詳細

川村　純一郎 （カワムラ　ジュンイチロウ）

  • 医学科　教授/主任
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

    ・大腸癌に対する腹腔鏡下手術／ロボット手術・直腸癌に対する肛門温存手術（出来るだけ自然肛門を残す手術術式） ・大腸癌肝転移に対する集学的治療（手術、肝動注、凝固療法などの併用）

  • 報道関連出演・掲載一覧

    ＜報道関連出演・掲載一覧＞ ●2021/1/22 　日本テレビ「ZIP！」 　坂本龍一さんの直腸がんについて ●2019/2/19 　朝日放送「おはよう朝日です」 　手術支援ロボットやハイブリッド手術室について

研究者情報

学位

  • 医学博士（2006年10月 京都大学）

ホームページURL

科研費研究者番号

  • 90422948

J-Global ID

研究キーワード

  • 大腸癌   ロボット支援下手術   腹腔鏡下手術   蛍光ナビゲーション   経肛門内視鏡手術   転移性肝癌   炎症性腸疾患   潰瘍性大腸炎   癌   カストリノーマ   膵・消化管神経内分泌腫瘍   

現在の研究分野（キーワード）

    ・大腸癌に対する腹腔鏡下手術／ロボット手術・直腸癌に対する肛門温存手術（出来るだけ自然肛門を残す手術術式）
    ・大腸癌肝転移に対する集学的治療（手術、肝動注、凝固療法などの併用）

研究分野

  • ライフサイエンス / 外科学一般、小児外科学

経歴

  • 2019年04月 - 現在  近畿大学外科教授
  • 2018年04月 - 2019年03月  近畿大学外科准教授
  • 2014年08月 - 2018年03月  近畿大学医学部外科講師
  • 2011年09月 - 2014年07月  滋賀県立成人病センター外科医長
  • 2010年02月 - 2011年08月  京都大学医学部附属病院消化管外科助教
  • 2009年01月 - 2010年01月  コーネル大学外科フェロー
  • 2006年11月 - 2008年12月  京都大学医学部附属病院消化管外科助教
  • 2004年04月 - 2006年10月  京都大学医学部附属病院消化管外科医員
  • 1996年04月 - 2000年03月  松江赤十字病院外科医員
  • 1995年05月 - 1996年03月  京都大学医学部附属病院外科研修医

学歴

  • 2000年04月 - 2004年03月   京都大学   大学院医学研究科
  • 1989年04月 - 1995年03月   京都大学   医学部

研究活動情報

論文

  • Masayoshi Iwamoto; Yusuke Makutani; Hokuto Ushijima; Ryotaro Ogawa; Yasumasa Yoshioka; Toshiaki Wada; Kazuki Ueda; Junichiro Kawamura
    Diseases of the colon and rectum 2024年02月
  • 局所進行直腸癌に対する術前治療の適応と治療成績
    吉岡 康多; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 岩本 哲好; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本内視鏡外科学会雑誌 28 7 3170 - 3170 (一社)日本内視鏡外科学会 2023年12月
  • ナビゲーションサージェリーの最前線 ICG蛍光法を用いる術中リンパ節ナビゲーションと体腔内吻合(腸管血流評価)を行うDouble ICG techniqueによる腹腔鏡下結腸切除術
    和田 聡朗; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 岩本 哲好; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A59 - A59 (一社)日本大腸肛門病学会 2023年09月
  • 潰瘍性大腸炎に対する腹腔鏡下手術の短期成績と栄養指数・大腰筋断面積との関連
    大東 弘治; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 岩本 哲好; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A168 - A168 (一社)日本大腸肛門病学会 2023年09月
  • 直腸切除術におけるCovering ileostomyに関する合併症の検討
    好田 匡志; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 和田 聡朗; 岩本 哲好; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A200 - A200 (一社)日本大腸肛門病学会 2023年09月
  • 当科における直腸切除術後の血流以外の縫合不全に関与する因子の検討
    幕谷 悠介; 家根 由典; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 和田 聡朗; 岩本 哲好; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A204 - A204 (一社)日本大腸肛門病学会 2023年09月
  • 頭側アプローチ先行によるロボット支援下結腸右半切除術の郭清手技
    岩本 哲好; 幕谷 悠介; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A209 - A209 (一社)日本大腸肛門病学会 2023年09月
  • 腹腔鏡下・経仙骨アプローチを併用し切除し得た巨大骨盤内孤立性繊維性腫瘍の1例
    梅田 一生; 和田 聡朗; 山田 淳史; 幕谷 悠介; 牛嶋 北斗; 尾川 諒太郎; 吉岡 康多; 岩本 哲好; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A282 - A282 (一社)日本大腸肛門病学会 2023年09月
  • 当院における局所進行下部直腸癌に対する側方郭清の適応と治療成績
    吉岡 康多; 幕谷 悠介; 牛嶋 北斗; 尾川 諒太郎; 岩本 哲好; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 9 A317 - A317 (一社)日本大腸肛門病学会 2023年09月
  • 頭側アプローチ先行によるロボット支援下結腸右半切除術の安全な導入における工夫
    岩本 哲好; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本消化器外科学会総会 78回 P049 - 3 (一社)日本消化器外科学会 2023年07月
  • 当科での腹腔鏡下結腸切除における体腔内吻合の手術手技と成績
    和田 聡朗; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 岩本 哲好; 大東 弘治; 上田 和毅; 所 忠男; 川村 純一郎
    日本消化器外科学会総会 78回 P202 - 8 (一社)日本消化器外科学会 2023年07月
  • 潰瘍性大腸炎に対する腹腔鏡下大腸全摘回腸嚢肛門吻合術の工夫
    大東 弘治; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 和田 聡朗; 岩本 哲好; 所 忠男; 上田 和毅; 川村 純一郎
    日本消化器外科学会総会 78回 P221 - 1 (一社)日本消化器外科学会 2023年07月
  • 頭側アプローチ先行によるロボット支援下結腸右半切除術の安全な導入における工夫
    岩本 哲好; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本消化器外科学会総会 78回 P049 - 3 (一社)日本消化器外科学会 2023年07月
  • 当科での腹腔鏡下結腸切除における体腔内吻合の手術手技と成績
    和田 聡朗; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 岩本 哲好; 大東 弘治; 上田 和毅; 所 忠男; 川村 純一郎
    日本消化器外科学会総会 78回 P202 - 8 (一社)日本消化器外科学会 2023年07月
  • 潰瘍性大腸炎に対する腹腔鏡下大腸全摘回腸嚢肛門吻合術の工夫
    大東 弘治; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 和田 聡朗; 岩本 哲好; 所 忠男; 上田 和毅; 川村 純一郎
    日本消化器外科学会総会 78回 P221 - 1 (一社)日本消化器外科学会 2023年07月
  • 腹壁瘢痕ヘルニア嵌頓に対する緊急腹腔鏡下修復術の手術手技
    和田 聡朗; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 岩本 哲好; 大東 弘治; 上田 和毅; 川村 純一郎; 所 忠男
    日本腹部救急医学会雑誌 43 2 381 - 381 (一社)日本腹部救急医学会 2023年02月
  • Masayoshi Iwamoto; Yusuke Makutani; Yoshinori Yane; Hokuto Ushijima; Yasumasa Yoshioka; Toshiaki Wada; Koji Daito; Tadao Tokoro; Yasutaka Chiba; Kazuki Ueda; Junichiro Kawamura
    Langenbeck's archives of surgery 408 1 33 - 33 2023年01月 [査読有り]
     
