術は感染コントロールのため穿孔腸管の切除、腹腔内洗浄のみ行い、吻合、人工肛門造設は行わない。open abdominal managementにて手術を終えた後、集中治療室での全身状態の安定化を図る。専門外科医、家族を含め治療方針の決定を行い、全身状態が安定したところで追加郭清、吻合、人工肛門造設を行う治療戦略である。今回、ショックを呈し救命が困難と考えられた92歳、女性の症例を提示し、われわれの治療戦略の意義を報告する。(著者抄録)
  • 腸腰筋膿瘍を合併したS状結腸癌に対しドレナージ後に腹腔鏡下切除を施行した1例
    天野 浩司; 中田 健; 辻江 正樹; 清水 克修; 川田 真大; 蛯原 健; 薬師寺 秀明; 常俊 雄介; 臼井 章浩; 中田 康城; 池田 直樹; 木村 豊; 藤田 淳也
    癌と化学療法 43 12 1824 - 1826 (株)癌と化学療法社 2016年11月 
    腸腰筋膿瘍を伴う大腸癌に対して、一期的手術を行うかドレナージを先行させてから手術を行うかは報告により様々である。今回われわれは、ドレナージを先行させたことで腹腔鏡で安全に切除を行うことができた。膿瘍形成している炎症期には手術を避け、先にドレナージで炎症と全身状態の改善を図ってから低侵襲に手術を行うことが患者にとっての利益が大きいと考えられた。(著者抄録)
  • 悪性大腸閉塞に対しストーマ造設後に化学放射線療法を施行した症例の検討
    西 秀美; 中田 健; 平木 洋子; 吉村 旬平; 笹松 信吾; 清水 克修; 井上 稔也; 三上 城太; 澤田 元太; 中平 伸; 間狩 洋一; 山本 為義; 辻江 正樹; 木村 豊; 大里 浩樹
    癌と化学療法 43 12 1452 - 1454 (株)癌と化学療法社 2016年11月 
    悪性大腸閉塞に対するストーマ造設が後続治療にもたらす影響を評価するため、当院の症例を後ろ向きに検討した。2012年5月〜2016年1月までの3年8ヵ月間に、36例にストーマ造設後に化学(放射線)療法を施行していた。ストーマ合併症が起こったのは9例で、ストーマ合併症を理由に治療開始までの期間が延長した症例はなかった。しかし、2例で化学療法の合併症によるストーマ管理困難を来し、治療戦略の変更を要した。一方、肺炎や脳梗塞、腫瘍の伸展に伴う敗血症など周術期合併症を起こした7例は治療開始までの期間が延長していた。悪性大腸閉塞に対する減圧法は様々だが、ストーマ造設を要する症例では周術期合併症の低減と後続治療によるストーマ合併症の予防に努めることが、安定した治療につながると考えられた。(著者抄録)
  • そこが知りたいPros and Cons 胸部食道癌縮小手術 積極派vs.慎重派 症例毎のリスク軽減の工夫による根治的リンパ節郭清を伴う食道癌外科治療戦略
    安田 卓司; 白石 治; 岩間 密; 加藤 寛章; 田中 裕美子; 平木 洋子; 安田 篤; 新海 政幸; 今野 元博; 木村 豊; 今本 治彦
    日本臨床外科学会雑誌 77 増刊 337 - 337 日本臨床外科学会 2016年10月
  • 胃切除後症例における食道癌再建手術の工夫 当院の胃切除後における食道切除後有茎空腸再建術の工夫
    白石 治; 田中 裕美子; 加藤 寛章; 岩間 密; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 376 - 376 日本臨床外科学会 2016年10月
  • 胸部食道癌周術期管理の進歩 合併症ゼロへ向けて 胸部食道癌手術における術後合併症予防の工夫
    岩間 密; 田中 裕美子; 加藤 寛章; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 423 - 423 日本臨床外科学会 2016年10月
  • 当院における腹腔鏡下胃切除術の工夫 臓器把持用クリップの活用
    木村 豊; 三上 城太; 間狩 洋一; 藤田 淳也; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 今野 元博; 古河 洋; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 618 - 618 日本臨床外科学会 2016年10月
  • 輪状咽頭筋切開による喉頭温存食道切除・高位吻合の有用性
    加藤 寛章; 田中 裕美子; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 659 - 659 日本臨床外科学会 2016年10月
  • CY1胃癌に対するPTX腹腔内投与+PCS全身化学療法の治療成績
    新海 政幸; 今野 元博; 平木 洋子; 田中 裕美子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本 治彦; 古河 洋; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 705 - 705 日本臨床外科学会 2016年10月
  • 胃癌術後5年目に発症した脾転移の1切除例
    田中 裕美子; 平木 洋子; 加藤 寛章; 岩間 密; 白石 治; 安田 篤; 新海 政幸; 木村 豊; 今野 元博; 今本 治彦; 安田 卓司
    日本臨床外科学会雑誌 77 増刊 709 - 709 日本臨床外科学会 2016年10月
  • Yutaka Kimura; Yoichi Makari; Johta Mikami; Shunji Kamigaki; Ayumi Ikejima; Chika Fujii; Genta Sawada; Shin Nakahira; Jun Yamamura; Ken Nakata; Tameyoshi Yamamoto; Naoki Ikeda; Masaki Tsujie; Junya Fujita; Hiroki Ohzato
    Japanese Journal of Cancer and Chemotherapy 43 10 1193 - 1196 2016年10月 [査読有り]
     
    Background: The REGARD and RAINBOW trials showed that ramucirumab (RAM) alone and RAM plus paditaxel (PTX) were effective therapies for advanced gastric cancer patients previously treated with chemotherapy. In this retrospective study, we evaluated the safety and efficacy of RAM alone and PTX plus RAM in such patients. Methods: Patients who were received RAM at 8 mg/kg or RAM plus PTX at 80 mg/m2 (on days 1, 8, and 15 of a 28-day cycle) between June 2015 and March 2016 were enrolled in this study. We compared the clinical outcome of RAM alone (RAM group, n = 10) with that of RAM plus PTX (PTX+RAM group, n = 13). Results: The RAM group contained many more patients with poor performance status or prior chemotherapy of 2 or more regimens than the PTX+RAM group. All patients in both groups received chemotherapy on an outpatient basis. One case of grade 3 or 4 hematological adverse events was found in the RAM group and 6 cases were found in the PTX+RAM group. The overall response rate was 10% in the RAM group and 30% in the PTX+RAM group. Progression-free survival was 54 days in the RAM group and 187 days in the PTX+RAM group (p=0.0374). Overall survival was 158 days in the RAM group and was not reached in the PTX+RAM group (p=0.109l). Conclusions: RAM alone and RAM plus PTX can be administered safely on an outpatient basis and are beneficial for advanced gastric cancer patients previously treated with chemotherapy.
  • 進行再発胃癌に対するRamucirumab治療例の検討 Ramucirumab単独療法とPaclitaxel+Ramucirumab療法の比較
    木村 豊; 間狩 洋一; 三上 城太; 神垣 俊二; 池島 あゆみ; 藤井 千賀; 澤田 元太; 中平 伸; 山村 順; 中田 健; 山本 為義; 池田 直樹; 辻江 正樹; 藤田 淳也; 大里 浩樹
    癌と化学療法 43 10 1193 - 1196 (株)癌と化学療法社 2016年10月 
    REGARD試験、RAINBOW試験の結果、進行再発胃癌に対する二次治療におけるramucirumab(RAM)単独療法、paclitaxel(PTX)+RAM療法の有効性が示された。今回、当院で経験したRAM使用例の安全性と臨床的効果を後方視的に検討した。方法:前治療に耐性となり、2015年6月〜2016年3月にRAMを使用して化学療法を行った進行再発胃癌患者23例を対象とした。RAM 8mg/kgはday 1、15に投与し、PTXを併用する場合はRAM投与後にPTX 80mg/m2をday 1、8、15に投与した。RAM単独療法を行った10例をRAM群、PTX+RAM療法を行った13例をPTX+RAM群として、安全性、治療経過、臨床的効果、無増悪生存期間(PFS)、全生存期間(OS)について両群を比較した。結果:RAM群には、PTX+RAM群と比較してPSが不良な症例や三次治療以後の症例が多く含まれていた。RAM群、PTX+RAM群ともにすべて外来で治療を行った。RAM群、PTX+RAM群のgrade 3以上の血液毒性はそれぞれ1例、6例であった。臨床的効果において、奏効例はRAM群で1例(10%)、PTX+RAM群で4例(30%)に認めた。PFSはそれぞれ54日、187日(p=0.0374)、OSはそれぞれ158日、50%に未到達であった(p=0.1091)。結語:化学療法の前治療歴のある進行再発胃癌に対して、RAMを使用した治療法は安全に外来で施行可能で効果も期待できる。(著者抄録)
  • Hiroshi Imamura; Kazuhiro Nishikawa; Kentaro Kishi; Kentaro Inoue; Jin Matsuyama; Yusuke Akamaru; Yutaka Kimura; Shigeyuki Tamura; Ryohei Kawabata; Junji Kawada; Yoshiyuki Fujiwara; Tomono Kawase; Junichi Fukui; Mari Takagi; Atsushi Takeno; Toshio Shimokawa
    ANNALS OF SURGICAL ONCOLOGY 23 9 2928 - 2935 2016年09月 [査読有り]
     
    Post-gastrectomy weight loss is associated with deterioration in quality of life, and influences the long-term prognosis of gastric cancer patients. We conducted a prospective, randomized controlled, open-label study to examine whether an oral elemental diet (Elental(A (R)), Ajinomoto Pharmaceuticals, Tokyo, Japan; hereafter referred to as ED) prevents postoperative weight loss in post-gastrectomy patients. Patients were randomly divided to receive the ED or control diet. The ED group received 300 kcal of ED plus their regular diet for 6-8 weeks after surgery, starting from the day the patient started a soft rice or equivalent diet after surgery, while the control group received the regular diet alone. The primary endpoint was the percentage of body weight loss (%BWL) from the presurgical body weight to that at 6-8 weeks after surgery. Secondary endpoints were dietary adherence, nutrition-related blood parameters, and adverse events. This study included 112 patients in eight hospitals. The mean treatment compliance rate in the ED group was 68.7 +/- 30.4 % (median 81.2 %). The %BWL was significantly different between the ED and control groups (4.86 +/- 3.72 vs. 6.60 +/- 4.90 %, respectively; p = 0.047). In patients who underwent total gastrectomy, the %BWL was significantly different between the two groups (5.03 +/- 3.65 vs. 9.13 +/- 5.43 %, respectively; p = 0.012). In multivariate analysis, ED treatment, surgery type, and preoperative performance status were independently associated with %BWL. No significant differences were observed in the other clinical variables. ED supplementation reduced postoperative weight loss in gastric cancer patients undergoing gastrectomy.
  • Takaki Yoshikawa; Satoshi Morita; Kazuaki Tanabe; Kazuhiro Nishikawa; Yuichi Ito; Takanori Matsui; Kazumasa Fujitani; Yutaka Kimura; Junya Fujita; Toru Aoyama; Tsutomu Hayashi; Haruhiko Cho; Akira Tsuburaya; Yumi Miyashita; Junichi Sakamoto
    EUROPEAN JOURNAL OF CANCER 62 103 - 111 2016年07月 [査読有り]
     
    Background: The prognosis for stage III gastric cancer is unsatisfactory by D2 gastrectomy and S-1 adjuvant chemotherapy. Both S-1 plus cisplatin (SC) and paclitaxel plus cisplatin (PC) are promising regimens as neoadjuvant chemotherapy; however, the optimal duration remains unclear. Patients and methods: In this 2x2 randomised phase II trial, stage III gastric cancer patients, those with a prognosis corresponding to stage III, and macroscopically resectable stage IV cases were randomised to two or four courses of S-1 (80 mg/m(2) for 21 d with 1 week rest)/cisplatin (60 mg/m2 at day 8) or PC (80 and 25 mg/m2, respectively, on days 1, 8, and 15 with 1 week rest) as neoadjuvant chemotherapy. The primary end-point was the 3-year overall survival (OS). Results: Between October 2009 and July 2011, 83 patients received 2 courses of SC (n = 21), 4 courses of SC (n = 20), 2 courses of PC (n = 21) and 4 courses of PC (n = 21). The 3-year OS was 60.9% for SC and 64.3% for PC and 64.3% for the two courses and 61.0% for the four courses. Subset analyses demonstrated no subgroup which showed any potential survival benefit by PC in comparison to SC or by four courses as in comparison to two courses. Conclusions: Two courses of SC as neoadjuvant chemotherapy are recommended as a test arm of a future phase III study for patients with locally advanced gastric cancer. Clinical trial number: UMIN-000002595. (C) 2016 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creathecommorls.ordliCerlses/by-ne-20/4.0/).
  • Ryohei Kawabata; Shuji Takiguchi; Yutaka Kimura; Hiroshi Imamura; Junya Fujita; Shigeyuki Tamura; Kazumasa Fujitani; Kentaro Kishi; Kazuyoshi Yamamoto; Shinichi Fujiwara; Yukinori Kurokawa; Masaki Mori; Yuichiro Doki
    Surgery today 46 5 561 - 8 2016年05月 [査読有り]
     
    PURPOSE: The Harmonic Ace ultrasonic scalpel has been popular in abdominal surgery; however, only a few clinical studies have evaluated the efficacy of this device in radical open gastrectomy for gastric cancer. METHODS: The present study was designed as a multicenter, prospective, randomized, controlled trial. Patients with resectable gastric cancer were randomly assigned to gastrectomy using the Harmonic scalpel or conventional monopolar electrosurgery. RESULTS: A total of 248 patients were enrolled, and 123 patients were included in the Harmonic group and 114 patients were included in the conventional group. The demographics of the patients were well balanced between the groups. There was no significant difference in the length of the operation from skin incision to resection of the gastric specimen (141 ± 36 min in the Harmonic group vs. 147 ± 13 min in the conventional group; p = 0.276) nor in the amount of blood lost (365 ± 293 vs. 336 ± 272 mL; p = 0.434). There was also no significant difference in the incidence of surgical complications or the post-surgical hospital stay between the groups. CONCLUSION: The Harmonic scalpel procedure was not superior to the conventional monopolar electrosurgery with regard to reducing the length of the operation, blood loss, postoperative complications, or postoperative hospital stay in radical open gastrectomy.
  • 腹部救急疾患に対する内視鏡下手術 ヘルニア、アッペ、その他 閉鎖孔ヘルニアに対し腹腔鏡下に修復しえた1例
    加藤 文崇; 常俊 雄介; 西 秀美; 清水 克修; 蛯原 健; 尾崎 貴洋; 天野 浩司; 中田 健; 臼井 章浩; 辻江 正樹; 木村 豊; 中田 康城; 大里 浩樹; 横田 順一朗
    日本腹部救急医学会雑誌 36 2 362 - 362 (一社)日本腹部救急医学会 2016年02月 [査読有り]
  • Open abdominal managementを用いた大腸穿孔に対する治療戦略
    天野 浩司; 川田 真大; 蛯原 健; 加藤 文崇; 尾崎 貴洋; 常俊 雄介; 臼井 章浩; 木村 豊; 中田 康城; 横田 順一朗
    日本腹部救急医学会雑誌 36 2 412 - 412 (一社)日本腹部救急医学会 2016年02月 [査読有り]
  • 虫垂憩室を伴う虫垂炎に対する治療方針
    蛯原 健; 常俊 雄介; 中田 健; 臼井 章浩; 清水 克修; 川田 真大; 尾崎 貴洋; 天野 浩司; 加藤 文崇; 中田 康城; 木村 豊; 横田 順一朗
    日本腹部救急医学会雑誌 36 2 415 - 415 (一社)日本腹部救急医学会 2016年02月 [査読有り]
  • Takahito Sugase; Tsuyoshi Takahashi; Kiyokazu Nakajima; Seiichi Hirota; Toru Masuzawa; Toshirou Nishida; Yutaka Kimura; Yasuhiro Miyazaki; Tomoki Makino; Yukinori Kurokawa; Makoto Yamasaki; Shuji Takiguchi; Masaki Mori; Yuichiro Doki
    Digestion 94 1 30 - 6 2016年 [査読有り]
     
    BACKGROUND: Duodenal gastrointestinal stromal tumors (GISTs) are a rare subset of GISTs (3-5%), and their clinicopathological features have not been fully described. The purpose of this retrospective study was to examine these characteristics and compare the operative procedures. METHODS: Twenty-five patients with duodenal GIST underwent complete resection, local resection (LR) or pancreaticoduodenectomy (PD) from 1990 to 2014 at our 2 hospitals. We analyzed patient characteristics, treatments, histological examinations, postoperative complications and survival outcomes. RESULTS: Twelve patients (48%) with no symptoms were incidentally diagnosed for unrelated reasons. Sixteen patients (64%) had c-kit mutations while 6 (24%) were wild-type, including 4 with a history of neurofibromatosis type 1. Comparing LR (n = 16) and PD (n = 9), the recurrence-free survival rate was significantly worse for PD. On multivariate analysis, however, tumor size was an independent and significant prognostic factor, but not operative procedure. There was no body weight change with LR, but body weight decreased by 7% with PD. CONCLUSION: Duodenal GISTs had different characteristic genetic mutations compared to other GISTs. LR for duodenal GISTs appears to be oncologically and nutritionally feasible.
  • 加藤 文崇; 中田 健; 笹松 信吾; 平木 洋子; 西 秀美; 清水 克修; 蛯原 健; 天野 浩司; 星野 宏光; 山村 順; 神垣 俊二; 山本 為義; 辻江 正樹; 木村 豊; 大里 浩樹
    癌と化学療法 42 12 1537 - 1539 (株)癌と化学療法社 2015年11月 [査読有り]
     
    緩和目的大腸ステントの有効性と安全性を評価するため、当院で緩和目的大腸ステント留置術を施行した症例を後ろ向きに検討した。2014年の1年間に当院では、9例に緩和治療目的大腸ステント留置術を施行した。挿入成功率は100%であり、合併症としては逸脱を1例認め、再留置を施行された。その他大きな合併症はなかった。半分以上の症例で、食事開始はステント留置後数日で可能となったが、1週間以上要した症例も3例あった。緩和治療目的大腸ステント留置により経口摂取ができ、栄養状態が改善すれば化学療法が可能になることもあり、予後の延長が期待できる。大腸ステント留置は手技が簡便であり、処置時間も短く、比較的安全に施行可能であり、患者のQOLの維持に有効な治療法といえる。当院の症例においては緩和目的大腸ステントの有効性、安全性が確認できた。長期予後は現在のところ明らかではなく、今後の検討が望まれる。(著者抄録)
  • 木村 豊; 蛯原 健; 加藤 文崇; 間狩 洋一; 三上 城太; 川瀬 朋乃; 浜川 卓也; 塚本 祐己; 藤森 正樹; 合原 彩; 光藤 大地; 薮田 隆正; 中田 健; 辻江 正樹; 北村 信次; 大里 浩樹
    癌と化学療法 42 12 1689 - 1691 (株)癌と化学療法社 2015年11月 [査読有り]
     
    症例は70歳代、男性。2009年3月、胃癌に対して幽門側胃切除術、D1郭清、Roux-en-Y再建を施行し、病理組織結果は印環細胞癌、T4a、N3a、H0、P1、CY1、M1、Stage IV、R2であった。2009年4月よりS-1+CDDPを17コース施行、2011年1月から術後5年目の2014年3月までS-1による化学療法19コースを行い、再発のないことを確認して化学療法を終了した。2014年6月に食欲不振、黄疸を認め、精査にて胃癌腹膜転移に伴う胆管狭窄、水腎症、直腸狭窄と診断された。胆管ステント、尿管カテーテルを挿入し、腸閉塞症状を伴う直腸Ra-Rsの狭窄に対して大腸ステント(NitiTM大腸ステント22mm×6cm)を挿入した。挿入後11日目にステント内への腫瘍のin-growthに対してAPC焼灼を行い、食事摂取が可能となり退院し、大腸ステント留置後67日目に原病死した。腹膜転移による直腸狭窄を伴う胃癌再発症例に対して、緩和目的の大腸ステントは有用である。(著者抄録)
  • 天野 浩司; 中田 健; 辻江 正樹; 笹松 信吾; 西 秀美; 平木 洋子; 清水 克修; 蛯原 健; 加藤 文崇; 星野 宏光; 三上 城太; 臼井 章浩; 山本 為義; 池田 直樹; 木村 豊
    癌と化学療法 42 12 2106 - 2108 (株)癌と化学療法社 2015年11月 [査読有り]
     
    播種性骨髄癌腫症は、しばしば播種性血管内凝固症候群(disseminated intravascular coagulation syndrome:DIC)を合併して急激な転帰をたどるが、大腸癌での報告は少なく、確立された治療法はない。症例は66歳、女性。盲腸癌・多発リンパ節転移・肝転移・骨転移と診断され治療開始予定であったところ、DICを伴う播種性骨髄癌腫症にて緊急入院となった。mFOLFOX6による全身化学療法を施行したところ、速やかにDICを離脱することができた。(著者抄録)
  • 蛯原 健; 山本 為義; 星野 宏光; 吉村 旬平; 笹松 信吾; 平木 洋子; 西 秀美; 清水 克修; 川田 真大; 井上 稔也; 加藤 文崇; 天野 浩司; 三上 城太; 山村 順; 間狩 洋一; 中田 健; 池田 直樹; 神垣 俊二; 辻江 正樹; 木村 豊; 中田 康城; 棟方 哲; 大里 浩樹
    癌と化学療法 42 12 2354 - 2356 (株)癌と化学療法社 2015年11月 [査読有り]
     
    症例は56歳、女性。身長156cm、体重90kg。BMI37と肥満を認め、糖尿病を罹患していた。右腎細胞癌(T2N0M0、Stage II:clear cell carcinoma)に対して右腎摘出術を行った。経過観察中にCTで脾門部に急速に増大する結節を認めた。PET-CTでは軽度のFDG集積(SUVmax=2.4)を認めた。膵との連続性は明らかではなかったが急速増大病変であり、造影CTで早期相が低吸収を呈していたことから膵癌と診断し、本人・家族に説明を行った上で膵体尾部脾合併切除術を行った。病理検査で脂肪置換部に発生した浸潤性膵管癌と診断した。術後、糖尿病の悪化、膵液瘻などの合併症は認めなかった。gemcitabineによる補助化学療法を行うも肺動脈血栓症を合併したため8コース目で中止となった。術後32ヵ月経過するが無再発生存中である。脂肪置換部では、腺房細胞は消失していたが膵管細胞は残存していた。膵管周囲は慢性の炎症像を認め、一部に浸潤性膵管癌と連続する上皮内癌を認めた。脂肪置換部は膵癌の前癌病変になり得る可能性がある。(著者抄録)
  • 蛯原 健; 臼井 章浩; 天野 浩司; 加藤 文崇; 森田 正則; 中田 健; 木村 豊; 横田 順一朗
    日本外科感染症学会雑誌 12 5 623 - 623 (一社)日本外科感染症学会 2015年11月 [査読有り]
  • 腹腔鏡下に摘出しえた後腹膜粘液嚢胞境界悪性腫瘍の1例
    加藤 文崇; 木村 豊; 蛯原 健; 天野 浩司; 星野 宏光; 森田 正則; 山村 順; 臼井 章浩; 中田 健; 神垣 俊二; 山本 為義; 池田 直樹; 辻江 正樹; 棟方 哲; 中田 康城; 大里 浩樹
    堺市立総合医療センター医学雑誌 16 30 - 33 (地独)堺市立病院機構堺市立総合医療センター 2015年11月 [査読有り]
     
    症例は20歳代女性で、左腹部の膨満感があり、腫瘤を自覚した。MRI検査で13cm大の嚢胞性腫瘤を指摘された。腹部(造影)CT検査では、左側腹部に13cm大の造影効果のない嚢胞性腫瘤を認めた。境界明瞭で内部は均一な低吸収域で、充実部分や隔壁は認めなかった。腹部MRI検査では左腹部に境界明瞭な腫瘤を認めた。T1強調画像で低信号、T2強調画像で高信号を呈し、嚢胞性腫瘤を認めた。嚢胞性リンパ管腫などの嚢胞性の後腹膜腫瘍の診断で、悪性腫瘍を完全に否定できないため、全身麻酔下に手術を施行した。術後経過は良好で、術後4日目に退院した。術後8ヵ月経過して再発を認めていない。
  • Kato F; Nakata K; Sasamatsu S; Hiraki Y; Nishi H; Shimizu K; Ebihara T; Amano K; Hoshino H; Yamamura J; Kamigaki S; Yamamoto T; Tsujie M; Kimura Y; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 1537 - 1539 2015年11月 [査読有り]
  • Kimura Y; Ebihara K; Kato F; Makari Y; Mikami J; Kawase T; Hamakawa T; Tsukamoto Y; Fujimori M; Gobaru A; Mitsudo D; Yabuta T; Nakata K; Tsujie M; Kitamura S; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 1689 - 1691 2015年11月 [査読有り]
  • Amano K; Nakata K; Tsujie M; Sasamatsu S; Nishi H; Hiraki Y; Shimizu K; Ebihara T; Kato F; Hoshino H; Mikami J; Usui A; Yamamoto T; Ikeda N; Kimura Y
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 2106 - 2108 2015年11月 [査読有り]
  • Ebihara T; Yamamoto T; Hoshino H; Yoshimura J; Sasamatsu S; Hiraki Y; Nishi H; Shimizu K; Kawada M; Inoue T; Kato F; Amano K; Mikami J; Yamamura J; Makari Y; Nakata K; Ikeda N; Kamigaki S; Tsujie M; Kimura Y; Nakata Y; Munakata S; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 2354 - 2356 2015年11月 [査読有り]
  • Kimura Y; Makari Y; Mikami J; Kawase T; Hamakawa T; Hoshino H; Nakata K; Yamamoto T; Yamamura J; Kamigaki S; Ikeda N; Tsujie M; Munakata S; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 1585 - 1587 2015年11月 [査読有り]
  • Shimizu K; Kimura Y; Hamakawa T; Mikami J; Makari Y; Kawase T; Hoshino H; Nakata K; Yamamura J; Kamigaki S; Ikeda N; Yamamoto T; Tsujie M; Ikeda H; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 1703 - 1705 2015年11月 [査読有り]
  • Hiraki Y; Kimura Y; Makari Y; Mikami J; Kawase T; Hamakawa T; Yamamura J; Kamigaki S; Hoshino H; Nakata K; Ikeda N; Yamamoto T; Tsujie M; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 42 12 1965 - 1967 2015年11月 [査読有り]
  • 回盲部切除術を必要とする急性虫垂炎の術前予測因子の検討
    清水 克修; 臼井 章浩; 蛯原 健; 加藤 文崇; 天野 浩司; 尾崎 貴洋; 三上 城太; 常俊 雄介; 木村 豊; 横田 順一朗
    Japanese Journal of Acute Care Surgery 5 2 243 - 243 日本Acute Care Surgery学会 2015年10月 [査読有り]
  • 内視鏡外科のトラブルシューティング(肝胆膵、腹壁瘢痕ヘルニア、イレウス、その他) 直腸穿孔に対する腹腔鏡下ハルトマン手術後、異なる機序によるイレウスで2回の手術を要した1例
    蛯原 健; 中田 健; 天野 浩司; 吉村 旬平; 笹松 信吾; 平木 洋子; 清水 克修; 西 秀美; 加藤 文崇; 尾崎 貴洋; 常俊 雄介; 臼井 章浩; 中田 康城; 木村 豊
    日本臨床外科学会雑誌 76 増刊 478 - 478 日本臨床外科学会 2015年10月 [査読有り]
  • 外科と救急を融合した、当院における若手育成 救命センター開設を経て
    常俊 雄介; 臼井 章浩; 蛯原 健; 尾崎 貴洋; 加藤 文崇; 天野 浩司; 中田 康城; 木村 豊; 大里 浩樹; 横田 順一朗
    日本臨床外科学会雑誌 76 増刊 551 - 551 日本臨床外科学会 2015年10月 [査読有り]
  • 当院の上部消化管穿孔症例におけるSSIのリスク因子についての検討
    天野 浩司; 臼井 章浩; 吉村 旬平; 笹松 信吾; 西 秀美; 平木 洋子; 清水 克修; 川田 真大; 井上 俊也; 尾崎 貴洋; 蛯原 健; 加藤 文崇; 木村 豊; 中田 康城; 横田 順一朗
    日本臨床外科学会雑誌 76 増刊 562 - 562 日本臨床外科学会 2015年10月 [査読有り]
  • 腹腔鏡下腹壁瘢痕ヘルニア修復術における三つの工夫
    中田 健; 辻江 正樹; 笹松 信吾; 平木 洋子; 西 秀美; 清水 克修; 蛯原 健; 加藤 文崇; 天野 浩司; 星野 宏光; 山村 順; 山本 為義; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 76 増刊 601 - 601 日本臨床外科学会 2015年10月 [査読有り]
  • 腹腔鏡下に摘出しえた粘液嚢胞腺腫の1例
    加藤 文崇; 笹松 信吾; 西 秀美; 平木 洋子; 清水 克修; 蛯原 健; 天野 浩司; 星野 宏光; 山村 順; 臼井 章浩; 中田 健; 山本 為善; 辻江 正樹; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 76 増刊 663 - 663 日本臨床外科学会 2015年10月 [査読有り]
  • 肝円索による肝静脈パッチ再建が有用であった大腸癌肝転移の1切除例
    星野 宏光; 山本 為義; 加藤 文崇; 三上 城太; 北原 睦識; 間狩 洋一; 山村 順; 中田 健; 神垣 俊二; 渋川 貴規; 池田 直樹; 辻江 正樹; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 76 増刊 883 - 883 日本臨床外科学会 2015年10月 [査読有り]
  • 繰り返す小腸イレウスをきたした好酸球性胃腸炎の1例
    笹松 信吾; 辻江 正樹; 棟方 哲; 栗生 明博; 片田 圭宜; 中田 健; 吉村 旬平; 平木 洋子; 西 秀美; 清水 克修; 井上 稔也; 蛯原 健; 加藤 文崇; 大天 浩司; 木村 豊
    日本臨床外科学会雑誌 76 増刊 962 - 962 日本臨床外科学会 2015年10月 [査読有り]
  • 若年症例に発症した急性陰圧性肺水腫の1例
    尾崎 貴洋; 臼井 章浩; 西 秀美; 清水 克修; 川田 真大; 蛯原 健; 加藤 文崇; 天野 浩司; 常俊 雄介; 田原 憲一; 森田 正則; 中田 康城; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 76 増刊 1020 - 1020 日本臨床外科学会 2015年10月 [査読有り]
  • 全身麻酔困難な終末期癌患者に発症した下部消化管閉塞に対し局所麻酔下に人工肛門造設術を施行した1例
    黒野 由莉; 天野 浩司; 中田 健; 笹松 信吾; 吉村 旬平; 西 秀美; 平木 洋子; 清水 克修; 川田 真大; 蛯原 健; 加藤 文崇; 三上 城太; 間狩 洋一; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 76 増刊 1173 - 1173 日本臨床外科学会 2015年10月 [査読有り]
  • Yukinori Kurokawa; Nariaki Matsuura; Yutaka Kimura; Shinichi Adachi; Junya Fujita; Hiroshi Imamura; Kenji Kobayashi; Yuhki Yokoyama; Mohammed Nouri Shaker; Shuji Takiguchi; Masaki Mori; Yuichiro Doki
    GASTRIC CANCER 18 4 691 - 697 2015年10月 [査読有り]
     
    Although some small-scale studies have suggested that human epidermal growth factor receptor 2 (HER2)-positive status in gastric cancer is associated with poor outcomes, the prognostic value of HER2 is still controversial. Since intratumoral HER2 heterogeneity is also an important issue, a multicenter large-scale study was conducted to evaluate the prognostic impacts of HER2 expression and intratumoral heterogeneity in gastric cancer. This study included 1,148 gastric cancer patients who underwent gastrectomy in 11 institutions. HER2 expression was centrally evaluated with immunohistochemistry and fluorescence in situ hybridization, and intratumoral HER2 heterogeneity was evaluated for HER2-positive tumors. Overall survival was compared between HER2-positive and HER2-negative patients and between the homogeneous and heterogeneous groups. The HER2-positive rate was 15.7 %, and HER2 expression was significantly associated with histological type. HER2 expression scores obtained by immunohistochemistry showed a distinct influence on survival, and HER2-positive patients showed much poorer survival than HER2-negative patients [hazard ratio (HR) 1.59, 95 % confidence interval (CI) 1.24-2.02; P < 0.001). The subgroup analysis by pathological tumor stage showed a similar trend of poor survival in HER2-positive patients. Both intestinal type and diffuse type showed significant poor survival in HER2-positive patients. Cox multivariate analysis revealed that HER2 expression was an independent prognostic factor (HR 1.96, 95 % CI 1.51-2.55; P < 0.001). HER2 heterogeneity was observed in 75.4 % of HER2-positive cases, but the prognosis in the heterogeneous group was similar to that in the homogeneous group. Our study demonstrated that HER2 overexpression is an independent prognostic factor in patients with any stage of resectable gastric cancer. Intratumoral HER2 heterogeneity did not affect prognosis.
  • 当院における高齢者虫垂炎症例の検討
    加藤 文崇; 西 秀美; 清水 克修; 蛯原 健; 天野 浩司; 森田 正則; 臼井 章浩; 木村 豊; 中田 康城; 大里 浩樹; 横田 順一朗
    日本救急医学会雑誌 26 8 299 - 299 (一社)日本救急医学会 2015年08月 [査読有り]
  • 【若手から見たAcute Care Surgery研修の現状、今求める研修とは】Acute Care Surgeonを目指す若手医師としての提言
    天野 浩司; 臼井 章浩; 西 秀美; 蛯原 健; 加藤 文崇; 森田 正則; 木村 豊; 中田 康城; 大里 浩樹; 横田 順一朗
    Japanese Journal of Acute Care Surgery 5 1 4 - 6 日本Acute Care Surgery学会 2015年07月 [査読有り]
  • Jun Yamamura; Shunji Kamigaki; Takuya Hamakawa; Hiromitsu Hoshino; Ken Nakata; Tameyoshi Yamamoto; Naoki Ikeda; Tomono Kawase; Masaki Tsujie; Yutaka Kimura; Hiroki Ozato
    Japanese Journal of Cancer and Chemotherapy 42 6 713 - 717 2015年06月 [査読有り]
     
    The CLEOPATRA trial showed a significant improvement in the progression-free survival (PFS) and overall survival of patients with HER2-positive first-line metastatic breast cancer (MBC) who were treated with pertuzumab (PER), trastuzumab (TRA), and docetaxel (DTX), compared to those treated with placebo, TRA, and DTX. PER was approved in 2013 for treating HER2-positive MBC in Japan. Herein, we present the retrospective review of data from 10 HER2-positive MBC patients who received PER in our hospital between September 2013 and August 2014. The median age was 52 years (range, 45-66 years), and 7 patients were positive for ER. Six patients had not received any previous chemotherapy for their metastatic disease, while the others had received comparatively heavy pretreatment doses of chemotherapy. Our patients received the PER, TRA, and DTX regimen, although 2 patients were treated without DTX. Four patients experienced a partial response, 6 patients experienced stable disease (SD), and 3 patients experienced SD for ≥ 6 months. The response rate was 40%, and the clinical benefit rate was 70%. The median PFS was 7.3 months (range, 2.5-11.5 months). Grade 3 neutropenia and allergic reactions were observed in 1 and 2 patients, respectively no Grade 4 adverse events were observed, and thus, the regimen was well tolerated. Further clinical research seems to be warranted for developing new treatment strategies involving PER for HER2-positive MBC.
  • Hirao M; Kurokawa Y; Fujita J; Imamura H; Fujiwara Y; Kimura Y; Takiguchi S; Mori M; Doki Y; Osaka University Clinical Research Group for Gastroenterological Study
    Surgery 157 6 1099 - 105 2015年06月 [査読有り]
     
    BACKGROUND: Bursectomy, a traditional operative procedure to remove the peritoneal lining covering the pancreas and the anterior plane of the transverse mesocolon, has been performed for serosa-positive gastric cancer in Japan and Eastern Asia. We conducted a multicenter, randomized, controlled trial to demonstrate the noninferiority of the omission of bursectomy. METHODS: Between July 2002 and January 2007, 210 patients with cT2-3 gastric adenocarcinoma were randomized intraoperatively to D2 gastrectomy with or without bursectomy. The primary endpoint was overall survival (OS). We provide the results of the final analysis of the complete 5-year follow-up data. RESULTS: After the median follow-up of 80 months, 5-year OS was 77.5% for the bursectomy group and 71.3% for the nonbursectomy group (2-sided P = .16 for superiority; 1-sided P = .99 for noninferiority). The hazard ratio for death in the nonbursectomy group was 1.40 (95% CI, 0.87-2.25). The 5-year recurrence-free survivals were 73.7% and 66.6% in the bursectomy and nonbursectomy groups, respectively (2-sided P = .33 for superiority; 1-sided P = .99 for noninferiority). Cox multivariate analysis revealed that bursectomy was an independent prognostic factor of good OS (P = .033). Subgroup analysis showed a trend toward improved survival after bursectomy for tumors in the middle or lower third of the stomach and for pathologically serosa-positive tumors. CONCLUSION: The final analysis could not demonstrate the noninferiority of the omission of bursectomy. Bursectomy should not be abandoned as a futile procedure.
  • 上部消化管 食道癌術前化学療法中の有害事象と術中後合併症との関連 「切除可能進行食道癌にたいする術前FAP versus DCF併用化学療法のランダム化比較試験(OGSG1003)」結果から
    平尾 素宏; 宮田 博志; 山崎 誠; 安田 卓司; 白石 治; 矢野 雅彦; 本告 正明; 藤谷 和正; 西川 和宏; 山本 和義; 小林 研二; 高地 耕; 川田 純司; 田村 茂行; 赤丸 祐介; 木村 豊; 古河 洋; 土岐 祐一郎
    日本外科学会定期学術集会抄録集 115回 OP - 7 (一社)日本外科学会 2015年04月
  • 栄養・感染症・緩和 緩和ループストーマ造設術における挙上腸管の選択と手技の問題点
    中田 健; 辻江 正樹; 笹松 信吾; 平木 洋子; 西 秀美; 清水 克修; 蛯原 健; 加藤 文崇; 天野 浩司; 浜川 卓也; 星野 宏光; 森田 正則; 山村 順; 臼井 章浩; 山本 為義; 神垣 俊二; 池田 直樹; 川瀬 朋乃; 中田 康城; 木村 豊; 大里 浩樹
    日本外科学会定期学術集会抄録集 115回 OP - 6 (一社)日本外科学会 2015年04月 [査読有り]
  • 救急・外傷 Acute Care Surgeryの実現 救命救急センターを開設するにあたり
    蛯原 健; 臼井 章浩; 西 秀美; 加藤 文崇; 天野 浩司; 森田 正則; 中田 康城; 木村 豊; 大里 浩樹; 横田 順一朗
    日本外科学会定期学術集会抄録集 115回 OP - 1 (一社)日本外科学会 2015年04月 [査読有り]
  • 2nd line化学療法をどうするか 諸臨床試験の結果をふまえて S-1単独またはS-1/CDDP併用治療抵抗性進行・再発胃癌に対する二次治療のランダム化第II相試験(OGSG0701)
    今村 博司; 後藤 昌弘; 木村 豊; 上田 修吾; 松山 仁; 西川 和宏; 藤田 淳也; 杉本 直哉; 広田 将司; 高田 晃宏; 坂井 大介; 黒川 幸典; 下川 敏雄; 辻仲 利政; 古河 洋
    日本胃癌学会総会記事 87回 196 - 196 (一社)日本胃癌学会 2015年03月
  • 腹部救急領域における周術期感染予防と治療の工夫 腹膜炎術後のSSI予防に対するNegative Pressure Wound Therapyの有用性
    臼井 章浩; 天野 浩司; 加藤 文崇; 蛯原 健; 中田 健; 浜川 卓也; 辻江 正樹; 木村 豊
    日本腹部救急医学会雑誌 35 2 356 - 356 (一社)日本腹部救急医学会 2015年02月 [査読有り]
  • 腹部救急疾患に対する鏡視下手術 ここまでできる鏡視下手術 急性腹症に対する緊急腹腔鏡手術の検討
    中田 健; 西 秀美; 蛯原 健; 加藤 文崇; 天野 浩司; 森田 正則; 臼井 章浩; 木村 豊; 中田 康城
    日本腹部救急医学会雑誌 35 2 363 - 363 (一社)日本腹部救急医学会 2015年02月 [査読有り]
  • 爪楊枝の胃壁穿通による肝膿瘍の1例
    加藤 文崇; 山本 為義; 西 秀美; 蛯原 健; 天野 浩司; 星野 宏光; 臼井 章浩; 木村 豊; 大里 浩樹; 横田 順一朗
    日本腹部救急医学会雑誌 35 2 391 - 391 (一社)日本腹部救急医学会 2015年02月 [査読有り]
  • イレウスに対して鏡視下手術を行った経験
    蛯原 健; 中田 健; 西 秀美; 天野 浩司; 加藤 文崇; 臼井 章浩; 森田 正則; 中田 康城; 木村 豊; 大里 浩樹; 横田 順一朗
    日本腹部救急医学会雑誌 35 2 425 - 425 (一社)日本腹部救急医学会 2015年02月 [査読有り]
  • 術前診断し腹腔鏡で手術した胆嚢捻転症の治療経験
    天野 浩司; 山本 為義; 星野 宏光; 西 秀美; 蛯原 健; 加藤 文崇; 臼井 章浩; 木村 豊; 大里 浩樹; 横田 順一朗
    日本腹部救急医学会雑誌 35 2 446 - 446 (一社)日本腹部救急医学会 2015年02月 [査読有り]
  • 宮﨑 進; 木村 豊; 藤谷 和正; 門田 卓士
    日本外科系連合学会誌 40 5 858 - 862 日本外科系連合学会 2015年 
    症例は73歳，男性，LD領域のtype2型の胃癌に対して平成18年６月幽門側胃切除，D2郭清，Roux-Y再建，胆囊摘出術を施行した．術後，吻合部狭窄以外に合併症を認めず，術後４週間で軽快退院となった．退院後２日目（術後30日目）より腹部膨満が出現し，入院となった．多量の腹水を認め，腹水性状は乳白色に混濁した乳縻腹水であった．絶食，高カロリー輸液，利尿剤投与，腹水ドレナージチューブ挿入による保存的治療が奏効し，入院後49日目に軽快退院となった．術後乳縻腹水は食事摂取開始早期から発症することが多く，術後１カ月以上経過して発症することは稀であるため，文献的考察を加えて報告した．
  • 福永 睦; 中田 健; 馬場谷 彰仁; 清水 克修; 石垣 貴彦; 蛯原 健; 大久保 聡; 加藤 文崇; 天野 浩司; 星野 宏光; 川端 良平; 山村 準; 神垣 俊二; 臼井 彰浩; 池田 直樹; 山本 為義; 川瀬 朋乃; 木村 豊; 大里 浩樹
    癌と化学療法 41 12 1773 - 1775 (株)癌と化学療法社 2014年11月 [査読有り]
     