    PURPOSE: Recently, a new certification system called the Endoscopic Surgical Skill Qualification System (ESSQS) has been launched in Japan to improve surgical safety. This study aimed to determine whether ESSQS-qualified surgeons affect the short- and long-term outcomes of laparoscopic right hemicolectomy. METHODS: A total of 187 colon cancer patients who underwent laparoscopic right hemicolectomy at Kindai University Hospital between January 2016 and December 2020 were enrolled. These patients were divided into two groups based on surgeries performed by ESSQS-qualified surgeons (QS group) and non-ESSQS-qualified surgeons (NQS group). The short- and long-term outcomes were compared between the two groups before and after propensity score matching (PSM). RESULTS: After PSM, 43 patients from each group were included in the matched cohort. In the short-term outcomes, the total operative time was significantly longer in the NQS group than in the QS group (229 vs. 174 min, p < 0.0001). However, there were no significant differences in the two groups regarding blood loss (0 vs. 0 ml, p = 0.7126), conversion (0.0% vs. 7.0%, p = 0.0779), Clavien-Dindo ≥ 2 complications (9.3% vs. 7.0%, p = 0.6933), mortality (2.3% vs. 0.0%, p = 0.3145), and postoperative hospital stay (9 vs. 9 days, p = 0.5357). In the long-term outcomes, there were no significant differences between the two groups in the 3-year overall survival (86.6% vs. 83.0%, p = 0.8361) and recurrence-free survival (61.7% vs. 72.0%, p = 0.3394). CONCLUSION: Laparoscopic right hemicolectomy performed by ESSQS-qualified surgeons contributed to shorter operative time. Under the supervision of ESSQS-qualified surgeons, almost equivalent safety and oncological outcomes are expected even in surgeries performed by non-ESSQS-qualified surgeons.
  • Kazuki Ueda; Hokuto Ushijima; Junichiro Kawamura
    Minimally Invasive Therapy & Allied Technologies 1 - 7 2023年01月 [査読有り]
     
    With the development of surgical technology, indocyanine green (ICG) fluorescence navigation systems may be useful in various areas of colorectal surgery, including tumor location confirmation, bowel perfusion, ureter identification, and lymph node mapping. This review provides an overview of the current status of ICG-based navigation surgery in colorectal surgery, emphasizing its role in lymphatic flow mapping. This state-of-the-art approach will allow for appropriate oncological surgeries in the field of colorectal cancer and improve the patient's prognosis.
  • 局所進行直腸癌に対する術前治療の適応と治療成績
    吉岡 康多; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 岩本 好哲; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 76 1 74 - 74 (一社)日本大腸肛門病学会 2023年01月
  • masayoshi iwamoto; Kazuki Ueda; Junichiro Kawamura
    Cancers 14 22 5623 - 5623 2022年11月 [査読有り]
     
    Anastomotic leakage is one of the most dreaded complications of colorectal surgery and is strongly associated with tissue perfusion. Indocyanine green fluorescence angiography (ICG-FA) using indocyanine green and near-infrared systems is an innovative technique that allows the visualization of anastomotic perfusion. Based on this information on tissue perfusion status, surgeons will be able to clearly identify colorectal segments with good blood flow for safer colorectal anastomosis. The results of several clinical trials indicate that ICG-FA may reduce the risk of AL in colorectal resection; however, the level of evidence is not high, as several other studies have failed to demonstrate a reduction in the risk of AL. Several large-scale RCTs are currently underway, and their results will determine whether ICG-FA is, indeed, useful. The major limitation of the current ICG-FA evaluation method, however, is that it is subjective and based on visual assessment by the surgeon. To complement this, the utility of objective evaluation methods for fluorescence using quantitative parameters is being investigated. Promising results have been reported from several clinical trials, but all trials are preliminary owing to their small sample size and lack of standardized protocols for quantitative evaluation. Therefore, appropriately standardized, high-quality, large-scale studies are warranted.
  • 和田 聡朗; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 岩本 哲好; 大東 弘治; 上田 和毅; 所 忠男; 川村 純一郎
    日本外科感染症学会雑誌 19 1 275 - 275 (一社)日本外科感染症学会 2022年10月
  • Jun Watanabe; Yukihide Kanemitsu; Hirokazu Suwa; Yoshihiro Kakeji; Soichiro Ishihara; Eiji Shinto; Heita Ozawa; Takeshi Suto; Junichiro Kawamura; Fumihiko Fujita; Michio Itabashi; Masayuki Ohue; Hideyuki Ike; Kenichi Sugihara
    Annals of Gastroenterological Surgery 7 2 265 - 271 2022年09月 [査読有り]
     
    AIM: There have been no reports of searching for metastases to lymph nodes along the accessory middle colic artery (aMCA). The aim of this study was to investigate the metastasis rate of the aMCA for splenic flexural colon cancer. METHODS: Patients with histologically proven colon carcinoma located in the splenic flexure, clinically diagnosed as stage I-III were eligible for this study. Patients were retrospectively and prospectively enrolled. The primary endpoint was frequency of lymph node metastasis to the aMCA (station 222-acc and 223-acc). The secondary endpoint was the frequency of lymph node metastasis to the middle colic artery (MCA) (station 222-lt and 223) and left colic artery (LCA) (station 232 and 253). RESULTS: Between January 2013 and February 2021, a total of 153 consecutive patients were enrolled. The location of the tumor was 58% in the transverse colon and 42% in the descending colon. Lymph node metastases were observed in 49 cases (32%). The presence of aMCA rate was 41.8% (64 cases). The metastasis rates of stations 221, 222-lt, and 223 were 20.0%, 1.6%, and 0%, and stations 231, 232, and 253 were 21.4%, 1.0%, and 0%, respectively. The metastasis rates of stations 222-acc and 223-acc were 6.3% (95% confidence interval: 1.7%-15.2%) and 3.7% (95% confidence interval: 0.1%-19%), respectively. CONCLUSIONS: This study identified the distribution of lymph node metastases from splenic flexural colon cancer. If the aMCA is present, this vessel should be targeted for dissection, taking into account the frequency of lymph node metastasis.
  • ロボット支援下直腸切除術における,術者間の術後短期成績の比較
    岩本 哲好; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 75 9 A127 - A127 (一社)日本大腸肛門病学会 2022年09月
  • ストーマ脱出に対してICG蛍光血流評価を併用した自動縫合器による修復術の1例
    吉岡 康多; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 岩本 哲好; 和田 聡朗; 大東 弘治; 所 忠男; 上田 和毅; 川村 純一郎
    日本大腸肛門病学会雑誌 75 9 A179 - A179 (一社)日本大腸肛門病学会 2022年09月
  • 腹腔鏡下結腸切除における体腔内吻合の安全な手術手技の確立
    和田 聡朗; 幕谷 悠介; 家根 由典; 牛嶋 北斗; 吉岡 康多; 岩本 哲好; 大東 弘治; 上田 和毅; 所 忠男; 川村 純一郎
    日本大腸肛門病学会雑誌 75 9 A216 - A216 (一社)日本大腸肛門病学会 2022年09月
  • Yusuke Makutani; Kazuko Sakai; Masahiro Yamada; Toshiaki Wada; Takaaki Chikugo; Takao Satou; Yoko Iwasa; Hidekazu Yamamoto; Marco A de Velasco; Kazuto Nishio; Junichiro Kawamura
    International journal of clinical oncology 27 7 1180 - 1187 2022年04月 [査読有り]
     