    症例は58歳、女性。S状結腸癌にて高位前方切除術後に多発性肝転移を認めた。一次治療としてbevacizumab+FOLFOX、二次治療としてbevacizumab+FOLFIRI、IRIS療法を施行し、その間に肝切除術3回とラジオ波焼灼術1回を施行した。その後、多発性肺転移に対し三次治療としてpanitumumab+irinotecanを投与し、PRを得た。PD後に他院にて治験薬(TAS102)の四次治療を受けた。PD後に五次治療としてcetuximab+irinotecanを施行し、2ヵ月後のCTでは23%の腫瘍縮小を認めた。最良効果はSDであったが、8ヵ月の治療継続後PDにて六次治療のregorafenibに移行した。KRAS野生型の再発大腸癌において、抗EGFR抗体薬の再導入は一部の患者においては腫瘍縮小が期待できる治療法と思われる。(著者抄録)
  • Fukunaga M; Nakata K; Babaya A; Shimizu K; Ishigaki T; Ebihara T; Okubo S; Kato F; Amano K; Hoshino H; Kawabata R; Yamamura J; Kamigaki S; Usui A; Ikeda N; Yamamoto T; Kawase T; Kimura Y; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 41 12 1773 - 1775 2014年11月 [査読有り]
  • Akihito Babaya; Ken Nakata; Mutsumi Fukunaga; Hiromitsu Hoshino; Ryohei Kawabata; Tameyoshi Yamamoto; Tomono Kawase; Yutaka Kimura; Hiroki Ohzato
    Japanese Journal of Cancer and Chemotherapy 41 12 1846 - 1848 2014年11月 [査読有り]
     
    A 60-year-old man presented to our hospital with melena. A submucosal tumor (24 mm) was found via magnetic resonance imaging between the prostate and the rectum (Rb). A gastrointestinal stromal tumor (GIST) that displaced the prostate ventrally was diagnosed via histopathology. Preoperative imatinib treatment was initiated to reduce the tumor size and prevent extensive surgery. Approximately 33% of the tumor was reduced using chemotherapy. First, laparoscopic rectal dissection and mobilization were performed reaching the pelvic floor. Then, we performed perineal partial rectal resection. There has been no recurrence.
  • 腹腔鏡下手術におけるラパーゼを用いたセプラフィルム貼付の工夫
    中田 健; 辻江 正樹; 加藤 文崇; 天野 浩司; 浜川 卓也; 星野 宏光; 山村 順; 山本 為義; 川瀬 朋乃; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 75 増刊 469 - 469 日本臨床外科学会 2014年10月 [査読有り]
  • 若手から見たAcute Care Surgery研修の現状、今求める研修とは Acute care surgeonを目指す若手としての将来像
    天野 浩司; 西 秀美; 蛯原 健; 加藤 文崇; 森田 正則; 臼井 章浩; 木村 豊; 中田 康城; 大里 浩樹; 横田 順一朗
    Japanese Journal of Acute Care Surgery 4 2 142 - 142 日本Acute Care Surgery学会 2014年09月 [査読有り]
  • Oncologic Emergencyに対するAcute Care Surgeryの現状と課題 閉塞性大腸癌に対する当院の治療についての検討
    加藤 文崇; 西 秀美; 蛯原 健; 天野 浩司; 森田 正則; 臼井 章浩; 中田 康城; 木村 豊; 大里 浩樹; 横田 順一朗
    Japanese Journal of Acute Care Surgery 4 2 171 - 171 日本Acute Care Surgery学会 2014年09月 [査読有り]
  • 直腸損傷に対する腹腔鏡手術の経験
    蛯原 健; 臼井 章浩; 西 秀美; 天野 浩司; 加藤 文崇; 中田 健; 森田 正則; 中田 康城; 木村 豊; 大里 浩樹; 横田 順一朗
    Japanese Journal of Acute Care Surgery 4 2 247 - 247 日本Acute Care Surgery学会 2014年09月 [査読有り]
  • Fujita J; Takiguchi S; Nishikawa K; Kimura Y; Imamura H; Tamura S; Ebisui C; Kishi K; Fujitani K; Kurokawa Y; Mori M; Doki Y
    Surgery today 44 9 1723 - 9 2014年09月 [査読有り]
     
    PURPOSE: LigaSure, a bipolar electronic vessel sealing system, has become popular in abdominal surgery but few clinical studies have been conducted to evaluate its effectiveness in radical gastrectomy for gastric cancer. METHODS: In this multicenter, prospective, randomized controlled trial, patients with curative gastric cancer were randomly assigned to undergo gastrectomy either with LigaSure or a conventional technique. RESULTS: Of the 160 patients enrolled, 80 were randomized to the LigaSure group and 78 to the conventional group. Patient characteristics were well balanced in the two groups. There were no significant differences between the LigaSure and conventional groups in blood loss (288 vs. 260 ml, respectively; P = 0.748) or operative time (223 and 225 min, respectively; P = 0.368); nor in the incidence of surgical complications or duration of postoperative hospital stay. In a subgroup analysis of patients who underwent gastrectomy that preserved the distal part of the greater omentum, the use of LigaSure significantly reduced blood loss (179 vs. 245 ml; P = 0.033), and the duration of the operation (195 vs. 221 min; P = 0.039). CONCLUSIONS: LigaSure did not contribute to reducing intraoperative blood loss, operative time, or other adverse surgical outcomes. The usefulness of the device may be limited to a specific part of the surgical procedure in open gastrectomy.
  • S-1単独またはS-1/CDDP併用治療抵抗性進行・再発胃癌に対する二次治療のランダム化第II相試験(OGSG0701)
    上田 修吾; 今村 博司; 後藤 昌弘; 木村 豊; 松山 仁; 西川 和宏; 藤田 淳也; 杉本 直俊; 黒川 幸典; 古河 洋
    日本消化器外科学会総会 69回 P - 4 (一社)日本消化器外科学会 2014年07月
  • S-1を含む治療に抵抗性となった進行胃癌に対する二次治療のランダム化第II相試験
    藤田 淳也; 今村 博司; 後藤 昌弘; 木村 豊; 上田 修吾; 松山 仁; 西川 和弘; 杉本 直俊; 田村 孝雄; 福島 紀雅; 坂井 大介; 黒川 幸典; 下川 敏雄; 辻仲 利政; 古河 洋
    日本癌治療学会誌 49 3 1287 - 1287 (一社)日本癌治療学会 2014年06月
  • 切除不能進行再発大腸癌に対する抗EGFR抗体薬再導入症例の検討
    中田 健; 福永 睦; 馬場谷 彰仁; 清水 克修; 石垣 貴彦; 蛯原 健; 加藤 文崇; 天野 浩司; 大久保 聡; 星野 宏光; 川端 良平; 山本 為義; 川瀬 朋乃; 木村 豊; 大里 浩樹
    日本癌治療学会誌 49 3 2014 - 2014 (一社)日本癌治療学会 2014年06月 [査読有り]
  • Takaki Yoshikawa; Kazuaki Tanabe; Kazuhiro Nishikawa; Yuichi Ito; Takanori Matsui; Yutaka Kimura; Shinichi Hasegawa; Toru Aoyama; Tsutomu Hayashi; Satoshi Morita; Yumi Miyashita; Akira Tsuburaya; Junichi Sakamoto
    ANNALS OF SURGICAL ONCOLOGY 21 385 - 389 2014年06月 [査読有り]
     
    Accuracy of the radiologic diagnosis of gastric cancer staging after neoadjuvant chemotherapy remains unclear. Patients enrolled in the COMPASS trial, a randomized phase II study comparing two and four courses of S-1 plus cisplatin and paclitaxel and cisplatin followed by gastrectomy, were examined. The radiologic stage was determined by using thin-slice computed tomography (CT) or multidetector low CT by following Habermann's method. A total of 75 patients registered in the COMPASS study who underwent surgical resection were examined in this study. The radiologic T and pathologic T stages were not significantly correlated (p = 0.221). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 42.7, 10.7, and 46.7%, respectively. When patients were stratified according to the pathologic response of the primary tumor, the correlation was not significant in either the responders (n = 32, p = 0.410) or the nonresponders (n = 43, p = 0.742). The radiologic accuracy was 37.5% in the responders and 42.7% in the nonresponders. The radiologic N and pathologic N stages were significantly correlated (p = 0.000). The radiologic accuracy and rates of underdiagnosis and overdiagnosis were 44, 29.3, and 26.7%, respectively. When stratifying the patients with measurable lymph nodes according only to the radiologic response, the correlation was significant in the nonresponders (n = 23, p = 0.035) but not in the responders (n = 28, p = 0.634). The radiologic accuracy was 39.3% in the responders and 52.1% in the nonresponders. Restaging using CT after neoadjuvant chemotherapy for gastric cancer is considered to be inaccurate and unreliable. In particular, the radiologic T-staging determined after neoadjuvant chemotherapy should not be considered in clinical decision-making.
  • Kazumasa Fujitani; Shigeyuki Tamura; Yutaka Kimura; Takeshi Tsuji; Jin Matsuyama; Shohei Iijima; Hiroshi Imamura; Kentaro Inoue; Kenji Kobayashi; Yukinori Kurokawa; Toshio Shimokawa; Toshimasa Tsujinaka; Hiroshi Furukawa
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 17 2 348 - 53 2014年04月 [査読有り]
     
    BACKGROUND: We have previously reported the superior feasibility and safety of adjuvant S-1 plus docetaxel in patients with stage III gastric cancer during a prospective phase II study. We report 3-year follow-up data on patients enrolled in this study. PATIENTS AND METHODS: Fifty-three patients with histologically confirmed stage III gastric cancer who underwent gastrectomy with D2 lymphadenectomy were enrolled into this study. They received oral S-1 (80 mg/m(2)/day) for 2 consecutive weeks and intravenous docetaxel (40 mg/m(2)) on day 1, repeated every 3 weeks (one cycle). Treatment was initiated within 45 days after surgery and repeated for four cycles, followed by S-1 monotherapy (4 weeks on, 2 weeks off) until 1 year after surgery. Three-year overall survival (OS) and disease-free survival (DFS) were evaluated. RESULTS: The OS rate at 3 years was 78.4 % [95 % confidence interval (CI), 67.9-90.6 %] and the DFS rate at 3 years was 66.2 % (95 % CI, 54.4-80.7 %). Subgroup analyses according to disease stage showed a 3-year OS and DFS rate of 85.7 % (95 % CI, 74.9-98.1 %) and 70.8 % (95 % CI, 57.1-87.8 %) for stage IIIA, and 62.5 % (95 % CI, 42.8-91.4 %) and 56.2 % (95 % CI, 36.5-86.7 %) for stage IIIB, respectively. CONCLUSIONS: On the basis of 3-year follow-up data, postoperative adjuvant therapy with S-1 plus docetaxel yielded promising OS and DFS in stage IIIA gastric cancer patients who had undergone D2 gastrectomy. We believe that this regimen is a candidate for future phase III trials studying the optimal adjuvant chemotherapy regimen for stage III gastric cancer.
  • Yoshiyuki Fujiwara; Kaoru Okada; Hiroyuki Hanada; Shigeyuki Tamura; Yutaka Kimura; Jyunya Fujita; Hiroshi Imamura; Kentaro Kishi; Masahiko Yano; Hirohumi Miki; Kazuyuki Okada; O. Takayama; Taro Aoki; Masaki Mori; Yuichiro Doki
    SURGERY 155 3 417 - 423 2014年03月 [査読有り]
     
    Purpose. We have developed a novel molecular method of diagnosis using the technique of transcriptase-reverse transcriptase concerted reaction (TRC) for the detection of cancer micrometastasis. This study prospectively examined the clinical importance of the TRC diagnosis with peritoneal lavage fluids collected from gastric cancer operations at multiple institutes. Methods. TRC amplification targeting carcinoembryonic antigen mRNA was applied to detect gastric cancer cells in peritoneal lavage fluids obtained during gastric cancer resections from nine different hospitals. A total of 137 patients with a clinical diagnosis of serosa-invading neoplasms were enrolled to investigate the correlation between the TRC diagnosis and patient prognosis. Results. Of the 137 patients, 27 (20%) were positive by cytologic examination. In contrast, TRC targeting carcinoembryonic antigen mRNA was positive in 59 of 137 (54%) patients. TRC positivity was associated with a poorer overall survival in all patients and in the 104 patients who underwent a curative operation. TRC positivity also was associated with the peritoneal recurrence-free survival rate in the 104 curative cases. Multivariate analysis showed that TRC positivity and the pathologic N factor were prognostic factors for the overall survival time. Conclusion. Our prospective multicenter study showed that the TRC test using peritoneal lavage fluids could be a potential prognostic factor to predict patient survival and peritoneal recurrence with clinically diagnosed, serosa-invading gastric cancer.
  • Shunji Endo; Shuji Takiguchi; Yasuhiro Miyazaki; Kazuhiro Nishikawa; Hiroshi Imamura; Ko Takachi; Yutaka Kimura; Atsushi Takeno; Shigeyuki Tamura; Masaki Mori; Yuichiro Doki
    JOURNAL OF SURGICAL ONCOLOGY 109 3 208 - 212 2014年03月 [査読有り]
     
    Background and ObjectivesGastroduodenal stents for gastric outlet obstruction due to unresectable advanced gastric cancer are increasingly used; however, their effects have not been fully evaluated. MethodsA multicenter prospective observational study was performed. Patients were eligible if they had stage IV gastric cancer with a gastric outlet obstruction scoring system (GOOSS) score of 0 (no oral intake) or 1 (liquids only). Self-expandable metallic stents were delivered endoscopically. The effects of stents were evaluated. ResultsTwenty patients were enrolled and 18 were eligible (15 men, three women; median age, 70 years). Stent placement was successfully performed in all patients, with no complications. After stenting, a GOOSS score of 2 (soft solids only) or 3 (low-residue or full diet) was achieved in 13 (72%) patients. An improvement in the GOOSS score by one or more points was obtained in 16 (94%) patients. The median duration of fasting and hospital stay was 3 (range, 0-9) days and 18 (6-168) days, respectively. Chemotherapy was performed after stenting in 13 (72%) patients. ConclusionsGastroduodenal stents are thought to be feasible, safe, and effective for gastric outlet obstruction due to unresectable advanced gastric cancer, with rapid clinical relief and a short hospital stay. J. Surg. Oncol. 2014 109:208-212. (c) 2013 Wiley Periodicals, Inc.
  • Shigeyuki Tamura; Yoshiyuki Fujiwara; Yutaka Kimura; Junya Fujita; Hiroshi Imamura; Masakatsu Kinuta; Masahiko Yano; Masahiro Hiratsuka; Kenji Kobayashi; Kaoru Okada; Masaki Mori; Yuichiro Doki
    JOURNAL OF SURGICAL ONCOLOGY 109 2 75 - 80 2014年02月 [査読有り]
     
    ObjectiveThe purpose of this study is to define the clinical significance of the molecular analysis of peritoneal lavage fluid in patients with gastric cancer in a multicenter prospective trial. MethodsQuantitative RT-PCR with CEA and CK-20 mRNA as target markers was introduced for peritoneal lavage diagnosis in 141 patients with clinically advanced gastric cancer from 9 different institutes. We then evaluated the prognostic factors in patients and also evaluated predictive markers for peritoneal recurrence in 124 patients without peritoneal metastasis at surgery ResultsOut of the 141 cases, 140 patients were successfully analyzed by RT-PCR of peritoneal lavage fluids. According to multivariate analysis, the combined results of RT-PCR (CEA and CK-20) and CK-20 alone in addition to pathological N (pN)-stage were significantly correlated with overall survival. Multivariate analysis showed that the RT-PCR (CEA and CK-20) and CEA alone in addition to pathological T-stage, pN-stage, and histological grade were significantly correlated with peritoneal recurrence after surgery. ConclusionThis is the first multicenter prospective study to show that RT-PCR analysis of peritoneal lavage fluid with the combination of CEA and CK-20 markers was useful for predicting overall survival and peritoneal recurrence in patients with clinically advanced gastric cancer. J. Surg. Oncol. 2014 109:75-80. (c) 2013 Wiley Periodicals, Inc.
  • Hiroshi Imamura; Tomono Kishimoto; Hiroya Takiuchi; Yutaka Kimura; Takashi Morimoto; Motohiro Imano; Shohei Iijima; Keishi Yamashita; Kentaro Maruyama; Toshio Otsuji; Yukinori Kurokawa; Hiroshi Furukawa
    Journal of chemotherapy (Florence, Italy) 26 1 57 - 61 2014年02月 [査読有り]
     