    BACKGROUND: The Biocartis Idylla™ platform is a fully automated, real-time PCR-based diagnostic system. The Idylla™ KRAS and NRAS-BRAF Mutation Tests have been developed for the qualitative detection of mutations in KRAS, NRAS and BRAF genes, facilitating the genomic profiling of patients with colorectal cancer. The aim of the present study was to evaluate clinical performances of these tests in Japan. METHODS: The RAS and BRAF mutation statuses of 253 formalin-fixed paraffin-embedded (FFPE) colorectal cancer tissues were analyzed using the Investigational Use Only Idylla™ KRAS Mutation Test and the Idylla™ NRAS-BRAF Mutation Test and an in vitro diagnostics (IVD) kit (MEBGEN RASKET™-B kit). RESULTS: The success rate for obtaining a valid mutational data without retest of the Idylla tests was 97.6% (247/253): 111 KRAS mutations (43.8%), 9 NRAS mutations (3.6%), and 36 BRAF V600E mutations (14.2%) were detected using the Idylla tests. Compared with the MEBGEN RASKET-B results, the positive concordance rate was 97.4%, the negative concordance rate was 95.7%, and the overall concordance rate was 95.3% (κ = 0.919, 95% CI 0.871-0.967). The average turnaround time to Idylla™ KRAS and NRAS-BRAF Mutation Test was 5.6 working days (range: 3-11 days). CONCLUSION: This result demonstrates a high concordance between the Idylla™ KRAS and NRAS-BRAF Mutation Tests and an existing IVD kit. In this manner, the Idylla™ mutation tests were validated for the detection of clinically significant KRAS, NRAS, and BRAF mutations in FFPE samples from colorectal cancer patients.
  • Kazutaka Yamada; Yasumitsu Saiki; Koji Komori; Akio Shiomi; Masashi Ueno; Masaaki Ito; Koya Hida; Seiichiro Yamamoto; Manabu Shiozawa; Soichiro Ishihara; Yukihide Kanemitsu; Hideki Ueno; Tatsuya Kinjo; Kotaro Maeda; Junichiro Kawamura; Fumihiko Fujita; Keiichi Takahashi; Tsunekazu Mizushima; Yasuhiro Shimada; Shin Sasaki; Eiji Sunami; Fumio Ishida; Keiji Hirata; Shinobu Ohnuma; Kimihiko Funahashi; Jun Watanabe; Yusuke Kinugasa; Shigeki Yamaguchi; Yojiro Hashiguchi; Masataka Ikeda; Takeshi Sudo; Yoshito Komatsu; Keiji Koda; Kazuhiro Sakamoto; Masazumi Okajima; Hideyuki Ishida; Yuichi Hisamatsu; Taiki Masuda; Shinichiro Mori; Kazuhito Minami; Seiji Hasegawa; Shungo Endo; Akinori Iwashita; Madoka Hamada; Yoichi Ajioka; Koichiro Usuku; Tokunori Ikeda; Kenichi Sugihara
    Cancer medicine 11 14 2735 - 2743 2022年03月 [査読有り]
     
    Anal canal cancer (ACC) has been reported to be an uncommon cancer in Japan, as in the USA, Europe, and Australia. This retrospective multi-institutional study was conducted to clarify the characteristics of ACC in Japan. First, the histological ACC type cases treated between 1991 and 2015 were collected. A detailed analysis of the characteristics of anal canal squamous cell carcinoma (SCC) cases was then conducted. The results of the histological types revealed that of the 1781 ACC cases, 435 cases (24.4%) including seven cases of adenosquamous cell carcinomas were SCC and 1260 cases (70.7%) were adenocarcinoma. However, the most common histological type reported in the USA, Europe, and Australia is SCC. Most ACC cases are adenocarcinomas and there is a low incidence of SCC in Japan which is different from the above-mentioned countries. Moreover, we reclassified T4 into the following two groups based on tumor size: T4a (tumor diameter of 5 cm or less) and T4b (tumor diameter of more than 5 cm). The results of the TNM classification of SCC revealed that the hazard ratio (HR) to T1 of T2, T3, T4a, and T4b was 2.45, 2.28, 2.89, and 4.97, respectively. As T4b cases had a worse prognosis than T4a cases, we propose that T4 for anal canal SCC in Japan be subclassified into T4a and T4b.
  • Yoshinori Yane; Jin-Ichi Hida; Yasutaka Chiba; Yusuke Makutani; Hokuto Ushijima; Yasumasa Yoshioka; Masayoshi Iwamoto; Toshiaki Wada; Koji Daito; Tadao Tokoro; Kazuki Ueda; Junichiro Kawamura
    Scientific reports 12 1 916 - 916 2022年01月 [査読有り]
     