    BACKGROUND: S-1+cisplatin (CDDP) is the standard treatment for advanced gastric cancer (AGC) in Japan and Korea. However, the usefulness of S-1 based chemotherapy for elderly patients is unclear. Therefore, we conducted a multicenter phase II study of S-1 monotherapy for AGC in elderly patients. MATERIALS AND METHODS: Chemotherapy-naïve patients aged over 75 years with AGC were enrolled. The starting dose of S-1 was determined on the basis of body surface area and modified according to the creatinine clearance value. S-1 was administered twice a day during a 4-week period followed by a 2-week rest period. RESULTS: Thirty-five patients were enrolled. The response rate (RR) was 14.3% and the median overall survival was 14.6 months. Grade 3 or more severe adverse events consisted of anaemia (3%), neutropaenia (3%), anorexia (3%), and fatigue (6%). There were no treatment-related deaths. CONCLUSION: Our study indicates that S-1 monotherapy is safe and well tolerated in chemotherapy-naïve elderly patients with AGC, but exerts limited activity when given using a tailor-made dosing strategy based on renal function.
  • Takaki Yoshikawa; Kazuaki Tanabe; Kazuhiro Nishikawa; Yuichi Ito; Takanori Matsui; Yutaka Kimura; Naoki Hirabayashi; Shoki Mikata; Makoto Iwahashi; Ryoji Fukushima; Nobuhiro Takiguchi; Isao Miyashiro; Satoshi Morita; Yumi Miyashita; Aakira Tsuburaya; Junichi Sakamoto
    ANNALS OF SURGICAL ONCOLOGY 21 1 213 - 219 2014年01月 [査読有り]
     
    Background. The prognosis for stage 3 gastric cancer is not satisfactory, even with S-1 adjuvant chemotherapy. A randomized phase II trial was conducted to compare two and four courses of neoadjuvant S-1/cisplatin (SC) and paclitaxel/cisplatin (PC) using a two-by-two factorial design for locally advanced gastric cancer. The primary endpoint was overall survival. We clarified the impact of these regimens on the secondary endpoints, including the clinical and pathological responses, chemotherapy-related toxicities, and surgical results. Methods. Patients received S-1 (80 mg/m(2) for 21 days with 1 week's rest)/cisplatin (60 mg/m(2) at day 8) or paclitaxel/cisplatin (80 and 25 mg/m(2), respectively, on days 1, 8, and 15 with 1 week's rest) as neoadjuvant chemotherapy. Results. Eighty-three patients were assigned to arm A (two courses of SC, n = 21), arm B (four courses of SC, n = 20), arm C (two courses of PC, n = 21), and arm D (four courses of PC, n = 21). Pathological response rate was 43 % in arm A, 40 % in arm B, 29 % in arm C, and 38 % in arm D. Pathological complete response was only observed in arms B (10 %) and D (10 %). Most bone marrow toxicities, nausea, vomiting, alopecia, and fatigue were slightly higher but acceptable in arms B and D. Grade 3/4 surgical morbidities were not commonly observed in all four arms. Conclusions. Pathological complete response could be induced by four courses of neoadjuvant chemotherapy without a marked increase of toxicities, regardless of a SC or PC regimen.
  • Toru Masuzawa; Shuji Takiguchi; Motohiro Hirao; Hiroshi Imamura; Yutaka Kimura; Junya Fujita; Isao Miyashiro; Shigeyuki Tamura; Masahiro Hiratsuka; Kenji Kobayashi; Yoshiyuki Fujiwara; Masaki Mori; Yuichiro Doki
    World Journal of Surgery 38 5 1100 - 1106 2014年 [査読有り]
     
    Background: Various surgical procedures are used to treat early gastric cancers in the upper third of the stomach (U-EGCs). However, there is no general agreement regarding the optimal surgical procedure. Methods: The medical records of 203 patients with U-EGC were collected from 13 institutions. Surgical procedures were classified as Roux-en-Y esophagojejunostomy after total gastrectomy (TG-RY), esophagogastrostomy after proximal gastrectomy (PG-EG), or jejunal interposition after PG (PG-JI). Patient clinical characteristics and perioperative and long-term outcomes were compared among these three groups. Results: TG-RY, PG-EG, and PG-JI were performed in 122, 49, and 32 patients, respectively. Tumors were larger in TG-RY patients than in PG-EG and PG-JI patients, and undifferentiated-type gastric adenocarcinoma tended to be more frequent in TG-RY than in PG-EG. The operative time was shorter for PG-EG than for PG-JI and TG-RY. Hospital stay and early postoperative complications were not different for the three procedures. With respect to gastrectomy-associated symptoms, a "stuck feeling" and heartburn tended to be more frequent in PG-EG patients, while dumping syndrome and diarrhea were more frequent in TG-RY patients. Post-surgical weight loss was not different among the three groups, however, serum albumin and hemoglobin levels tended to be lower in TG-RY patients. Conclusion: Three surgical procedures for U-EGC did not result in differences in weight loss, but PG-EG and PG-JI were better than TG-RY according to some nutritional markers. In U-EGC, where patients are expected to have long survival times, PG-EG and PG-JI should be used rather than TG-RY. © 2013 Société Internationale de Chirurgie.
  • 腹壁ヘルニア・その他の手術法の工夫 当院における腹壁瘢痕ヘルニアに対する腹腔鏡下手術の検討
    馬場谷 彰仁; 中田 健; 石垣 貴彦; 清水 克修; 蛯原 健; 大久保 聡; 天野 浩司; 加藤 文崇; 星野 宏光; 川端 良平; 山本 為義; 川瀬 朋乃; 木村 豊; 福永 睦; 大里 浩樹
    日本内視鏡外科学会雑誌 18 7 349 - 349 (一社)日本内視鏡外科学会 2013年11月 [査読有り]
  • 下部消化管穿孔に対し腹腔鏡下ハルトマン手術を施行した3例
    中田 健; 福永 睦; 馬場谷 彰仁; 清水 克修; 石垣 貴彦; 蛯原 健; 大久保 聡; 加藤 文崇; 天野 浩司; 星野 宏光; 川端 良平; 山本 為義; 川瀬 朋乃; 木村 豊; 大里 浩樹
    日本内視鏡外科学会雑誌 18 7 545 - 545 (一社)日本内視鏡外科学会 2013年11月 [査読有り]
  • Nakata K; Fukunaga M; Ebihara T; Kato F; Amano K; Babaya A; Matsushita A; Furukawa H; Matsushima Y; Matsumoto H; Fujihara S; Kawabata R; Usui A; Yamamoto T; Oda K; Kawase T; Kimura Y; Nakata Y; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 40 12 1702 - 1704 2013年11月 [査読有り]
  • Furukawa H; Fukunaga M; Munakata S; Kawabata R; Nakata K; Yamamoto T; Kawase T; Kimura Y; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 40 12 2068 - 2070 2013年11月 [査読有り]
  • Kimura Y; Kawase T; Kawabata R; Imamura H; Nakata K; Yamamoto T; Kamigaki S; Oda K; Munakata S; Fukunaga M; Ohzato H
    Gan to kagaku ryoho. Cancer & chemotherapy 40 12 2235 - 2237 2013年11月 [査読有り]
  • 直腸憩室穿孔に対し、腹腔鏡下ハルトマンおよび腹腔鏡下リバーサルを施行した一例
    加藤 文崇; 中田 健; 石垣 貴彦; 清水 克修; 福永 睦; 大久保 聡; 馬場谷 彰仁; 天野 浩司; 大里 浩樹; 星野 宏光; 川端 良平; 山村 順; 山本 為義; 岸本 朋乃; 木村 豊
    日本臨床外科学会雑誌 74 増刊 638 - 638 日本臨床外科学会 2013年10月 [査読有り]
  • ストーマ脱出に対し腹壁固定術を施行した5例の経験
    中田 健; 福永 睦; 石垣 恒彦; 清水 克修; 蛯原 健; 大久保 聡; 馬場谷 彰仁; 加藤 文崇; 天野 浩司; 星野 宏光; 川端 良平; 川瀬 朋乃; 山本 為義; 木村 豊; 大里 浩樹
    日本臨床外科学会雑誌 74 増刊 758 - 758 日本臨床外科学会 2013年10月 [査読有り]
  • CTにて術前診断しえた大腿ヘルニア虫垂嵌頓の1例
    大久保 聡; 石垣 貴彦; 清水 克修; 馬場谷 彰仁; 加藤 文崇; 星野 宏光; 川端 良平; 川瀬 朋乃; 中田 健; 木村 豊; 福永 睦; 大里 浩樹
    日本臨床外科学会雑誌 74 増刊 784 - 784 日本臨床外科学会 2013年10月 [査読有り]
  • 切除不能転移再発大腸癌に対し抗EGFR抗体薬を使用した82例の検討
    中田 健; 福永 睦; 馬場谷 彰仁; 清水 克修; 石垣 貴彦; 蛯原 健; 加藤 文崇; 天野 浩司; 大久保 聡; 星野 宏光; 川端 良平; 山本 為義; 川瀬 朋乃; 木村 豊; 大里 浩樹
    日本癌治療学会誌 48 3 1470 - 1470 (一社)日本癌治療学会 2013年09月 [査読有り]
  • 柳川 雄大; 吉田 哲也; 木村 豊; 渡部 亜実; 門田 卓士; 今岡 真義
    日本臨床外科学会雑誌 = The journal of the Japan Surgical Association 74 7 1832 - 1837 Japan Surgical Association 2013年07月 
    症例は76歳，女性．平成15年5月に右乳癌にてBt+Ax施行した．病理結果は乳頭腺管癌，ER71％，PgR33％，HER2（-），pT4bN1M0，Stage IIIBで，術後CMF療法・PMRTを施行した．平成17年5月に縦隔・頸部・腹部リンパ節転移を認め，ホルモン療法（ANA→LET→TAM）を開始したが，平成22年10月 胸部中部食道に2型腫瘍を認めた．生検結果はGroup V，ER（+），HER2（+）で乳癌の食道転移と診断した．trastuzumab+docetaxel→trastuzumab+vinorelbine→FECを施行したところ腫瘍部に食道気管支瘻を生じ，平成23年8月から肺炎を繰り返したため，食道カバードステントを留置した．その後，trastuzumab+S-1にてステント留置後2カ月目から肺炎発症はなく，その後，約8カ月間良好なQOLを保つことができた．
  • Fujitani K; Miyashiro I; Mikata S; Tamura S; Imamura H; Hara J; Kurokawa Y; Fujita J; Nishikawa K; Kimura Y; Takiguchi S; Mori M; Doki Y
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 16 3 301 - 8 2013年07月 [査読有り]
     
    BACKGROUND: It remains uncertain whether radical lymphadenectomy combined with total gastrectomy actually contributes to long-term survival for Siewert type II adenocarcinoma of the cardia. We identified the pattern of abdominal nodal spread in advanced type II adenocarcinoma and defined the optimal extent of abdominal lymphadenectomy. METHODS: Eighty-six patients undergoing R0 total gastrectomy for advanced type II adenocarcinoma were identified from the gastric cancer database of 4,884 patients. Prognostic factors were investigated by multivariate analysis. The therapeutic value of lymph node dissection for each station was estimated by multiplying the incidence of metastasis by the 5-year survival rate of patients with positive nodes in each station. RESULTS: The overall 5-year survival rate was 37.1%. Age less than 65 years [hazard ratio, 0.455 (95% confidence interval (CI), 0.261-0.793)] and nodal involvement with pN3 as referent [hazard ratio for pN0, 0.129 (95% CI, 0.048-0.344); for pN1, 0.209 (95% CI, 0.097-0.448); and for pN2, 0.376 (95% CI, 0.189-0.746)] were identified as significant prognosticators for longer survival. Perigastric nodes of the lower half of the stomach in positions 4d-6 were considered not beneficial to dissect, whereas there were substantial therapeutic benefits to dissecting the perigastric nodes of the upper half of the stomach in positions 1-3 and the second-tier nodes in positions 7 and 11. CONCLUSIONS: Limited lymphadenectomy attained by proximal gastrectomy might suffice as an alternative to extended lymphadenectomy with total gastrectomy for obtaining potential therapeutic benefit in abdominal lymphadenectomy for advanced Siewert type II adenocarcinoma.
  • Hirao M; Takiguchi S; Imamura H; Yamamoto K; Kurokawa Y; Fujita J; Kobayashi K; Kimura Y; Mori M; Doki Y; Osaka University Clinical Research Group for Gastroenterological Study
    Annals of surgical oncology 20 5 1591 - 7 2013年05月 [査読有り]
     
    PURPOSE: This randomized, controlled trial evaluated the clinical efficacy of Billroth I (BI) and Roux-en-Y (RY) reconstruction at 1 year after distal gastrectomy for gastric cancer. METHODS: The primary end point was the amount of body weight lost at 1 postoperative year, and secondary end points included other items related to nutritional status such as serum albumin and lymphocyte count, as well as endoscopic examination findings of the remnant stomach and esophagus. Of the 332 patients enrolled, 163 were assigned to the BI group and 169 were randomized to the RY group. RESULTS: The loss in body weight 1 year after surgery did not differ significantly between the BI and RY groups (9.1 % and 9.7 %, respectively, p = 0.39). There were no significant differences in other aspects of nutritional status between the 2 groups. Endoscopic examination 1 year after gastrectomy showed reflux esophagitis in 26 patients (17 %) in the BI group versus 10 patients (6 %) in the RY group (p = 0.0037), while remnant gastritis was observed in 71 patients (46 %) in the BI group versus 44 patients (28 %) in the RY group (p = 0.0013); differences were significant for both conditions. Multivariable analysis showed that the only reconstruction was the independently associated factor with the incidence of reflux esophagitis. CONCLUSIONS: RY reconstruction was not superior to BI in terms of body weight change or other aspects of nutritional status at 1 year after surgery, although RY more effectively prevented reflux esophagitis and remnant gastritis after distal gastrectomy.
  • Tomono Kishimoto; Hiroshi Imamura; Ryohei Kawabata; Yutaka Kimura; Mutsumi Fukunaga; Hiroki Ohzato
    Japanese Journal of Cancer and Chemotherapy 40 4 489 - 492 2013年04月 [査読有り]
     
    We retrospectively examined the feasibility and outcome of S-1 adjuvant chemotherapy for 18 patients with gastric cancer treated based on the liaison-clinical pathway (liaison group), and compared them with those of 26 patients treated before the induction of the liaison-clinical pathway (non-liaison group). The persistent rate of S-1 adjuvant chemotherapy for one year except for recurrence, the relative performance (RP) value of cases who had received S-1 for one year, and Grade 3/4 adverse events in non-liaison group/liaison group, were 88.5/87.5% (p=0.93), 87.0/92.9% (p=0.56), and 26.9/5.6% (p=0.07), respectively. This did not show a significant difference. The rate of patients administered medication for coexistent diseases in our hospital in the non-liaison group/liaison group was 53.8/0% (p=0.0002), which reflected the accomplishment of the transfer of medical care for coexistent disease from a hospital to a clinic on the liaison-clinical pathway. Furthermore, a neighboring clinic could be arranged to accommodate 9 (64.3%) of 14 patients living quite far from the hospital in the liaison group. In conclusion, S-1 adjuvant chemotherapy for patients with gastric cancer treated based on the liaison-clinical pathway was feasible, led to the effective practice of sharing between hospital and clinic, and the shorter trip for treatment at a neighboring clinic by patients living far from a hospital.
  • Motohiro Hirao; Toshimasa Tsujinaka; Hiroshi Imamura; Yukinori Kurokawa; Kentaro Inoue; Yutaka Kimura; Toshio Shimokawa; Hiroshi Furukawa
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 16 2 239 - 44 2013年04月 [査読有り]
     
    BACKGROUND: Our objective was to assess the risk factors for surgical site infections (SSIs) in gastric surgery using the results of the Osaka Gastrointestinal Cancer Chemotherapy Study Group (OGSG) 0501 phase 3 trial. METHODS: The OGSG 0501 trial was conducted to compare standard prophylactic antibiotic administration versus extended prophylactic antibiotic administration in 355 patients who underwent open distal gastrectomy for gastric cancer. Various risk factors associated with the incidence of SSI following gastrectomy were analyzed from the results of this multi-institutional randomized controlled trial. RESULTS: Among the 355 patients, there were 24 SSIs, for an overall SSI rate of 7 %. Multivariate analysis using eight baseline factors (administration of antibiotics, age, sex, body mass index [BMI], prognostic nutritional index, tumor stage, lymph node dissection, reconstructive method) identified that BMI ≥ 25 kg/m(2) was an independent risk factor for the occurrence of SSI (odds ratio 2.82; 95 % confidence interval [CI] 1.05-7.52; P = 0.049). BMI also showed significant relationships with the volume of blood loss and the operation time (P = 0.001 and P < 0.001, respectively). CONCLUSION: Compared with patients of normal weight, overweight patients had a significantly higher risk of SSI after distal gastrectomy for cancer.
  • Yutaka Kimura; Hiroshi Yano; Hiroshi Imamura; Kazumasa Fujitani; Motohiro Imano; Yukihiko Tokunaga; Masaki Matsuoka; Yukinori Kurokawa; Toshio Shimokawa; Hiroya Takiuchi; Toshimasa Tsujinaka; Hiroshi Furukawa
    Japanese journal of clinical oncology 43 2 125 - 31 2013年02月 [査読有り]
     
    OBJECTIVE: S-1 and cisplatin combination therapy is a standard regimen for patients with advanced gastric cancer in Japan. The primary objective of this study was to determine the maximum tolerated dose and dose-limiting toxicities of a triplet regimen adding paclitaxel to S-1 and cisplatin combination therapy. METHODS: Patients with previously untreated metastatic or recurrent gastric cancer were enrolled. Patients received S-1 (40 mg/m(2) p.o., twice daily, on days 1-21 every 35 days), cisplatin (30 mg/m(2) divided, on days 1 and 15) and paclitaxel (divided on days 1 and 15). The starting dose of paclitaxel was 50 mg/m(2) (level 1); the dose was escalated to 60 (level 2), 70 (level 3) and 80 mg/m(2) (level 4) in a stepwise fashion. Dose-limiting toxicity was determined during the first treatment cycle. RESULTS: Eighteen patients enrolled. During the first cycle, no dose-limiting toxicity was observed at dose levels 1 and 2. At dose level 3, one of the six patients had dose-limiting toxicity (one patient had grade 4 neutropenia) and at dose level 4, one of the six patients had dose-limiting toxicity (one patient had febrile neutropenia, hypoalbuminemia and fatigue of grade 3). The maximum tolerated dose was not reached at level 4; however, grade 3 hyponatremia and hypokalemia in two of the six patients occurred during the second treatment course at level 4. From the point of view of safety in the outpatient setting, the recommended dose of paclitaxel was determined at 70 mg/m(2). The overall response rate was 50%. CONCLUSIONS: The recommended dose of paclitaxel added to S-1 (80 mg/m(2) days 1-21) plus cisplatin (30 mg/m(2) days 1 and 15) was 70 mg/m(2) on days 1 and 15 of a 5-week cycle.
  • 松本 紘典; 川端 良平; 岸本 朋乃; 山本 絵美子; 木村 豊; 今村 博司; 山本 為義; 武元 浩新; 福永 睦; 大里 浩樹
    癌と化学療法 39 12 2441 - 2443 (株)癌と化学療法社 2012年11月 
    MRSA感染を伴う難治性深部手術部位感染に対し、リネゾリド投与が奏効した1例を経験したので報告する。症例は66歳、男性。進行接合部癌に対し術前化学療法を施行後、左開胸開腹胃全摘術を施行した。術後3日目に開胸創部に深部手術部位感染を併発し、培養検査にてMRSAが検出された。創部のデブリドメント、洗浄処置を続けたが排膿は継続し、術後10ヵ月後には肋骨が露出するようになった。術後11ヵ月後より抗MRSA薬のリネゾリドの経口投与を開始したところ、1週間でMRSAは陰性化し、1ヵ月後には創の治癒が得られた。外来患者で難治性のMRSA深部手術部位感染に対し、リネゾリド投与は有用な治療法と考えられた。(著者抄録)
  • K. Fujitani; T. Tsujinaka; J. Fujita; I. Miyashiro; H. Imamura; Y. Kimura; K. Kobayashi; Y. Kurokawa; T. Shimokawa; H. Furukawa
    BRITISH JOURNAL OF SURGERY 99 5 621 - 629 2012年05月 [査読有り]
     
    Background: Perioperative enteral immunonutrition is thought to reduce postoperative morbidity in patients undergoing major gastrointestinal surgery. This study assessed the clinical effects of preoperative enteral immunonutrition in well nourished patients with gastric cancer undergoing total gastrectomy. Methods: Well nourished patients with primary gastric cancer, fit for total gastrectomy, were randomized to either a control group with regular diet, or an immunonutrition group that received regular diet supplemented with 1000 ml/day of immunonutrients for 5 consecutive days before surgery. The primary endpoint was the incidence of surgical-site infection (SSI). Secondary endpoints were rates of infectious complications, overall postoperative morbidity and C-reactive protein (CRP) levels on 3-4 days after surgery. Results: Of 244 randomized patients, 117 were allocated to the control group and 127 received immunonutrition. SSIs occurred in 27 patients in the immunonutrition group and 23 patients in the control group (risk ratio (RR) 1.09, 95 per cent confidence interval 0.66 to 1.78). Infectious complications were observed in 30 patients in the immunonutrition group and 27 in the control group (RR 1.11, 0.59 to 2.08). The overall postoperative morbidity rate was 30.8 and 26.1 per cent respectively (RR 1.18, 0.78 to 1.78). The median CRP value was 11.8 mg/dl in the immunonutrition group and 9.2 mg/dl in the control group (P = 0.113). Conclusion: Five-day preoperative enteral immunonutrition failed to demonstrate any clear advantage in terms of early clinical outcomes or modification of the systemic acute-phase response in well nourished patients with gastric cancer undergoing elective total gastrectomy. Registration number: ID 000000648 (University Hospital Medical Information Network (UMIN) database).
  • Hiroshi Imamura; Yukinori Kurokawa; Toshimasa Tsujinaka; Kentaro Inoue; Yutaka Kimura; Shohei Iijima; Toshio Shimokawa; Hiroshi Furukawa
    The Lancet. Infectious diseases 12 5 381 - 7 2012年05月 [査読有り]
     
    BACKGROUND: Although evidence for the efficacy of postoperative antimicrobial prophylaxis is scarce, many patients routinely receive such treatment after major surgeries. We aimed to compare the incidence of surgical-site infections with intraoperative antimicrobial prophylaxis alone versus intraoperative plus postoperative administration. METHODS: We did a prospective, open-label, phase 3, randomised study at seven hospitals in Japan. Patients with gastric cancer that was potentially curable with a distal gastrectomy were randomly assigned (1:1) to receive either intraoperative antimicrobial prophylaxis alone (cefazolin 1 g before the surgical incision and every 3 h as intraoperative supplements) or extended antimicrobial prophylaxis (intraoperative administration plus cefazolin 1 g once after closure and twice daily for 2 postoperative days). Randomisation was stratified using Pocock and Simon's minimisation method for institution and American Society of Anesthesiologists scores, and Mersenne twister was used for random number generation. The primary endpoint was the incidence of surgical-site infections. We assessed non-inferiority of intraoperative therapy with a margin of 5%. Analysis was by intention-to-treat. During hospital stay, infection-control personnel assessed patients for infection, and the principal surgeons were required to check for surgical-site infections at outpatient clinics until 30 days after surgery. This study is registered with UMIN-CTR, UMIN000000631. FINDINGS: Between June 2, 2005, and Dec 6, 2007, 355 patients were randomly assigned to receive either intraoperative antimicrobial prophylaxis alone (n=176) or extended antimicrobial prophylaxis (n=179). Eight patients (5%, 95% CI 2-9%) had surgical-site infections in the intraoperative group compared with 16 (9%, 5-14) in the extended group. The relative risk of surgical-site infections with intraoperative antimicrobial prophylaxis was 0·51 (0·22-1·16), which revealed statistically significant non-inferiority (p<0·0001). INTERPRETATION: Elimination of postoperative antimicrobial prophylaxis did not increase the incidence of surgical-site infections after a gastrectomy. Therefore, this treatment is not recommended after gastric cancer surgery.
  • Takiguchi S; Yamamoto K; Hirao M; Imamura H; Fujita J; Yano M; Kobayashi K; Kimura Y; Kurokawa Y; Mori M; Doki Y; Osaka University Clinical Research Group for Gastroenterological Study
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 15 2 198 - 205 2012年04月 [査読有り]
     
    BACKGROUND: Both Billroth I (B-I) and Roux-en-Y (R-Y) reconstructions are commonly performed as standard procedures, but it has yet to be determined which reconstruction is better for patients. A randomized prospective phase II trial with body weight loss at 1 year after surgery as a primary endpoint was performed to address this issue. The current report delivers data on the quality of life and degree of postoperative dysfunction, which were the secondary endpoints of this study. METHODS: Gastric cancer patients who underwent distal gastrectomy were intraoperatively randomized to B-I or R-Y. Postsurgical QOL was evaluated using the EORTC QLQ-C30 and DAUGS 20. RESULTS: Between August 2005 and December 2008, 332 patients were enrolled in a randomized trial comparing B-I versus R-Y. A mail survey questionnaire sent to 327 patients was completed by 268 (86.2%) of them. EORTC QLQ-C30 scores were as follows: global health status was similar in each group (B-I 73.5 ± 18.8, R-Y 73.2 ± 20.2, p = 0.87). Scores of five functional scales were also similar. Only the dyspnea symptom scale showed superior results for R-Y than for B-I (B-I 13.6 ± 17.9, R-Y 8.6 ± 16.3, p = 0.02). With respect to DAUGS 20, the total score did not differ significantly between the R-Y and B-I groups (24.8 vs. 23.6, p = 0.41). Only reflux symptoms were significantly worse for B-I than for R-Y (0.7 ± 0.6 vs. 0.5 ± 0.6, p = 0.01). CONCLUSIONS: The B-I and R-Y techniques were generally equivalent in terms of postoperative QOL and dysfunction. Both procedures seem acceptable as standard reconstructions after distal gastrectomy with regard to postoperative QOL and dysfunction.
  • Miyagaki H; Takiguchi S; Kurokawa Y; Hirao M; Tamura S; Nishida T; Kimura Y; Fujiwara Y; Mori M; Doki Y
    World journal of surgery 36 4 851 - 7 2012年04月 [査読有り]
     
    BACKGROUND: The incidence of internal hernia after gastrectomy can increase with the increasing use of laparoscopic surgery, although this trend has not been elucidated. METHODS: Clinical information was collected from medical records and by questionnaire for 18 patients who underwent surgical treatment for internal hernia after gastrectomy for gastric cancer in 24 hospitals from January 2005 to December 2009. RESULTS: Gastrectomy for gastric cancer was open/distal gastrectomy (DG) in five (28%) patients, open/total gastrectomy (TG) in seven (39%), laparoscopy-assisted/DG in three (17%), and laparoscopy-assisted/TG in 3 (17%). Reconstruction was by Roux-Y methods in all patients. The hernia orifice was classified as a jejunojejunostomy mesenteric defect in eight patients (44%), dorsum of the Roux limb (Petersen's space) in eight (44%), and one (5%) each of esophageal hiatus and mesenterium of the transverse colon. Among 8,983 patients who underwent gastrectomy for gastric cancer, a postoperative survey revealed that 13 patients underwent surgical treatment for internal hernia in the same hospitals. The 3-year incidence rate of the internal hernia was 0.19%, which was significantly higher after laparoscopy-assisted than open gastrectomy (0.53 vs. 0.15%, p = 0.03). Patients with an internal hernia had a mean (±SD) low weight at hernia operation (body mass index 17.9 ± 1.6 kg/m(2)) and marked weight loss after gastrectomy (weight reduction 15.6 ± 5.8%). CONCLUSIONS: Gastrectomy with Roux-Y reconstruction for gastric cancer leaves several spaces that can cause internal hernia formation. Laparoscopic surgery and postoperative body weight loss are potential risk factors.
  • 進行再発胃癌におけるTS-1+CDDP+PTX併用化学療法の多施設共同第2相臨床試験(OGSG0703)
    間狩 洋一; 飯島 正平; 木村 豊; 今村 博司; 藤谷 和正; 後藤 昌弘; 今野 元博; 尾下 正秀; 上田 修吾; 下川 敏雄; 黒川 幸典; 瀧内 比呂也; 辻仲 利政; 古河 洋
    日本胃癌学会総会記事 84回 240 - 240 (一社)日本胃癌学会 2012年02月
  • K. Inoue; Y. Nakane; M. Kogire; K. Fujitani; Y. Kimura; H. Imamura; S. Tamura; S. Okano; A. H. Kwon; Y. Kurokawa; T. Shimokawa; H. Takiuchi; T. Tsujinaka; H. Furukawa
    European Journal of Surgical Oncology 38 2 143 - 149 2012年02月 [査読有り]
     
    Background: The aim of this study was to evaluate the efficacy and feasibility of preoperative chemotherapy with S-1 plus cisplatin in patients with initially unresectable locally advanced gastric cancer. Methods: We enrolled patients with initially unresectable locally advanced gastric cancer because of severe lymph node metastases or invasion of adjacent structures. Preoperative chemotherapy consisted of S-1 at 80 mg/m 2 divided in two daily doses for 21 days and cisplatin at 60 mg/m 2 intravenously on day 8, repeated every 35 days. If a tumor decreased in size, patients received 1 or 2 more courses. Surgery involved radical resection with D2 lymphadenectomy. Results: Between December 2000 and December 2007, 27 patients were enrolled on the study. No CR was obtained, but PR was seen in 17 cases, and the response rate was 63.0%. Thirteen patients (48.1%) had R0 resections. There were no treatment related deaths. The median overall survival time (MST) and the 3-year overall survival (OS) of all patients were 31.4 months and 31.0%, respectively. Among the 13 patients who underwent curative resection, the median disease-free survival (DFS) and the 3-year DFS were 17.4 months and 23.1%, respectively. The MST and the 3-year OS were 50.1 months and 53.8%, respectively. The most common site of initial recurrence after the R0 resection was the para-aortic lymph nodes. Conclusions: Preoperative S-1 plus cisplatin can be safely delivered to patients undergoing radical gastrectomy. This regimen is promising as neoadjuvant chemotherapy for resectable gastric cancer. For initially unresectable locally advanced gastric cancer, new trials using more effective regimens along with extended lymph node dissection are necessary. © 2011 Elsevier Ltd. All rights reserved.
  • Fujita J; Kurokawa Y; Sugimoto T; Miyashiro I; Iijima S; Kimura Y; Takiguchi S; Fujiwara Y; Mori M; Doki Y
    Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association 15 1 42 - 8 2012年01月 [査読有り]
     
    BACKGROUND: Bursectomy is regarded as a standard surgical procedure during gastrectomy for serosa-positive gastric cancer in Japan. There is little evidence, however, that bursectomy has clinical benefit. We conducted a randomized controlled trial to demonstrate non-inferiority of treatment with the omission of bursectomy. METHODS: Between July 2002 and January 2007, 210 patients with cT2-T3 gastric adenocarcinoma were intraoperatively randomized to radical gastrectomy and D2 lymphadenectomy with or without bursectomy. The primary endpoint was overall survival (OS). Secondary endpoints were recurrence-free survival, operative morbidity, and levels of amylase in drainage fluid on postoperative day 1. Two interim analyses were performed, in September 2008 and August 2010. RESULTS: Overall morbidity (14.3%) and mortality (0.95%) rates were the same in the two groups. The median levels of amylase in drainage fluid on postoperative day 1 were similar in the two groups (P = 0.543). In the second interim analysis, the 3-year OS rates were 85.6% in the bursectomy group and 79.6% in the non-bursectomy group. The hazard ratio for death without bursectomy was 1.44 (95% confidence interval [CI] 0.79-2.61; P = 0.443 for non-inferiority). Among 48 serosa-positive (pT3-T4) patients, the 3-year OS was 69.8% for the bursectomy group and 50.2% for the non-bursectomy group, conferring a hazard ratio for death of 2.16 (95% CI 0.89-5.22; P = 0.791 for non-inferiority). More patients in the non-bursectomy group had peritoneal recurrences than in the bursectomy group (13.2 vs. 8.7%). CONCLUSIONS: The interim analyses suggest that bursectomy may improve survival and should not be abandoned as a futile procedure until more definitive data can be obtained.
  • Shuji Takiguchi; Toru Masuzawa; Motohiro Hirao; Hiroshi Imamura; Yutaka Kimura; Junya Fujita; Shigeyuki Tamura; Yoshiyuki Fujiwara; Masaki Mori; Yuichiro Doki
    Hepato-Gastroenterology 58 110-111 1823 - 1827 2011年 [査読有り]
     
    Background/Aims: Various surgical treatments are indicated for early gastric cancers in upper third of the stomach (U-EGC) because of its anatomical property and favorable prognosis. Methodology: Five hundred and eighty six cases of U-EGCs were collected for 9 years from 19 hospitals in Japan. Surgical procedures were classified as total (TG) and proximal gastrectomy (PG), and the latter was subclassified as esophagogastrostomy (PG-EG) and jejunal interposition (PG-JI) reconstruction. Results: TG was more frequent than PG (76.3% vs. 21.8%, p< .0001). PG was more frequently performed in high volume hospitals than in low volume hospitals (26.8% vs. 10.2%, p< .0001), however there were still large difference in frequency of PG even among high volume hospitals, ranging from 5.0% to 72.0%. For reconstruction after PG, PG-EG and PG-JI were representatively performed in 50 (39.1%) and 35 (27.3%) patients. Each institute tended to preferentially employ either PG-EG or PG-JI. Tumor size was significantly larger in TG than in PG (38.8mm vs. 22.3mm, p< .0001) and diffuse type tended to be more frequent in TG as well. Conclusions: There is a huge variety of surgical treatment for U-ECG in general hospitals in our country. A multi-institutional large cohort randomized trial might be urgent to establish the standard surgical procedure of this infrequent disease. © H.G.E. Update Medical Publishing S.A.
  • Tamura S; Fujitani K; Kimura Y; Tsuji T; Matsuyama J; Iijima S; Imamura H; Inoue K; Kobayashi K; Kurokawa Y; Furukawa H; Osaka Gastrointestinal; Cancer Chemotherapy; Study Group
    Oncology 80 5-6 296 - 300 2011年 [査読有り]
     
    OBJECTIVE: The aim of this prospective study was to evaluate the feasibility and safety of adjuvant S-1 plus docetaxel in patients with stage III gastric cancer. METHODS: We enrolled 53 patients with pathological stage III gastric cancer who underwent D2 gastrectomy. They received oral S-1 (80 mg/m(2)/day) administration for 2 consecutive weeks and intravenous docetaxel (40 mg/m(2)) on day 1, repeated every 3 weeks (1 cycle). The treatment was started within 45 days after surgery and repeated for 4 cycles, followed by S-1 monotherapy (4 weeks on, 2 weeks off) until 1 year after surgery. The feasibility of the 4 cycles of chemotherapy, followed by S-1 administration, was evaluated. RESULTS: A total of 42 patients (79.2%, 95% CI 65.9-82.9) tolerated the planned 4 cycles of treatment with S-1 and docetaxel, and 34 patients (64.2%, 95% CI 49.8-76.9) completed subsequent S-1 monotherapy for 1 year. Grade 4 neutropenia was observed in 28% and grade 3 febrile neutropenia in 9% of the patients, while grade 3 nonhematological toxicities were relatively low. CONCLUSIONS: Adjuvant S-1 plus docetaxel therapy is feasible and has only moderate toxicity in stage III gastric cancer patients. We believe that this regimen will be a candidate for future phase III trials seeking the optimal adjuvant chemotherapy for stage III gastric cancer patients.
  • 進行・再発胃癌に対するS-1+CPT11療法とS-1+TXL療法のランダム化比較第二相試験
    飯島 正平; 藤谷 和正; 瀧内 比呂也; 上堂 文也; 今村 博司; 木村 豊; 今野 元博; 黒川 幸典; 後藤 昌弘; 杉本 直俊; 井上 健太郎; 下川 敏雄; 辻仲 利政; 古河 洋
    日本癌治療学会誌 45 2 531 - 531 (一社)日本癌治療学会 2010年09月
  • 高齢者(75歳以上)の進行・再発胃癌に対するTS-1単独療法の第II相臨床試験(OGSG0404)
    木村 豊; 今村 博司; 後藤 昌弘; 森本 卓; 今野 元博; 飯島 正平; 山下 啓史; 松岡 正樹; 丸山 憲太郎; 黒川 幸典; 下川 敏雄; 瀧内 比呂也; 古河 洋
    日本胃癌学会総会記事 82回 371 - 371 (一社)日本胃癌学会 2010年03月
  • Yutaka Kimura; Hirohisa Machida; Kazumasa Fujitani; Moritoshi Yamamoto; Kazunari Tominaga; Hiroshi Yano; Toshio Shimokawa; Hiroya Takiuchi; Toshimasa Tsujinaka; Hiroshi Furukawa
    Japanese Journal of Cancer and Chemotherapy 37 1 151 - 155 2010年 [査読有り]
     
    Background: The standard therapy for gastric cancer with peritoneal metastasis has remained unclear. Purpose: This prospective feasibility study was aimed to investigate the efficacy and safety of S-1 plus paclitaxel for advanced/recurrent gastric cancer patients with peritoneal metastasis able to take oral feeding. Patients and methods: Seven patients were enrolled in this study. Paclitaxel 50 mg/m2 was administered on days 1 and 8. S-1 was administered orally at 40 mg/m2 bid for 14 consecutive days, followed by a 1-week rest. Overall survival, the response rate and safety were examined for efficacy and tolerability. Results: The median survival time was 310 days. The response rate in five patients was 80.0%. Grade 3 toxicity was observed in two patients. Combination chemotherapy of weekly paclitaxel and S-1 demonstrated efficacy and tolerable toxicity. This regimen will be one of the initial treatment options for unresectable or metastatic gastric cancer with peritoneal metastasis.
  • Hiroya Takiuchi; Masahiro Goto; Hiroshi Imamura; Hiroshi Furukawa; Motohiro Imano; Haruhiko Imamoto; Yutaka Kimura; Hideyuki Ishida; Kazumasa Fujitani; Hiroyuki Narahara; Toshio Shimokawa
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 38 3 176 - 181 2008年03月 [査読有り]
     
    Background: A pre-clinical study demonstrated that paclitaxel induced thymidine phosphorylase in the tumor tissues. The combination of paclitaxel and doxifluridine is expected to exert extra anti-tumor effects. We evaluated the efficacy of this combination in patients with unresectable or recurrent gastric cancer who had been previously treated with S-1. Methods: Registration was started to enroll 35 patients with advanced/recurrent gastric cancer, who were selected among those with measurable lesions fitting to response evaluation criteria in solid tumors, and with resistant to S-1 treatment. This regimen is consisted of paclitaxel, 80 mg/m(2), iv on days 1 and 8; and doxifluridine, 600 mg/m(2), po on days 1-14. The treatment was repeated every three weeks. Primary endpoint was response rate (RR); and secondary endpoints were overall survival (OS), progression free survival (PFS) and onset rate of adverse events. Results: From September 2003 to March 2005, 35 patients were registered: including 28 men; 7 women; median age of 66 years (range, 49-75 years); and performance status (PS) levels were, zero with 21 and one with 14 patients. In 33 eligible patients, except two, clinical usefulness was evaluated resulting in RR of 18.2% (partial response, 6; stable disease, 15; progressive disease, 10; and not evaluable, 2 patients). Median survival time was 321 days and median PFS was 119 days. Severe adverse events were found in three patients to discontinue the present treatment. Conclusions: The combination of paclitaxel and doxifluridine might be a treatment of choice as a second line chemotherapy for patient undergone S-1 treatment.
  • K Nishioka; Y Doki; H Miyata; S Tamura; T Yasuda; Y Kimura; K Kishi; K Yoshida; Y Fujiwara; M Yano; M Monden
    JOURNAL OF SURGICAL RESEARCH 132 1 130 - 135 2006年05月 [査読有り]
     