    The use of temporary diverting stoma has become more common in low colorectal anastomosis to reduce anastomotic complications. Surgical site infection (SSI) at the stoma closure site has been one of the most frequent postoperative complications. The aim of this study was to compare the short-term outcomes between conventional primary suture closure and negative pressure wound therapy with instillation and dwelling (NPWTi-d) therapy following purse-string suturing, using propensity score matching analysis. We retrospectively evaluated the medical records of 107 patients who underwent stoma closure between January 2016 and October 2020. The primary outcome was the proportion of SSI. The secondary outcome was the day of postoperative length of stay. Propensity score matching with one-to-one match was performed for reducing treatment selection bias. Of a total of 107 patients, 67 patients had been treated with conventional primary closure and 40 with NPWTi-d therapy. The propensity score matching derived 37 pairs. The respective SSI proportions were 0% and 16.2% in the groups with NPWTi-d and primary closure (P = 0.025). The respective median days of postoperative hospital stay were 9.0 and 10.0 in the groups with NPWTi-d and primary closure (P = 0.453). NPWTi-d therapy with purse-string suturing was effective in reducing SSI after stoma closure.
  • Yusuke Makutani; Hisato Kawakami; Takahiro Tsujikawa; Kanako Yoshimura; Yasutaka Chiba; Akihiko Ito; Junichiro Kawamura; Koji Haratani; Kazuhiko Nakagawa
    Frontiers in oncology 12 956270 - 956270 2022年 
    Matrix metalloproteinase 14 (MMP14) expression is implicated in progression of colorectal cancer, but its role in the tumor microenvironment (TME) has been unclear. The relevance of MMP14 to colorectal cancer progression was explored by analysis of transcriptomic data for colorectal adenocarcinoma patients (n = 592) in The Cancer Genome Atlas. The role of MMP14 in the TME was investigated in a retrospective analysis of tumor samples from 86 individuals with stage III colorectal cancer by single cell-based spatial profiling of MMP14 expression as performed by 12-color multiplex immunohistochemistry (mIHC). Analysis of gene expression data revealed that high MMP14 expression was associated with tumor progression and implicated both cancer-associated fibroblasts (CAFs) and tumor-associated macrophages in such progression. Spatial profiling by mIHC revealed that a higher percentage of MMP14+ cells among intratumoral CAFs (MMP14+ CAF/CAF ratio) was associated with poorer relapse-free survival. Multivariable analysis including key clinical factors identified the MMP14+ CAF/CAF ratio as an independent poor prognostic factor. Moreover, the patient subset with both a high MMP14+ CAF/CAF ratio and a low tumor-infiltrating lymphocyte density showed the worst prognosis. Our results suggest that MMP14+ CAFs play an important role in progression of stage III colorectal cancer and may therefore be a promising therapeutic target.
  • 消化器外科手術アトラス 側方リンパ節郭清を伴うロボット支援下直腸低位前方切除術(術前放射線化学療法後)
    川村 純一郎; 岩本 哲好; 大東 弘治; 和田 聡明; 吉岡 康多; 牛嶋 北斗; 家根 由典; 幕谷 悠介; 所 忠男; 上田 和毅
    消化器外科 44 9 1371 - 1384 (株)へるす出版 2021年08月
  • 消化器外科手術アトラス 側方リンパ節郭清を伴うロボット支援下直腸低位前方切除術(術前放射線化学療法後)
    川村 純一郎; 岩本 哲好; 大東 弘治; 和田 聡明; 吉岡 康多; 牛嶋 北斗; 家根 由典; 幕谷 悠介; 所 忠男; 上田 和毅
    消化器外科 44 9 1371 - 1384 (株)へるす出版 2021年08月
  • Yoshinori Yane; Junichiro Kawamura; Hokuto Ushijima; Yasumasa Yoshioka; Hiroaki Kato; Kazuki Ueda
    International journal of surgery case reports 85 106207 - 106207 2021年07月 [査読有り]
     
    INTRODUCTION: Cirrhosis is a significant determinant of postoperative morbidity and mortality. Patients with severe liver cirrhosis are substantially contraindicated for surgical treatment of inguinal hernia because of the substantial recurrence rate and high postoperative morbidity and mortality. However, hernia with incarceration and strangulation, which could become life-threatening, should be repaired urgently even for patients with severe liver cirrhosis. No clear surgical guidelines have been established regarding the treatment strategy for inguinal hernia in patients with cirrhosis. PRESENTATION OF CASE: A 62-year-old man with a history of chronic C-type liver cirrhosis (Child-Pugh classification C) and hepatocellular carcinoma was referred to us for surgical treatment of an irreducible right inguinal hernia. An abdominal computed tomography (CT) scan revealed that the small intestine had herniated into the scrotum and severe abdominal wall varicose veins due to liver cirrhosis. We performed a hybrid method that combines examination laparoscopy and Lichtenstein's technique to observe the abdominal cavity and to avoid the risks due to severe varicosis of the inferior epigastric vein. DISCUSSION: There have been some reports of inguinal hernia with cirrhosis and ascites, but no reports of incarcerated inguinal hernia with abdominal wall varicose veins. In the present case, we chose a laparoscopic approach to observe the abdominal cavity to confirm intestinal necrosis. Hybrid surgery using laparoscopy and Lichtenstein's technique for incarcerated inguinal hernia could be performed safely. CONCLUSION: Hybrid surgery using laparoscopy and Lichtenstein's technique may be an effective method for patients with incarcerated inguinal hernia with end-stage cirrhosis and severe abdominal varicosis.
  • 吉岡 康多; 所 忠男; 川村 純一郎
    手術 75 8 1289 - 1294 金原出版(株) 2021年07月
  • Hokuto Ushijima; Jin-ichi Hida; Masahiro Haeno; Masashi Koda; Kazuki Ueda; Junichiro Kawamura
    INTERNATIONAL JOURNAL OF SURGERY CASE REPORTS 84 106064 - 106064 2021年07月 [査読有り]
     