    Background. We have reported G1 progression and cyclooxygenase-2 (COX-2) induction during carcinogenesis of the squamous epithelium of the esophagus. As bile acid induces COX-2 expression and promotes carcinogenesis in the digestive tract, we investigated the effect of bile acid on the proliferation of squamous cell carcinoma of the esophagus (ESCC). Materials and methods. MTT assay, Western blot analysis of COX-2 and cell cycle-related molecules in the G1 phase (Rb, CDC25A, cyclin D1), and CDK2 kinase assay were performed on chenodeoxycholic acid (CDCA) exposure to ESCC cell lines (TE2R, TE3, TE13, TE15). Results. In the presence of gradient bile acid concentration (up to 100 mu M), growth of ESCC cell lines was stimulated at a low concentration (maximally at 20-30 mu M), but suppressed at a higher concentration. Only a low dose of bile acid induced the expression of cyclin D1 and CDC25A and showed high Rb phosphorylation and high CDK2 kinase activity. In contrast, bile acid progressively induced COX-2 expression in a dose-dependent manner, regardless of its biphasic effects on cell proliferation, and a COX-2 specific inhibitor (JTE-522) did not suppress growth stimulation by a low dose of bile acid. Conclusions. Bile acid at a low dose stimulates the proliferation of ESCC by inducing G1-regulating molecules. However, COX-2 expression, which is also induced by bile acid, does not affect cell proliferation. Further work is needed to elucidate its role in carcinogenesis. (c) 2006 Elsevier Inc. All rights reserved.
  • 矢野 浩司; 浅岡 忠史; 今里 光伸; 村上 昌裕; 武元 浩敏; 中野 芳明; 東野 健; 大西 直; 木村 豊; 加納 寿之; 門田 卓士
    日本臨床外科学会雑誌 66 2 316 - 321 Japan Surgical Association 2005年 
    血液,脾疾患に対する腹腔鏡下脾摘出術25例の有効性を検討するため,それ以前に施行した8例の開腹下脾摘出術とretrospectiveに比較した.平均手術時間 (145分 vs 163分),平均出血量 (80g vs 136g)は腹腔鏡下手術の方がともに少なかったが有意差はなかった.術後の排ガス期間 (1.8日 vs 5.2日),第1歩行期間 (1.2日 vs 2.3日),経口摂取開始期間 (1.2日 vs 3.5日),硬膜外麻酔使用期間 (3.4日 vs 4.3日),在院日数 (9.6日 vs 16.3日) はすべて腹腔鏡下手術の方が短く,硬膜外麻酔使用期間以外は有意差が認められた.合併症は腹腔鏡下手術に術後一過性に肺水腫が1例認められるのみであった.以上より血液,脾疾患に対する腹腔鏡下脾摘出術は開腹下手術に匹敵する程安全な手術術式と言える.術後回復は開腹下手術に比べ有意に早く,患者のquality of lifeの向上に貢献していると思われた.
  • Kimura Y; Yasuda T; Fujiwara Y; Takiguchi S; Miyata H; Nagano H; Yano M; Monden M
    Gan to kagaku ryoho. Cancer & chemotherapy 31 11 1825 - 1827 2004年10月 [査読有り]
     
    The prognosis of patients with hepatic metastasis of gastric cancer is poor, and standard therapies for patients are not established. Here we present two cases of hepatic metastasis from gastric cancer. In both cases, no other organ metastasis except the liver was confirmed, in which hepatic arterial infusion chemotherapy with 5-FU, adriamycin and cisplatin (FAP) were performed because TS-1 chemotherapy was not an effective chemotherapy. Case 1: An 80-year-old man had distal gastrectomy for type 2 gastric cancer (Stage II) in January 2001. A liver S8 metastatic recurrence was discovered in the 18th month post operation. After chemotherapy with TS-1 for 5 courses, a hepatic arterial infusion treatment was performed for 7 courses. The effect was PR, but the treatment was canceled because of a catheter obstruction. The patient is living without recurrence. Case 2: This case was a 73-year-old man who had distal gastrectomy for type 0 IIc gastric cancer (Stage IA) in May 1999. Multiple hepatic metastases recurred in the 32nd month post operation. After chemotherapy with TS-1 for 2 courses, a hepatic arterial infusion treatment was performed for 10 courses. The effect was CR, but a peritoneal recurrence was discovered, and a systemic chemotherapy was performed. The patient is living without recrudescence of hepatic metastasis. The hepatic arterial infusion chemotherapy with FAP was effective for gastric cancer patients with liver metastasis because TS-1 chemotherapy was not an effective chemotherapy. It is necessary to consider combined chemotherapy in addition to systemic chemotherapy.
  • 新規抗癌剤の臨床応用(胃) TS-1/Paclitaxel併用療法における推奨用量と有効性および有害事象(胃癌を対象とした多施設共同第I/II相臨床試験OGSG0105)
    井上 健太郎; 中根 恭司; 藤谷 和正; 辻仲 利政; 後藤 昌弘; 瀧内 比呂也; 楢原 啓之; 上堂 文也; 木村 豊; 今野 元博; 今村 博司; 古河 洋
    日本癌治療学会誌 39 2 366 - 366 (一社)日本癌治療学会 2004年09月
  • Makari Y; Fujiwara Y; Yasuda T; Takiguchi S; Kimura Y; Yano M; Monden M
    Gan to kagaku ryoho. Cancer & chemotherapy 31 4 609 - 611 2004年04月 [査読有り]
     
    Chemotherapy with TS-1 has recently become the first-line chemotherapy for recurrent and unresectable gastric cancer in Japan. Therefore, the establishment of a second-line chemotherapy is needed for cases that show resistance and aberrant effect to TS-1. In this study, 7 patients were treated with weekly administrations of paclitaxel after TS-1 treatment. We assessed the therapeutic effect and feasibility of chemotherapy with weekly administration of paclitaxel. Our results showed that weekly administration of paclitaxel could be a promising regimen as a second-line chemotherapy after TS-1.
  • Fujiwara Y; Taniguchi H; Kimura Y; Takiguchi S; Yasuda T; Yano M; Monden M
    Gan to kagaku ryoho. Cancer & chemotherapy 30 11 1614 - 1617 2003年10月 [査読有り]
     
    Forty-eight patients with serosa-invaded advanced gastric cancer were administered to pre-operative intra-peritoneal chemotherapy to prevent peritoneal recurrence. There were no severe adverse effects from the intra-peritoneal chemotherapy. Of these patients, 2 showed malignant ileus shortly after intra-peritoneal chemotherapy and gastrectomy, and needed laparotomy because of dilatation of duodenum stump and liver dysfunction. The intestines and mesothelium showed diffuse thickness and hardness. We report the clinicopathological features of these cases and therapeutic limitation of intra-peritoneal chemotherapy.
  • Yasuda T; Yano M; Takiguchi S; Kimura Y; Fujiwara Y; Monden M
    Gan to kagaku ryoho. Cancer & chemotherapy 30 11 1737 - 1740 2003年10月 [査読有り]
     
    We report the response of our new regimen of chemoradiotherapy for advanced esophageal carcinoma. The patient was a 66-year-old man who had double primary esophageal carcinomas: type o-IIc tumor of the cervical esophagus from the esophageal inlet to 23 cm from incisors and a 9 cm length type 3 tumor of the middle to lower thoracic esophagus with a 2 cm diameter cardiac lymph node metastasis. Since he completely rejected surgical treatment, new definitive chemoradiotherapy with 2 courses of FAP chemotherapy (cisplatin 50 mg/m2 and adriamycin 20 mg/m2 on day 1 and 5-FU 700 mg/day from day 1 to 5 continuously) concurrent with a split course of radiotherapy to a total dose of 60 Gy in 30 fractions was devised and administered. The treatment was completed and there was no severe toxicity except grade 3 leukocytopenia. Just after treatment, cervical tumor and cardiac lymph node reached complete response but stenosis and wall thickness remained in the thoracic tumor. Soon after, however, these findings improved and, at present 1 year later, complete response has continued. Our new regimen of chemoradiotherapy concurrent with FAP chemotherapy seems to be effective and promising for advanced esophageal carcinoma.
  • 荒井 邦佳; 岩崎 善毅; 木村 豊; 高橋 慶一; 山口 達郎; 本間 重紀; 高橋 俊雄
    癌と化学療法 30 9 1297 - 1301 (株)癌と化学療法社 2003年09月 
    新規経口抗癌剤TS-1を単剤投与した胃癌患者55症例を対象に評価可能病変を有する28症例(TUM群)と術後補助化学療法として投与した27症例(ADJ群)に分けて有効性と安全性について検討した.投与コース数はTUM群平均5.9コース,ADJ群平均5.4コースであり,TUM群25症例の奏効度はCR 4例・PR 6例・NC 4例・PD 9例(奏効率40%)で,奏効10例の投与コース数は平均2.2コースと短期間に奏効していた.評価可能25症例のTS-1投与開始からのmedian survival timeは15.4ヵ月で,奏効例(21.7ヵ月)は非奏効症例(9.6ヵ月)より有意に良好であった.有害事象は45症例(82%)に発現し,TUM群に比べADJ群がやや高頻度であり,その内容は白血球減少が21例(38%)と最も多く,次いで食思不振・総ビリルビン値上昇の順で,多くはgrade 2までの軽微なものであった.有害事象発現時には休薬や2週投与・1週休薬への変更,減量などにより比較的安全に投与可能で,有効性が期待できると考えられた
  • 荒井 邦佳; 岩崎 善毅; 木村 豊; 高橋 慶一; 山口 達郎; 本間 重紀; 高橋 俊雄
    癌と化学療法 30 5 699 - 702 (株)癌と化学療法社 2003年05月 
    68歳男.主訴は口内炎,結膜炎,手掌の皮膚炎.慢性腎不全合併再発胃癌であり,TS-1投与早期にgrade 3の口内炎とgrade 2の結膜炎を伴うgrade 2の四肢皮膚炎を発症した.これらの症状は,ビタミン剤投与や皮膚外用クリーム等の使用により軽快した.本症例におけるhand-foot syndrome発症機序として,F-β-alanine等の5-FU分解産物の関与も否定できないが,慢性腎不全による腎機能低下により5-FU分解酵素阻害剤が蓄積された結果,血中5-FU濃度の持続的上昇をきたし発症したと考えられた
  • 高橋 慶一; 森 武生; 山口 達郎; 本間 重紀; 荒井 邦佳; 岩崎 善毅; 木村 豊
    癌と化学療法 29 Suppl.III 480 - 483 (株)癌と化学療法社 2002年12月 
    大腸癌肝転移に対する予防的肝動注療法施行72例,切除不能H3肝転移119例を対象に,治療効果と副作用の出現頻度から,肝動注療法の留意点について検討した.大腸癌肝転移に対する肝動注療法の奏効率は60〜70%と,高い奏効率を示し,局所効果の非常に高い化学療法で,在宅化学療法に適した治療法であった.しかし,193例中66例(34.2%)と高頻度の有害事象を認め,監視を怠ると重大事故につながる危険性を知っておく必要があると思われた
  • 山口 達郎; 森 武生; 高橋 慶一; 大植 雅之; 本間 重紀; 荒井 邦佳; 岩崎 善毅; 木村 豊
    癌と化学療法 29 12 2370 - 2372 (株)癌と化学療法社 2002年11月 
    53歳女.直腸癌術後経過中に浮腫,腹部膨満感,全身倦怠感が出現し,腹部CTで肝臓の腫大・多発性肝転移・傍大動脈領域のリンパ節腫大を認めた.CPT-11による肝動注療法を施行したところ,肝転移巣の消失・縮小を認め縮小率64%,PRと判定した.傍大動脈領域リンパ節は著明に縮小した.CPT-11肝転移のみならず肝外再発に対しても効果を示した
  • 直腸癌側方郭清の意義 直腸癌に対する側方リンパ節郭清の意義
    山口 達郎; 森 武生; 高橋 慶一; 大植 雅之; 本間 重紀; 柴田 直史; 荒井 邦佳; 岩崎 善毅; 木村 豊
    日本臨床外科学会雑誌 63 増刊 246 - 246 日本臨床外科学会 2002年10月
  • 大腸癌術後補助化学療法の個別化への提案
    高橋 慶一; 森 武生; 大植 雅之; 山口 達郎; 本間 重紀; 柴田 直史; 荒井 邦佳; 岩崎 善毅; 木村 豊
    日本臨床外科学会雑誌 63 増刊 539 - 539 日本臨床外科学会 2002年10月
  • 直腸癌治療における放射線治療の意義
    高橋 慶一; 森 武生; 大植 雅之; 山口 達郎; 本間 重紀; 荒井 邦佳; 岩崎 善毅; 木村 豊
    日本癌治療学会誌 37 2 228 - 228 (一社)日本癌治療学会 2002年09月
  • 丸山 憲太郎; 塩崎 均; 田村 茂行; 井上 雅智; 五福 淳二; 高山 卓也; 木村 豊; 山本 真; 門田 守人
    日本臨床外科医学会雑誌 = The journal of the Japanese Practical Surgeon Society 57 7 1612 - 1616 Japan Surgical Association 1996年07月 
    逆流性食道炎に併存した食道表在癌の1例を経験した.症例は67歳の男性で,中咽頭癌の診断で当院耳鼻科にて外科的治療を受けた.術後2カ月目に貧血の精査目的で上部消化管内視鏡検査を行ったところ,食道胃接合部直上に逆流性食道炎が見られた.生検の一部に癌が疑われ再検を要したが,その後誤嚥による遷延性肺炎を起こしたため経過観察できていなかった. 2年4カ月経過後に施行した内視鏡検査では,食道胃接合部直上に径20mm大のO-IIc型表在癌が認められた.外科的に切除し検索したところ,深達度m3の中分化型扁平上皮癌であった.おそらく逆流性食道炎に併存して診断困難であった小癌病変が, 2年4カ月経過後に明らかになったものと考えられた.本症例のような頭頸部癌担癌患者等の食道癌high risk群の場合,逆流性食道炎の治療を行うとともに,厳重な食道癌合併の検索が必要であると思われた.