    Introduction and importance: Chylous ascites (CA) is an infrequent, intractable complication that may arise after abdominal surgery. Although various attempts at treatment have been adopted, to date, none of them have been consistently effective. We describe the successful treatment of CA using lymphangiography and embolization with lipiodol.Case presentation: A 79-year-old woman underwent laparoscopic surgery for rectum cancer at another hospital. She was discharged on postoperative day (POD) 9; however, she had to be treated and hospitalized for CA three times until POD 76. She visited our hospital to undergo treatment for CA on POD 90 because the previous conservative treatment had not improved her condition. The computed tomography (CT) scans revealed ascites effusion. We performed lymphangiography and embolization with lipiodol two times. Repeated CT on POD 134 showed that the ascites had not increased.Clinical discussion: Lymphangiography and embolization with lipiodol effectively resolved chylous leakage that occurred after abdominal surgery. Additionally, we compare the features of two groups of cases of CA: one group in which patients were treated by lymphatic intervention and the second in which patients were treated through surgical procedures.Conclusion: We were thus able to demonstrate the clinical effectiveness of lipiodol lymphangiography in treating CA.
  • Kazuki Ueda; Koji Daito; Hokuto Ushijima; Yoshinori Yane; Yasumasa Yoshioka; Tadao Tokoro; Masayoshi Iwamoto; Toshiaki Wada; Yusuke Makutani; Junichiro Kawamura
    Surgical endoscopy 36 4 2661 - 2670 2021年05月 [査読有り]
     
    BACKGROUND: Complete mesocolic excision (CME) with central vascular ligation (CVL) for colon cancer is an essential procedure for improved oncologic outcomes after surgery. Laparoscopic surgery for splenic flexure colon cancer was recently adopted due to a greater understanding of surgical anatomy and improvements in surgical techniques and innovative surgical devices. METHODS: We retrospectively analyzed the data of patients with splenic flexure colon cancer who underwent laparoscopic CME with CVL at our institution between January 2005 and December 2017. RESULTS: Forty-five patients (4.8%) were enrolled in this study. Laparoscopic CME with CVL was successfully performed in all patients. The median operative time was 178 min, and the median estimated blood loss was 20 g. Perioperative complications developed in 6 patients (13.3%). The median postoperative hospital stay was 9 days. According to the pathological report, the median number of harvested lymph nodes was 15, and lymph node metastasis developed in 14 patients (31.1%). No metastasis was observed at the root of the middle colic artery or the inferior mesenteric artery. The median follow-up period was 49 months. The cumulative 5-year overall survival and disease-free survival rates were 85.9% and 84.7%, respectively. The cancer-specific survival rate in stage I-III patients was 92.7%. Recurrence was observed in 5 patients (11.1%), including three patients with peritoneal dissemination and two patients with distant metastasis. CONCLUSIONS: Laparoscopic CME with CVL for splenic flexure colon cancer appears to be oncologically safe and feasible based on the short- and long-term outcomes in our study. However, it is careful to introduce this procedure to necessitate the anatomical understandings and surgeon's skill. The appropriate indications must be established with more case registries because our experience is limited.
  • 【消化器癌;診断と治療のすべて】消化器癌の診断・病期分類・治療・成績 結腸癌 外科治療と成績
    和田 聡朗; 所 忠男; 川村 純一郎
    消化器外科 44 6 738 - 743 (株)へるす出版 2021年05月
  • Yoshinori Yane; Jin-Ichi Hida; Yusuke Makutani; Hokuto Ushijima; Yasumasa Yoshioka; Masayoshi Iwamoto; Toshiaki Wada; Koji Daito; Tadao Tokoro; Kazuki Ueda; Junichiro Kawamura
    BMC surgery 21 1 157 - 157 2021年03月 [査読有り]
     
    BACKGROUND: Temporary stomas have been widely used to avoid the risk of complications such as anastomotic leakage after colorectal resection. Stoma closure is relatively easy; however, postoperative surgical site infection (SSI) may be a problem. Various methods have been used to reduce the incidence of SSI. We aimed to evaluate a new technique for stoma wound closure. METHODS: We enrolled patients who underwent stoma closure at our hospital between September 2019 and May 2020. We selected patients who lived far from our hospital and had difficulty visiting the hospital regularly and who agreed to undergo this surgical technique. We used negative pressure wound therapy with instillation and dwelling (NPWTi-d) and delayed primary closure for these patients. RESULTS: Four patients underwent NPWTi-d and delayed primary closure without the occurrence of SSI. The median postoperative hospital stay was 9 days (range: 7-14 days), and the median number of days to confirmation of epithelialization was 11.5 days (range: 10-16 days). CONCLUSION: The combined use of NPWTi-d and delayed primary closure for the stoma wound was very effective. This method may be a valuable new technique for wound management after stoma closure.
  • Hokuto Ushijima; Jin-Ichi Hida; Yoshinori Yane; Hiroaki Kato; Kazuki Ueda; Junichiro Kawamura
    International journal of surgery case reports 81 105728 - 105728 2021年03月 [査読有り]
     
    INTRODUCTION AND IMPORTANCE: We describe the case of a patients with a diaphragmatic hernia associated with radiofrequency ablation for hepatocellular carcinoma who was treated by laparoscopic repair. CASE PRESENTATION: An 82-years-old man with history of HCC with hepatitis C virus-related liver cirrhosis (Child-Pugh B). The patient was treated RFA to HCC for segment 4, 5, 6, 8. After 16 months from latest RFA for segment 8, the patient was admitted to our hospital because of mild dyspnea. Computed tomography revealed a diaphragmatic herniation of bowel loops into the right thoracic cavity. The patients electively underwent laparoscopic repair of the diaphragmatic hernia. The patient was discharged from hospital without any post-operative complications. CLINICAL DISCUSSION: The only treatment to diaphragmatic hernia is surgery, but liver cirrhosis patients limits this possibility. For the surgical treatment of patients with severe cirrhosis, the operation should be carefully assessed. We believe that a laparoscopic approach should be used for repairing diaphragmatic hernia. In the present case, we considered that a laparoscopic approach was safer and more feasible than open laparotomy. CONCLUSION: Diaphragmatic hernia is a rare late-onset complication associated with RFA for HCC. And patients with HCC often have severe liver dysfunction and cirrhosis. A laparoscopic approach is safe and minimally invasive for sever cirrhosis patients.
  • 【見直そう!大腸癌に対する腹腔鏡・ロボット手術の基本手技】腹腔鏡下S状結腸切除術
    吉岡 康多; 岩本 哲好; 川村 純一郎
    消化器外科 43 13 1765 - 1773 (株)へるす出版 2020年12月
  • 大東 弘治; 家根 由典; 牛嶋 北斗; 岩本 哲好; 上田 和毅; 川村 純一郎
    手術 74 13 1885 - 1894 金原出版(株) 2020年12月
  • 家根 由典; 肥田 仁一; 幕谷 悠介; 牛嶋 北斗; 吉岡 康多; 岩本 哲好; 大東 弘治; 所 忠男; 上田 和毅; 筑後 孝章; 諸富 公昭; 川村 純一郎
    日本消化器外科学会雑誌 53 11 916 - 924 (一社)日本消化器外科学会 2020年11月 
    症例は56歳の男性で,15年前より痔瘻と診断され近医で加療されていた.難治性痔瘻増悪の診断で当科を紹介受診された際には,臀部から陰嚢および陰茎にかけて多数の瘻孔と排膿が認められた.肛門管後壁の瘻孔からの生検にて痔瘻癌と診断した.また,腸管同士の瘻孔形成を認め,尿道・膀胱への瘻孔形成が疑われた.痔瘻は広汎かつ深部に及び,会陰部の炎症が強いため,まずS状結腸人工肛門造設術を行い,全身状態と会陰部の炎症所見を改善させたうえで,外性器を含む広汎な会陰皮膚組織切除を伴う骨盤内臓全摘を行い,会陰欠損部に対して腹直筋皮弁形成術を施行した.現在,術後19ヵ月無再発生存中である.本例のように,腸管や尿道・膀胱への浸潤に加え,広汎な会陰部の皮膚浸潤が疑われる局所進展痔瘻癌に対しては,根治のために外性器切除を含めた広範囲の一塊切除が必要であると考えられる.(著者抄録)
  • 【手術の達人から学ぶ基本手技】腹腔鏡下手術 腹腔鏡下直腸切除術における電気メスの使い方とコツ
    岩本 哲好; 川村 純一郎
    消化器外科 43 11 1567 - 1579 (株)へるす出版 2020年10月
  • Hokuto Ushijima; Junichiro Kawamura; Kazuki Ueda; Yoshinori Yane; Yasumasa Yoshioka; Koji Daito; Tadao Tokoro; Jin-Ichi Hida; Kiyotaka Okuno
    Scientific reports 10 1 14274 - 14274 2020年08月 [査読有り]
     