書籍

講演・口頭発表等

  • 臓器把持用クリップを活用した肥満患者に対する腹腔鏡下胃切除術の工夫．  [通常講演]
    木村 豊; 安田 篤; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 今本治彦; 安田卓司
    第30回日本内視鏡外科学会総会 2017年12月 ポスター発表 京都
  • 高齢食道癌患者における術後肺炎と予後に関する検討．  [通常講演]
    木村 豊; 岩間 密; 白石 治; 平木洋子; 加藤寛章; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第30回日本外科感染症学会総会 2017年11月 ポスター発表 東京
  • 深達度SE/SSの切除可能胃癌に対する網嚢切除の意義．  [通常講演]
    寺島雅典; 土岐祐一郎; 黒川幸典; 水澤純基; 片井 均; 吉川貴己; 木村 豊; 瀧口修司; 西田靖仙; 岩崎善毅; 福島紀雅; 佐野 武; 片山 宏; 中村健一; 笹子三津留
    第79回日本臨床外科学会総会 2017年11月 シンポジウム・ワークショップパネル（公募） 東京
  • 胃切除術後症候群に対する膵酵素補充剤の有用性に関する検討．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第79回日本臨床外科学会総会 2017年11月 シンポジウム・ワークショップパネル（公募） 東京
  • 医師主導治験における食道亜全摘術評価の困難性．  [通常講演]
    宮崎安弘; 矢野雅彦; 安田卓司; 山崎 誠; 牧野知紀; 田中晃司; 宮田博志; 杉村啓二郎; 木村 豊; 黒川幸典; 高橋 剛; 森 正樹; 土岐祐一郎
    第79回日本臨床外科学会総会 2017年11月 シンポジウム・ワークショップパネル（公募） 東京
  • 左側臥位食道切除術における安定した術野確保のための肺圧排固定器具の開発．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第79回日本臨床外科学会総会 2017年11月 シンポジウム・ワークショップパネル（公募） 東京
  • The effect of pancrelipase against diarrhea in patients after gastrectomy．  [通常講演]
    Kimura Y; Mikami J; Makari Y; Hiraki Y; Kato H; Iwama M; Shiraishi O; Yasuda A; Shinkai M; Imano M; Imamoto H; Fujita J; Yasuda T
    21st Asian Congress of Surgery 2017年11月 ポスター発表 東京
  • A newly modified esophagogastrostomy after proximal gastrectomy in our institution．  [通常講演]
    Yasuda A; Kimura Y; Hiraki Y; Kato H; Iwama M; Shiraishi O; Shinkai M; Imano M; Imamoto H; Yasuda T
    21st Asian Congress of Surgery 2017年11月 ポスター発表 東京
  • 既治療に耐性の進行再発胃癌に対するramu-cirumab療法における蛋白尿に関する検討．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 今本治彦; 古河 洋; 藤田淳也; 安田卓司
    第55回日本癌治療学会学術集会 2017年10月 ポスター発表 横浜
  • ｃT4食道癌の外科治療の限界と成績．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 宮田博志; 新海政幸; 今野元博; 木村 豊; 矢野雅彦; 今本治彦
    第55回日本癌治療学会学術集会 2017年10月 シンポジウム・ワークショップパネル（公募） 横浜
  • 食道癌特異的ペプチドワクチンの術後補助療法としての有用性と腫瘍微小環境との関連．  [通常講演]
    安田卓司; 錦 耕平; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 奥野清隆; 中村祐輔
    第55回日本癌治療学会学術集会 2017年10月 ポスター発表 横浜
  • 良性潰瘍に対する胃切既往のある胸部食道癌における、腹部リンパ節転移状況の検討．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第25回日本消化器関連学会週間（JDDW） 2017年10月 ポスター発表 福岡
  • 胃切除術後の体重減少抑制に対する取り組み．  [通常講演]
    木村 豊; 西川和弘; 岸健太郎; 井上健太郎; 松山 仁; 赤丸祐介; 田村茂行; 川端良平; 川瀬朋乃; 山田岳史; 下川敏雄; 今村博司
    第3回平成次世代外科医療研究会 2017年10月 口頭発表（一般） 熱海
  • 食道癌術後気管切開における甲状腺上アプローチの有用性．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第25回日本消化器関連学会週間（JDDW） 2017年10月 ポスター発表 福岡
  • 進行再発胃癌に対するramucirumab使用例における蛋白尿の検討．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 今本治彦; 古河 洋; 藤田淳也; 安田卓司
    第25回日本消化器関連学会週間（JDDW） 2017年10月 ポスター発表 福岡
  • 85歳以上の超高齢胃癌患者におけるNCDリスクカリキュレーターの意義と転帰について．  [通常講演]
    山本和義; 藤田正一郎; 藤田淳也; 木村 豊; 安達 慧; 高 正浩; 野中亮児; 藤江裕二郎; 橋本和彦; 大西 直
    第25回日本消化器関連学会週間（JDDW） 2017年10月 ポスター発表 福岡
  • 鏡視下手術の導入を考慮した当科における腹腔鏡補助下噴門側胃切除後食道残胃吻合法．  [通常講演]
    安田 篤; 木村 豊; 今本治彦; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 今野元博; 安田卓司
    近畿内視鏡外科研究会 第30回記念大会 2017年09月 シンポジウム・ワークショップパネル（公募） 大阪
  • 高齢食道癌患者における術後の誤嚥・肺炎に関する検討．  [通常講演]
    木村 豊; 白石 治; 加藤寛章; 今本治彦; 安田卓司
    第70回日本胸部外科学会定期学術集会 2017年09月 その他 札幌
  • 高度進行胸部食道癌への外科的挑戦〜術前治療と拡大手術の意義と適応．  [通常講演]
    安田卓司; 白石 治; 加藤寛章; 宮田博志; 木村 豊; 矢野雅彦; 今本治彦
    第70回日本胸部外科学会定期学術集会 2017年09月 シンポジウム・ワークショップパネル（公募） 札幌
  • 高齢食道癌患者における術後の誤嚥・肺炎に関する検討．  [通常講演]
    木村 豊; 白石 治; 加藤寛章; 今本治彦; 安田卓司
    第70回日本胸部外科学会定期学術集会 2017年09月 その他 札幌
  • 胸部食道癌に対する選択的3領域リンパ節郭清の妥当性．  [通常講演]
    白石 治; 加藤寛章; 木村 豊; 今本治彦; 安田卓司
    第70回日本胸部外科学会定期学術集会 2017年09月 シンポジウム・ワークショップパネル（公募） 札幌
  • 胃癌術後患者に対する成分栄養剤早期介入の有効性に関する他施設前向き無作為化比較試験（KSES001）．  [通常講演]
    松山 仁; 西川和宏; 木村 豊; 岸健太郎; 井上健太郎; 赤丸祐介; 田村茂行; 川端良平; 今村博司; 下川敏雄
    第21回関西がんチーム医療研究会 2017年09月 シンポジウム・ワークショップパネル（公募） 大阪
  • 術後短期的な栄養介入は1年後の体重減少を抑制するのか？〜KSES002試験〜．  [通常講演]
    木村 豊; 西川和弘; 岸健太郎; 井上健太郎; 松山 仁; 赤丸祐介; 田村茂行; 川端良平; 川瀬朋乃; 山田岳史; 下川敏雄; 今村博司
    第21回関西がんチーム医療研究会 2017年09月 シンポジウム・ワークショップパネル（公募） 大阪
  • 進行食道癌に対する術前化学療法ランダム化比較試験FAP vs DCF（OGSG1003）におけるリンパ節微小転移制御効果．  [通常講演]
    平木洋子; 今野元博; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 木村 豊; 今本治彦; 安田卓司
    第26回日本がん転移学会学術集会・総会 2017年07月 シンポジウム・ワークショップパネル（公募） 大阪
  • 高齢・胃切後胸部食道癌に対する嚥下機能温存と血行付加を考慮した新規縦隔横断胸骨後経路高位胸腔内吻合．  [通常講演]
    平木洋子; 白石 治; 岩間 密; 加藤寛章; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • cT4 局所進行食道癌に対するSalvage 手術を前提とした導入化学放射線療法による治療戦略．  [通常講演]
    岩間 密; 白石 治; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 病期IIIA/IIIB 胃癌に対する術後補助化療としてのDTX+S1療法6 ヶ月間継続投与のFeasibility の検討(OGSG1002)．  [通常講演]
    松山 仁; 藤谷和正; 木村 豊; 今村博司; 藤田淳也; 川端良平; 坂井大介; 黒川幸典; 下川敏雄; 佐藤太郎
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 胃切除術後早期の体重減少抑制を目指した取り組み．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也; 平木洋子; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 胃切既往のある胸部食道癌の腹部リンパ節転移の検討〜残胃全摘の省略は許容されるか〜．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 菱形残胃作成と食道裂孔挿入を付加した噴門側胃切除・食道残胃吻合法．  [通常講演]
    安田 篤; 新海政幸; 加藤寛章; 平木洋子; 岩間 密; 白石 治; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 シンポジウム・ワークショップパネル（公募） 石川
  • 腹膜炎術後創に対するNPWT の使用経験．  [通常講演]
    三上城太; 岸本朋也; 澤田元太; 中平 伸; 間狩洋一; 中田健; 辻江正樹; 木村 豊; 藤田淳也; 大里浩樹
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 安定した術野確保のための右肺圧排固定器具の開発と胸腔鏡拡大画像に基づく左側臥位縦隔リンパ節郭清手技．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第72回日本消化器外科学会 2017年07月 シンポジウム・ワークショップパネル（公募） 石川
  • リンパ節転移状況に基づく進行EGJ 腺癌に対するNAC+胸腹連続郭清．  [通常講演]
    白石 治; 平木洋子; 加藤寛章; 岩間 密; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 シンポジウム・ワークショップパネル（公募） 石川
  • CY(+) 進行胃癌に対するPTX 腹腔内投与+PCS 全身化学療法の有用性の検討．  [通常講演]
    新海政幸; 今野元博; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本治彦; 安田卓司
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 85 歳以上の超高齢胃癌患者におけるNCD リスクカリキュレーター予測死亡率と実際の手術成績との比較．  [通常講演]
    山本和義; 藤田正一郎; 藤田淳也; 木村 豊; 安達 慧; 高 正浩; 野中亮児; 藤江裕二郎; 橋本和彦; 大西 直
    第72回日本消化器外科学会 2017年07月 口頭発表（一般） 石川
  • 食道癌術後の進行胃管癌に対して胃管分節切除術で切除できた1例．  [通常講演]
    幕谷悠介; 白石 治; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 ポスター発表 京都
  • 巨大胃GISTに対して術前イマチニブ投与を行い、根治切除可能であった1例．  [通常講演]
    平木洋子; 加藤寛章; 安田 篤; 田中裕美子; 岩間 密; 白石 治; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 集学的加療により咽頭温存とともにR0切除を得た胸部上部食道癌1切除例．  [通常講演]
    岩間 密; 白石 治; 加藤寛章; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 食道入口部に及ぶ大型頸部食道癌に対し、喉頭温存手術を成し得た1例．  [通常講演]
    白石 治; 加藤寛章; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 胸部食道癌の術前化学療法にて腫瘍穿破寸前の状態に陥り、緊急手術を行った1例．  [通常講演]
    安田 篤; 木村 豊; 加藤寛章; 平木洋子; 田中裕美子; 岩間 密; 白石 治; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 噴門部GISTに対する機能温存を配慮した腹腔鏡下胃内手術の有用性．  [通常講演]
    安田 篤; 木村 豊; 新海政幸; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 今野元博; 今本治彦; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • P0CY1胃癌に対するPTX腹腔内投与＋PCS3剤全身化学療法の治療成績．  [通常講演]
    新海政幸; 今野元博; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 今本治彦; 木村 豊; 古河 洋; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • paclitaxel＋ramcirumab療法によりgrade3の蛋白尿をきたした再発胃癌の1例．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 今本治彦; 古河 洋; 藤田淳也; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 内視鏡生検でがん細胞が検出できなかったスキルス胃癌の切除例．  [通常講演]
    古河 洋; 中室 誠; 中野博史; 近藤禎晃; 石川和男; 大久保遊平; 今野元博; 木村 豊; 安田卓司
    第39回日本癌局所療法研究会 2017年06月 口頭発表（一般） 京都
  • 胃癌手術既往のある異時性重複食道癌における、腹腔内リンパ節転移の検討〜残胃温存は許容されるか？〜．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第60回関西胸部外科学会学術集会 2017年06月 口頭発表（一般） 大阪
  • 胃切除後の食道癌患者に対する新しい術式〜縦隔横断胸骨後経路高位胸腔内吻合〜．  [通常講演]
    木村 豊; 白石 治; 平木洋子; 岩間 密; 加藤寛章; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第60回関西胸部外科学会学術集会 2017年06月 口頭発表（一般） 大阪
  • 胃癌，頭頸部癌との重複食道癌に対する治療戦略．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第71回日本食道学会学術集会 2017年06月 ポスター発表 軽井沢
  • 当科におけるSalvage手術の安全性と有効性に関する検討．  [通常講演]
    岩間 密; 白石 治; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第71回日本食道学会学術集会 2017年06月 シンポジウム・ワークショップパネル（公募） 軽井沢
  • 切除可能進行食道癌に対する術前DCF vs ACF療法多施設ランダム化比較第?相試験．  [通常講演]
    白石 治; 山崎 誠; 本告正明; 宮田博志; 牧野知紀; 木村 豊; 平尾素宏; 矢野雅彦; 土岐祐一郎; 安田卓司
    第71回日本食道学会学術集会 2017年06月 シンポジウム・ワークショップパネル（公募） 軽井沢
  • 高齢食道癌患者に対する手術における誤嚥，肺炎の発症の低減を目指した治療選択．  [通常講演]
    木村 豊; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第71回日本食道学会学術集会 2017年06月 ポスター発表 軽井沢
  • 食道癌RO切除困難症例への挑戦．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第71回手術手技研究会 2017年05月 口頭発表（一般） 名古屋
  • 頸部食道癌術後2年目発症の気管食道瘻に対し、遊離前腕皮弁による瘻孔閉鎖・気管孔再形成が有用であった1例．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第71回手術手技研究会 2017年05月 その他 名古屋
  • 食道癌手術において捻転イレウスを回避できる腹腔鏡下空腸瘻増設術．  [通常講演]
    白石 治; 加藤寛章; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第71回手術手技研究会 2017年05月 その他 名古屋
  • 胃切除術の既往のある高齢胸部食道癌患者に対する縦隔横断胸骨後経路高位胸腔内吻合．  [通常講演]
    木村 豊; 白石 治; 平木洋子; 岩間 密; 加藤寛章; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第71回手術手技研究会 2017年05月 その他 名古屋
  • 胸部食道癌根治術後再発とその治療戦略―再び根治を目指して―．  [通常講演]
    加藤寛章; 白石 治; 岩間 密; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第117回日本外科学会定期学術集会 2017年04月 シンポジウム・ワークショップパネル（公募） 横浜
  • 噴門側胃切除・食道残胃吻合における食道胃逆流防止の工夫．  [通常講演]
    安田 篤; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 今野元博; 今本治彦; 木村 豊; 古河 洋; 安田卓司; 奥野清隆
    第117回日本外科学会定期学術集会 2017年04月 シンポジウム・ワークショップパネル（公募） 横浜
  • 腹腔鏡下にD2郭清を伴う腹腔鏡下胃切除術を安全に行うための工夫．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 古河 洋; 今本治彦; 安田卓司
    第117回日本外科学会定期学術集会 2017年04月 ポスター発表 横浜
  • 胸部食道癌手術における頸部郭清の合理化は可能か―Standard or Selective―．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第117回日本外科学会定期学術集会 2017年04月 その他 横浜
  • 安全性を目指した胸部食道癌手術における再建術の工夫．  [通常講演]
    岩間 密; 加藤寛章; 白石 治; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第117回日本外科学会定期学術集会 2017年04月 ポスター発表 横浜
  • 切除可能進行胃癌に対する術前TS-1＋Cisplatin＋Paclitaxel併用療法（PCS療法）．  [通常講演]
    新海政幸; 今野元博; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本治彦; 安田卓司
    第117回日本外科学会定期学術集会 2017年04月 その他 横浜
  • 80歳以上の胃癌患者における予後予測因子の検討．  [通常講演]
    三上城太; 岸本朋也; 澤田元太; 中平 伸; 間狩洋一; 中田 健; 辻江正樹; 木村 豊; 藤田淳也; 大里浩樹
    第117回日本外科学会定期学術集会 2017年04月 ポスター発表 横浜
  • A study about gastric tube cancer after radical esophagectomy for thoracic esophageal cancer． 胸部食道癌術後胃管癌に関する検討．  [通常講演]
    岩間 密; 白石 治; 加藤寛章; 平木洋子; 田中裕美子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦; 安田卓司
    第89回日本胃癌学会総会 2017年03月 ポスター発表 広島
  • Feasibility of neoadjuvant chemoradiation therapy for resectable advanced gastric cancer． 根治切除可能な大型3型／4型胃癌に対する術前化学放射線療法の実現可能性．  [通常講演]
    白石 治; 田中裕美子; 加藤寛章; 岩間 密; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 古河 洋; 塩? 均; 安田卓司
    第89回日本胃癌学会総会 2017年03月 口頭発表（一般） 広島
  • Examination of Pylorus Preserving Gastrectomy in our institution． 当科での幽門保存胃切除術の検討．  [通常講演]
    安田 篤; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 古河 洋; 今野元博; 木村 豊; 今本治彦; 安田卓司; 奥野清隆
    第89回日本胃癌学会総会 2017年03月 ポスター発表 広島
  • The examination of factors affecting body weight loss in patients after total gastrectomy． 胃全摘術後早期の体重減少に影響を及ぼす因子に関する検討．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第89回日本胃癌学会総会 2017年03月 ポスター発表 広島
  • Neoadjuvant combination chemotherapy with S-1, CDDP and PTX for resectable advanced gastric cancer． 切除可能進行胃癌に対する術前PCS療法．  [通常講演]
    新海政幸; 今野元博; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 木村 豊; 今本治彦; 安田卓司
    第89回日本胃癌学会総会 2017年03月 ポスター発表 広島
  • Efficacy of oxaliplatin plus S-1 for advanced gastric cancer 進行胃癌に対するS-1＋oxaliplatin療法の検討．  [通常講演]
    三上城太; 岸本智也; 澤田元太; 中平 伸; 間狩洋一; 中田 健; 辻江正樹; 木村 豊; 藤田淳也; 大里浩樹
    第89回日本胃癌学会総会 2017年03月 ポスター発表 広島
  • 内視鏡的に止血困難な出血性進行胃癌に対する血管塞栓術に関する検討．  [通常講演]
    平木洋子; 木村 豊; 藤田淳也; 安田卓司
    日本消化器病学会近畿支部第106回例会 2017年02月 シンポジウム・ワークショップパネル（公募） 大阪
  • 胃全摘術後早期の体重減少に影響を及ぼす因子に関する検討．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也
    日本消化器病学会近畿支部第106回例会 2017年02月 シンポジウム・ワークショップパネル（公募） 大阪
  • 噴門胃切除後の菱形残胃作成と偽穹窿部食道裂孔挿入による食道残胃吻合法．  [通常講演]
    安田 篤; 今本治彦; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 木村 豊; 今野元博; 古河 洋; 安田卓司; 奥野清隆
    第29回日本内視鏡外科学会総会 2016年12月 口頭発表（一般） 横浜
  • 腹腔鏡下胃切除術において出血を減少させるための工夫．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 彭 英峰; 新海政幸; 今野元博; 今本治彦; 安田卓司
    第29回日本内視鏡外科学会総会 2016年12月 口頭発表（一般） 横浜
  • 教育企画プログラム．  [通常講演]
    木村 豊
    第29回日本外科感染症学会総会学術集会 2016年11月 その他 東京
  • 当院の胃切除後における食道切除後有茎空腸再建術の工夫．  [通常講演]
    白石 治; 田中裕美子; 加藤寛章; 岩間 密; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第78回日本臨床外科学会総会 2016年11月 シンポジウム・ワークショップパネル（公募） 東京
  • 当院における腹腔鏡下胃切除術の工夫―臓器把持用クリップの活用―．  [通常講演]
    木村 豊; 三上城太; 間狩洋一; 藤田淳也; 平木洋子; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 今野元博; 古河 洋; 今本治彦; 安田卓司
    第78回日本臨床外科学会総会 2016年11月 口頭発表（一般） 東京
  • 胃癌術後5年目に発症した脾転移の1切除例．  [通常講演]
    田中裕美子; 平木洋子; 加藤寛章; 岩間 密; 白石 治; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第78回日本臨床外科学会総会 2016年11月 口頭発表（一般） 東京
  • 胸部食道癌手術における術後合併症予防の工夫．  [通常講演]
    岩間 密; 田中裕美子; 加藤寛章; 白石 治; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第78回日本臨床外科学会総会 2016年11月 シンポジウム・ワークショップパネル（公募） 東京
  • CY1胃癌に対するPTX腹腔内投与＋PCS全身化学療法の治療成績．  [通常講演]
    新海政幸; 今野元博; 平木洋子; 加藤寛章; 岩間密; 白石治; 安田篤; 木村豊; 今本治彦; 古河洋; 安田卓司
    第78回日本臨床外科学総会 2016年11月 口頭発表（一般） 東京
  • 輪状咽頭筋切開による咽頭温存食道切除・高位吻合の有用性．  [通常講演]
    加藤寛章; 田中裕美子; 岩間 密; 白石 治; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第78回日本臨床外科学会総会 2016年11月 口頭発表（一般） 東京
  • 高齢者胸部食道癌手術におけるリスク因子と対策．  [通常講演]
    白石 治; 田中裕美子; 加藤寛章; 岩間 密; 安田 篤; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第68回日本気管食道科学会 2016年11月 シンポジウム・ワークショップパネル（公募） 東京
  • がん治療における医科歯科連携による口腔ケアの効果に関する検討．  [通常講演]
    木村 豊; 小倉孝文; 間狩洋一; 三上城太; 藤田淳也; 大里浩樹
    第40回大阪府医師会医学会総会 2016年11月 口頭発表（一般） 大阪
  • 手術サポートセンターの現状とその課題について．  [通常講演]
    三淵未央; 福里富美子; 青井良太; 小倉孝文; 宇高 歩; 木村 豊
    第38回日本手術医学会総会 2016年11月 シンポジウム・ワークショップパネル（公募） 宜野湾
  • 進行再発胃癌に対するラムシルマブ治療例の検討．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 神垣俊二; 池島あゆみ; 藤井千賀; 澤田元太; 中平 伸; 山村 順; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    JDDW第14回日本消化器外科学会大会 2016年11月 ポスター発表 神戸
  • 胃癌に対するSOX (S-1＋oxaliplatin)療法の治療経験．  [通常講演]
    三上城太; 木村 豊; 間狩洋一; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    JDDW第58回日本消化器病学会大会 2016年11月 ポスター発表 神戸
  • 進行胃癌に対する血管塞栓術の有効性に関する検討．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 清水克修; 平木洋子; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 栗生明博; 大里浩樹
    JDDW第58回日本消化器病学会大会 2016年11月 ポスター発表 神戸
  • 症例頃のリスク軽減の工夫による根治的リンパ節郭清を共な食道癌外科治療戦略．  [通常講演]
    安田卓司; 白石 治; 岩間 密; 加藤寛章; 田中裕美子; 平木洋子; 安田 篤; 新海政幸; 今野元博; 木村 豊; 今本治彦
    第78回日本臨床外科学会総会 2016年11月 口頭発表（招待・特別） 東京
  • 高齢者幽門側胃切除後の呼吸器合併症に対する嚥下リハビリ介入の効果に対する検討．  [通常講演]
    田中裕美子; 安田 篤; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第46回胃外科・術後障害研究会 2016年10月 口頭発表（一般） 鳥取
  • 当科における噴門側胃切除後食道残胃吻合（菱形残胃作成と食道裂孔挿入の意義）．  [通常講演]
    加藤寛章; 安田 篤; 田中裕美子; 岩間 密; 白石 治; 新海政幸; 木村 豊; 今野元博; 今本治彦; 安田卓司
    第46回胃外科・術後障害研究会 2016年10月 口頭発表（一般） 鳥取
  • 高齢者に対する腹腔鏡補助下幽門側胃切除後の検討．  [通常講演]
    安田 篤; 今本治彦; 田中裕美子; 加藤寛章; 岩間 密; 白石 治; 新海政幸; 木村 豊; 今野元博; 安田卓司
    第46回胃外科・術後障害研究会 2016年10月 口頭発表（一般） 鳥取
  • A newly modified esophagogastrostomy in laparoscopy-assisted proximal gastrectomy．  [通常講演]
    Yasuda A; Yasuda T; Imamoto H; Tanaka Y; Iwama M; Shiraishi O; Shinkai M; Kimura Y; Imano M; Furukawa H; Okuno K
    第62回国際外科学会日本部会総会・ 第40回国際外科学会世界総会 2016年10月 ポスター発表 京都
  • 胃 癌 の 二 次 治 療 に お け る nab-PTX(weekly/q3w) と weekly PTX と の 第 3 相 比 較 試 験(ABSOLUTE)．  [通常講演]
    中山昇典; 設楽紘平; 島淳生; 藤谷和正; 肥田圭介; 原浩樹; 廣中秀一; 西川和宏; 木村豊; 天貝賢二; 吉田和弘; 明石雄策; 下平秀樹; 仁科智裕; 小泉和三郎
    第54回日本癌治療学会学術集会 2016年10月 シンポジウム・ワークショップパネル（公募） 横浜
  • 術前化学療法の効果予測バイオマーカー探索 COMPASS附随研究．  [通常講演]
    田邊和照; 大島貴; 吉川貴己; 宮城洋平; 森田智視; 西川和宏; 伊藤友一; 松井隆則; 木村豊; 青山徹; 林勉; 尾形高士; 長晴彦; 円谷彰; 坂本純一
    第54回日本癌治療学会学術集会 2016年10月 シンポジウム・ワークショップパネル（公募） 横浜
  • 進行再発胃癌に対するpaclitaxel+ramcirumab療法の検討．  [通常講演]
    木村豊; 間狩洋一; 三上城太; 藤田淳也; 神垣俊二; 池島あゆみ; 藤井千賀; 辻江正樹; 大里浩樹; 今本治彦; 安田卓司
    第54回日本癌治療学会学術集会 2016年10月 シンポジウム・ワークショップパネル（公募） 横浜
  • 腹腔鏡手術における安定した術野展開のための工夫−臓器把持用クリップの活用とその開発−．  [通常講演]
    木村 豊
    第2回平成次世代外科医療研究会 2016年10月 口頭発表（一般） 函館
  • 局所進行食道癌に対する集学的治療の至適切除時期．  [通常講演]
    白石 治; 加藤寛章; 木村 豊; 今本治彦; 安田卓司
    第69回日本胸部外科学会定期学術集会 2016年09月 口頭発表（一般） 岡山
  • 高度進行食道癌に対する至適集学的治療〜成績向上のための戦略と課題．  [通常講演]
    安田卓司; 白石 治; 加藤寛章; 木村 豊; 今本治彦
    第69回日本胸部外科学会定期学術集会 2016年09月 シンポジウム・ワークショップパネル（公募） 岡山
  • ディスカッション「胃癌術後化学療法における最適な治療とは」．  [通常講演]
    木村 豊
    Gastric Cancer Forum in KAWAGOE 2016年08月 その他 川越
  • 胃癌の２次化学療法を対象としたnab-PTX（３週ごと／毎週）とPTXの毎週投与法とのランダム化第III相比較試験．  [通常講演]
    原浩樹; 設楽紘平; 島淳生; 藤谷和正; 肥田圭介; 中山昇典; 廣中秀一; 西川和宏; 木村豊; 小泉和三郎
    第14回日本臨床腫瘍学会学術集会 2016年07月 その他 神戸
  • 経口抗がん薬のアドヒアランスを向上させるための取り組み．  [通常講演]
    今村博司; 西川和宏; 岸健太郎; 井上健太郎; 松山仁; 赤丸祐介; 木村豊; 田村茂行; 川瀬朋乃; 広田将司; 下川敏雄
    第14回日本臨床腫瘍学会学術集会 2016年07月 ポスター発表 神戸
  • Bacteroides spp.に対する適切な抗菌薬の検討．  [通常講演]
    蛯原 健; 和泉多映子; 川田真大; 尾崎貴洋; 天野浩司; 常俊雄介; 臼井章浩; 中田康城; 木村 豊; 横田順一朗
    第71日本消化器外科学会総会 2016年07月 ポスター発表 徳島
  • 合併症と再発を減らす腹腔鏡下腹壁瘢痕ヘルニア修復術の工夫．  [通常講演]
    中田 健; 三上城太; 澤田元太; 中平 伸; 間狩洋一; 山本為義; 辻江正樹; 木村 豊; 大里浩樹
    第71日本消化器外科学会総会 2016年07月 シンポジウム・ワークショップパネル（公募） 徳島
  • 胃癌肝転移に対する，定位放射線照射治療(SRT) の治療経験．  [通常講演]
    間狩洋一; 木村 豊; 三上城太; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第71日本消化器外科学会総会 2016年07月 ポスター発表 徳島
  • 胃癌骨転移の検討．  [通常講演]
    三上城太; 澤田元太; 中平 伸; 間狩洋一; 中田 健; 山本為義; 辻江正樹; 木村 豊
    第71日本消化器外科学会総会 2016年07月 ポスター発表 徳島
  • 単孔式手術で摘出し得た有茎性線維腫の1例．  [通常講演]
    笹松信吾; 中平 伸; 木村 豊; 棟方 哲; 間狩洋一; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第71日本消化器外科学会総会 2016年07月 シンポジウム・ワークショップパネル（公募） 徳島
  • 食道癌化学療法中に急性動脈閉塞をきたした1例．  [通常講演]
    三上城太; 間狩洋一; 木村 豊; 澤田元太; 中平 伸; 中田健; 山本為義; 辻江正樹; 大里浩樹
    第70日本食道学会学術集会 2016年07月 ポスター発表 東京
  • 狭窄を伴う下咽頭癌術後の早期食道癌に対して経胃的逆行性にESDを施行した1例．  [通常講演]
    木村 豊; 黒野由莉; 三上城太; 天野浩司; 間狩洋一; 中田 健; 光藤大地; 北村信次; 山本為義; 辻江正樹; 大里浩樹; 安田卓司
    第70日本食道学会学術集会 2016年07月 その他 東京
  • 化学放射線療法が奏効した、上大静脈腫瘍血栓を伴う進行食道小細胞癌の1例．  [通常講演]
    間狩洋一; 木村 豊; 笹松信吾; 三上城太; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第70日本食道学会学術集会 2016年07月 ポスター発表 東京
  • 治癒切除不能閉塞性左側大腸癌に対しステント留置後に化学療法を施行した 7 症例の検討．  [通常講演]
    中田 健; 西 秀美; 平木洋子; 吉村旬平; 笹松信吾; 清水克修; 井上捻也; 三上城太; 澤田元太; 北原睦織; 中平 伸; 山村 順; 間狩洋一; 神垣俊二; 山本為義; 澁川貴規; 池田直樹; 辻江正樹; 木村 豊; 大里浩樹
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 悪性大腸閉塞に対しストーマ造設後に化学（放射線）療法を施行した症例の検討．  [通常講演]
    西 秀美; 中田 健; 平木洋子; 吉村旬平; 笹松信吾; 清水克修; 井上捻也; 三上城太; 澤田元太; 北原睦織; 中平 伸; 山村 順; 間狩洋一; 神垣俊二; 山本為義; 澁川貴規; 池田直樹; 辻江正樹; 木村 豊; 大里弘樹
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 大腸癌穿孔に対する Damage control Surgery〜92 歳の超高齢症例を通して〜  [通常講演]
    蛯原 健; 清水克修; 川田真大; 尾崎貴洋; 天野浩司; 常俊雄介; 臼井章浩; 中田 健; 辻江正樹; 木村 豊; 中田康城; 横田順一朗
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 腸腰筋膿瘍を合併した S 状結腸癌に対し、ドレナージ後に腹腔鏡下切除を施行した1 例．  [通常講演]
    天野浩司; 中田 健; 川田真大; 蛯原 健; 尾崎貴洋; 清水克修; 常俊雄介; 臼井章浩; 辻江正樹; 木村 豊; 中田康城; 横田順一朗
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • S-1治療中の胃癌患者における眼症状に関する検討．  [通常講演]
    藤井千賀; 木村 豊; 間狩洋一; 三上城太; 林 仁; 石坂敏彦
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 大腸ステントが有用であった胃癌腹膜転移の 1 例．  [通常講演]
    三上城太; 間狩洋一; 木村 豊; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 胃癌肝転移に対する、定位放射線照射治療（SRT）の治療経験．  [通常講演]
    間狩洋一; 木村 豊; 吉村旬平; 笹松信吾; 平木洋子; 西 秀美; 井上捻也; 三上城太; 澤田元太; 中平 伸; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • paclitaxel+ramcirumab療法が奏効した高齢の切除不能胃癌の1例．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 吉村旬平; 井上稔也; 澤田元太; 中平 伸; 山村 順; 神垣俊二; 中田 健; 山本為義; 池田直樹; 辻江正樹; 大里浩樹
    第38回日本癌局所療法研究会 2016年06月 ポスター発表 東京
  • 化学療法施行中に出血をきたした進行胃癌に対して血管塞栓術を行った3例．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 平木洋子; 清水克修; 笹松信吾; 澤田元太; 中平 伸; 山村 順; 神垣俊二; 中田 健; 山本為義; 池田直樹; 辻江正樹; 粟生明博; 大里浩樹
    第38回日本癌局所療法研究会 2016年06月 口頭発表（一般） 東京
  • 当院における腹腔鏡下胃切除術の工夫．  [通常講演]
    木村 豊
    第17回南大阪で内視鏡手術を極める会 2016年05月 口頭発表（一般） 大阪
  • 胃癌腹膜転移に対して大腸ステントを用いた5例の検討．  [通常講演]
    三上城太; 木村 豊; 間狩洋一; 星野浩光; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第116回日本外科学会 2016年04月 ポスター発表 大阪
  • 直腸切除術後の縫合不全に対する腹腔鏡下Drainage ＆ Diverting Stoma造設術の検討．  [通常講演]
    中田 健; 辻江正樹; 吉村旬平; 西 秀美; 平木洋子; 笹松信吾; 清水克修; 井上稔也; 三上城太; 星野宏光; 間狩洋一; 北原睦識; 山村 順; 神垣俊二; 山本為義; 池田直樹; 木村 豊; 大里浩樹
    第116回日本外科学会 2016年04月 ポスター発表 大阪
  • イリノテカン+トラスツズマブ併用療法の進行・再発HER2陽性胃癌既治療例に対する多施設第II相試験OGSG1203（HERBIS-5）：前治療の解析．  [通常講演]
    清水 健; 坂井大介; 川田純司; 西川和宏; 川瀬朋乃; 岡義雄; 川端良平; 西嶌準一; 遠藤俊治; 木村 豊; 松山仁; 野口明則; 黒川幸典; 下川敏雄; 藤谷和正; 佐藤太郎
    第116回日本外科学会 2016年04月 口頭発表（一般） 大阪
  • 癌治療における医科歯科連携の効果．  [通常講演]
    木村 豊; 小倉孝文; 木田久美子; 間狩洋一; 三上城太; 北原睦識; 星野宏光; 山村 順; 中田 健; 神垣俊二; 山本為義; 池田直樹; 澁川貴規; 辻江正樹; 大里浩樹
    第116回日本外科学会 2016年04月 口頭発表（一般） 大阪
  • 経皮的動脈塞栓術により止血され、治療継続が可能であった出血性進行胃癌の3例．  [通常講演]
    平木洋子; 木村 豊; 間狩洋一; 三上城太; 山村 順; 中田 健; 池田直樹; 神垣俊二; 山本為義; 辻江正樹; 大里浩樹
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • 胃粘液癌の臨床病理学的因子および予後についての検討．  [通常講演]
    橋本直佳; 栗川幸典; 木村 豊; 今村博司; 足立真一; 藤田淳也; 宮崎安弘; 牧野知紀; 高橋 剛; 山崎 誠; 瀧口修司; 森 正樹; 土岐祐一郎
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • 出血性進行胃癌に対し放射線療法により止血を得た2例．  [通常講演]
    清水克修; 木村 豊; 間狩洋一; 三上城太; 山村 順; 中田 健; 池田直樹; 神垣俊二; 山本為義; 辻江正樹; 大里浩樹; 池田 恢
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • 胃癌腹膜転移に対して大腸ステントを用いた3例．  [通常講演]
    三上城太; 木村 豊; 間狩洋一; 星野浩光; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • IRI+Tmab併用療法の進行・再発HER2陽性胃癌既治療例に対する多施設第II相 試験．  [通常講演]
    岡義雄; 坂井大介; 川田純司; 西川和宏; 川端良平; 川瀬朋乃; 杉本直俊; 清水健; 長谷川裕子; 遠藤俊治; 木村豊; 松山仁; 黒川幸典; 下川敏雄; 佐藤太郎
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • 行再発胃癌に対するラムシルマブの使用経験．  [通常講演]
    木村 豊; 間狩洋一; 三上城太; 神垣俊二; 池島あゆみ; 藤井千賀; 星野宏光; 山村 順; 中田 健; 山本為義; 辻江正樹; 大里浩樹
    第88回日本胃癌学会総会 2016年03月 ポスター発表 大分
  • がん薬物療法患者に対する口腔ケアの効果に関する検討．  [通常講演]
    藤井千賀; 木村 豊; 小倉孝文; 斎藤孝子; 宮脇未来; 柳下祐貴子; 安井友佳子; 石坂敏彦
    日本臨床薬学会学術大会2016 2016年03月 口頭発表（一般） 鹿児島
  • Open abdominal managementを用いた大腸穿孔に対する治療戦略．  [通常講演]
    天野浩司; 川田真大; 蛯原健; 加藤文崇; 尾崎貴洋; 常俊雄介; 臼井章浩; 木村豊; 中田康城; 横田順一朗
    日本腹部救急学会 2016年03月 口頭発表（一般） 東京
  • 虫垂憩室に伴う虫垂炎の治療方針．  [通常講演]
    蛯原健; 常俊雄介; 中田健; 臼井章浩; 清水克修; 川田真大; 尾崎貴洋; 天野浩司; 加藤文崇; 中田康城; 木村豊; 横田順一朗
    日本腹部救急学会 2016年03月 口頭発表（一般） 東京
  • 回盲部切除術を必要とする急性虫垂炎の術前予測因子の検討．  [通常講演]
    清水克修; 臼井章浩; 川田真大; 蛯原健; 尾崎貴洋; 天野浩司; 三上城太; 常俊雄介; 中田康城; 木村豊; 横田順一朗
    日本腹部救急学会 2016年03月 口頭発表（一般） 東京
  • 胃全摘術後早期の体重減少に対するパンクレリパーゼ製剤の効果．  [通常講演]
    木村 豊; 三上城太; 間狩洋一
    日本消化器病学会近畿支部第104回例会 2016年02月 シンポジウム・ワークショップパネル（公募） 大阪
  • A phase II trial of trastuzumab combined with irinotecan in patients with advanced HER2-positive chemo-refractory gastric cancer: OGSG1203 (HERBIS-5)．  [通常講演]
    Nishikawa K; Sakai D; Kawada J; Kawabata R; Kawase T; Oka Y; Sugimoto N; Shimizu T; Nishijima J; Hasegawa H; Endo S; Isozaki Y; Kimura Y; Matsuyama J; Kurokawa Y; Shimokawa T; Fujitani K; Satoh T
    American Society of Clinical Oncology (ASCO)-Gastrointestinal Cancers Symposium 2016年01月 ポスター発表 サンフランシスコ
  • 根治切除可能な漿膜浸潤を伴う胃癌に対する周術期化学療法（TS-1、パクリタキセル経静脈・腹腔内投与併用療法） 第?相試験．  [通常講演]
    今野元博; 石神浩徳; 藪崎 裕; 小林大介; 伊藤誠二; 上之園芳一; 上田修吾; 木村 豊; 山口博紀; 今本治彦; 梨本 篤; 古河 洋; 安田卓司; 竹吉 泉; 福島亮治; 小寺泰弘; 北山丈二
    第115回日本外科学会定期学術集会 2015年04月 シンポジウム・ワークショップパネル（公募） 名古屋
  • 病期IIIA/B 胃がん患者を対象としたドセタキセル＋TS-1併用術後化学療法の第II相試験 (OGSG0604)の予後解析．  [通常講演]
    平尾素宏; 藤谷和正; 佐藤太郎; 木村 豊; 田村茂行; 辻 毅; 松山 仁; 今村博司; 飯島正平; 黒川幸典; 下川敏雄; 辻仲利政; 古河 洋
    第87回日本胃癌学会総会 2015年03月 ポスター発表 広島
  • Stage III胃癌に対する術後補助化学療法としての5か月間のドセタキセル＋S-1投与の検討(OGSG1002)．  [通常講演]
    藤田淳也; 藤谷和正; 田村茂行; 木村 豊; 松山 仁; 今村博司; 飯島正平; 上田修吾; 下川敏雄; 黒川幸典; 佐藤太郎; 辻仲利政; 古河 洋
    第87回日本胃癌学会総会 2015年03月 ポスター発表 広島
  • Randomized phase II study of CPT-11 versus PTX: +/- S1 in advanced gastric cancer refractory to S1 or S1 + platinum (OGSG 0701)  [通常講演]
    Naotoshi Sugimoto; Hiroshi Imamura; Masahiro Gotoh; Yutaka Kimura; Shugo Ueda; Yukinori Kurokawa; Daisuke Sakai; Toshio Shimokawa; Toshimasa Tsujinaka; Hiroshi Furukawa
    第12回日本臨床腫瘍学会 2014年07月 その他 福岡
  • Randomized phase II study of CPT-11 versus PTX versus each combination chemotherapy with S-1 in patients with advanced gastric cancer refractory to S-1 or S-1 plus CDDP.  [通常講演]
    T Kawase; H Imamura; M Goto; Y Kimura; S Ueda; J Matsuyama; K Nishikawa; N Sugimoto; J Fujita; T Tamura; N Fukushima; R Kawabata; Y Kurokawa; T Shimokawa; D Sakai; T Tsujinaka; H Furukawa
    米国臨床腫瘍学会（ASCO2014） 2014年05月 ポスター発表 シカゴ
  • 胃切除術における術後SSIの発生に影響するリスク因子解析とSSI予防対策  [通常講演]
    平尾素宏; 山本和義; 西川和宏; 宮本敦史; 池田正孝; 高見康二; 中森正二; 関本貢嗣; 今村博司; 井上健太郎; 木村 豊; 飯島正平; 藤谷和正; 辻仲利政; 下川敏雄; 古河 洋; 黒川幸典; 小林省吾; 伊藤壽記; 森 正樹; 土岐祐一郎
    第114回日本外科学会定期学術集会 2014年04月 口頭発表（一般） 京都

MISC

受賞

  • 2020年11月 日本消化器外科学会 第18回日本消化器外科学会大会ポスター優秀演題賞
     進行食道癌に対する術前化学療法後のリンパ節における微小転移の臨床的意義に関する検討
  • 2020年08月 日本外科学会 第120回日本外科学会定期学術集会優秀演題賞
     75歳以上の根治切除可能な大型3型 / 4型胃癌に対する術前TS-1併用化学放射線療法の第I相臨床試験（OGSG1303）
  • 2019年10月 胃外科・術後障害研究会 第49回胃外科・術後障害研究会優秀演題賞
     胃切除術後の早期栄養介入は長期的な体重減少の抑制に影響するか～KSES002試験～
  • 2014年08月 日本癌治療学会 第52回日本癌治療学会学術集会優秀演題賞
     Stage III胃癌に対するdocetaxel+S-1術後補助化学療法(3ヵ月投与)の第2相試験(OGSG0604)
  • 2010年03月 日本胃癌学会 第82回日本胃癌学会総会優秀演題賞
     高齢者(75歳以上)の進行・再発胃癌に対するTS-1単独療法の第II相臨床試験（OGSG0404）

共同研究・競争的資金等の研究課題

  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2017年04月 -2022年03月 
    代表者 : 加藤 寛章; 安田 卓司; 今本 治彦; 今野 元博; 木村 豊; 新海 政幸; 安田 篤; 白石 治; 岩間 密; 平木 洋子
     
    食道癌術中の胸部操作終了後～標本摘出までの間に食道をカバーした袋内に貯留した液中の悪性細胞の有無を検討し、63例中3例（4.8％）で食道標本からの遊離癌細胞が陽性（2例：細胞診陽性、1例はセルブロックのみ陽性）であった。食道癌術中の胸部操作終了後～標本摘出までの間に食道から遊離癌細胞が漏出することをはじめて明らかにした。
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2015年04月 -2020年03月 
    代表者 : 安田 卓司; 今本 治彦; 木村 豊; 今野 元博; 新海 政幸; 安田 篤; 白石 治; 岩間 密; 加藤 寛章; 田中 裕美子; 平木 洋子; 曽我部 俊介
     
    食道癌術後は誤嚥のリスクが高く、重篤な肺炎に繋がる可能性からその予防は大きな課題である。嚥下運動機能障害による誤嚥は術式の改良やリハビリテーションによって改善されてきたが、嚥下反射の低下による誤嚥は未解決のままである。嚥下反射は脳の刺激で分泌されるサブスタンスP（SP）により制御されているので、術前血中SP値と無症候性脳梗塞および術前後の嚥下機能との関連を検討した。60歳以上の半数に認めると言われた無症候性脳梗塞は5%程度しか認めなかったが、血中SP低値の症例は術後の嚥下機能が悪く、誤嚥発症率は有意に高かった。以上より、血中SPの測定は術後の嚥下機能予測に有用である可能性が示唆された

委員歴

  • 2018年10月 - 現在   日本外科感染症学会   編集員会委員
  • 2018年06月 - 現在   日本胃癌学会   財務委員会委員
  • 2013年11月 - 現在   日本外科感染症学会   教育委員会委員

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