    Intraoperative visualization of lymphatic flow could guide surgeons performing laparoscopic colon cancer surgery on the extent of intestinal resection required. The purpose of this study was to investigate indocyanine green fluorescence imaging for intraoperative detection of lymphatic flow and nodes in such patients. All patients undergoing elective laparoscopic surgery for colorectal cancer from October 2016 to July 2017 were included in this study. Indocyanine green was injected submucosally around the tumors via a colonoscope and lymphatic flow assessed with a laparoscopic near-infrared camera system intraoperatively. Lymphatic flow was visualized perioperatively in 43 of 57 patients (75.4%). The rate of visualized lymphatic flow was significantly higher in patients with a lower clinical stage than in those with a higher clinical stage (p = 0.0103). Among the 14 patients in whom lymphatic flow was not visualized, 10 (71.4%) had cStage III or IV cancer. Our results indicate the potential role of intraoperative navigation in colon cancer surgery in early-stage colon cancers. This method allows the surgeon to clearly identify lymphatic flow during surgery and allows the determination and individualization of the lymph node dissection range.
  • Polypropylene Meshによる修復術を行った下腰ヘルニアの1例
    家根 由典; 松田 恭典; 西澤 聡; 坂田 親治; 山本 隆嗣; 川村 純一郎; 徳原 太豪
    日本ヘルニア学会誌 6 2 28 - 34 日本ヘルニア学会 2020年07月 
    症例は73歳の女性で、5年程前より放置していた右腰背部の膨隆が増大傾向を認めたため受診された。腹部MRI検査にて腸骨稜の頭側で右脊柱起立筋群と右側腹筋群との間に後腹膜脂肪組織の脱出を認め、下腰ヘルニアと診断した。手術は腹横筋腱膜の直接縫合閉鎖とポリプロピレンメッシュ留置による修復を行った。経過は良好で、術後7日目に退院した。術後3年経過した現在、再発は認めていない。下腰ヘルニアは稀な疾患であり、手術術式に関しては検討が必要であるが、本症例のように、直接縫合閉鎖とメッシュ補強を用いた修復法は、解剖学的にも合理的で有効な方法であると思われるため、報告する。(著者抄録)
  • 【術前・術後管理必携2020】術後合併症とその管理 消化器系 ストマ関連合併症(ヘルニア・狭窄)
    岩本 哲好; 川村 純一郎
    消化器外科 43 5 875 - 877 (株)へるす出版 2020年04月
  • Yoshinori Yane; Jin ichi Hida; Yusuke Makutani; Hokuto Ushijima; Yasumasa Yoshioka; Masayoshi Iwamoto; Koji Daito; Tadao Tokoro; Kazuki Ueda; Takaaki Chikugo; Tadaaki Morotomi; Junichiro Kawamura
    Japanese Journal of Gastroenterological Surgery 53 11 916 - 924 2020年 
    We present a case of locally advanced anal fistula cancer that was resected by total pelvic exenteration with genitalia resection and extensive perineal skin tissue resection. The patient was a 56-year-old man with a history of anal fistula treated at another hospital 15 years earlier. He was referred to our hospital for intractable anal fistula exacerbation and presented with many fistulas and drainage from the buttocks to the scrotum and penis. He was diagnosed with anal fistula cancer by biopsies from a fistula in the posterior wall of the anal canal. Preoperative CT and MRI revealed small bowel fistulas and suspected fistulas involving the urethra and bladder, which caused severe inflammation in the perineum. We performed sigmoid colostomy to improve his general condition prior to curative surgery. The patient then underwent total pelvic exenteration with genitalia resection, extensive perineal skin tissue resection, and treatment with a rectus abdominis musculocutaneous flap. He is currently alive without evidence of recurrence 19 months after surgery. For locally advanced anal fistula cancer with massive invasion into surrounding tissues and perineal skin, a wide en bloc resection including external genital resection is the preferred treatment.
  • Junichiro Kawamura
    Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology 117 7 580 - 588 2020年 [査読有り]
  • 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)
  • Junichiro Kawamura; Hokuto Ushijima; Yasumasa Yoshioka; Koji Daito; Kazuki Ueda; Tadao Tokoro; Jin-ichi Hida; Haruhiko Imamoto; Kiyotaka Okuno
    International Surgery 104 7-8 348 - 351 2019年07月 [査読有り]
     
    Introduction Mesenteric cysts are rare intra-abdominal masses. They do not show classic clinical findings and are detected incidentally during imaging because of their absent or nonspecific clinical presentation. We herein report 2 cases of mesenteric cysts that were successfully diagnosed and resected through a laparoscopic approach. Case presentation In a 35-year-old man underwent a comprehensive medical checkup at another hospital, during which ultrasound incidentally revealed a cystic mass in his right retroperitoneum. The patient was referred to our hospital for surgical treatment. He was asymptomatic and his medical history was unremarkable. Physical examination revealed no palpable abdominal mass, and all laboratory test results were within normal ranges. Contrast-enhanced computed tomography showed a 7.2-cm-diameter smooth-surfaced, well-demarcated mass behind the right colon without a contrast effect (Fig. 1). We considered the cyst to be benign and localized in the mesentery of the ascending colon. In one patient, the cyst was located in the mesentery of the ascending colon and removed via a right hemicolectomy; in the other patient, the cyst was located in the sigmoid mesentery, which was completely resected through the operative wound under an open procedure after laparoscopic mobilization of the sigmoid mesentery. We chose the laparoscopic approach in both cases because the cysts were considered benign, noninfectious, and nonhemorrhagic. Histologic examination revealed cystic lymphangioma in both cases. Conclusion For mesenteric cysts, laparoscopy could be a preferred approach in properly selected patients.
  • Yasumasa Yoshioka; Junichiro Kawamura; Hokuto Ushijima; Koji Daito; Kazuki Ueda; Tadao Tokoro; Jinichi Hida; Kiyotaka Okuno
    Gan to kagaku ryoho. Cancer & chemotherapy 45 13 2196 - 2198 2018年12月 [査読有り]
     
    We report a relatively rare case of cecal cancer with dermatomyositis. An 81-year-old man was diagnosed with dermatomyositis associated with the symptoms of eruption, limb muscle weakness, and difficulty swallowing. Colonoscopy revealed a type 2 tumor in the cecum. The patient underwent laparoscopic ileocecal resection. Although it was impossible for the patient to stand before the surgery, he could stand 10 days after the surgery and walk without assistance 14 days after the surgery. In addition, the eruption disappeared, and the preoperatively high creatine kinase(CK)value normalized. Dermatomyositis with malignant tumor has been reported to be associated with poor prognosis. Symptoms related to dermatomyositis may be improved by the resection of the associated tumor. Therefore, it is important to treat the malignant tumor when the patient's condition permits.
  • Kawamura J; Ueda K; Ushijima H; Daito K; Okuno K
    Colorectal Disease 20 7 646 - 647 2018年07月 [査読有り]
  • Junichiro Kawamura; Fumiaki Sugiura; Yasushi Sukegawa; Yasumasa Yoshioka; Jin-Ichi Hida; Shoichi Hazama; Kiyotaka Okuno
    Cancer Science 109 5 1545 - 1551 2018年05月 [査読有り]
     
    We previously reported a phase I clinical trial of a peptide vaccine ring finger protein 43 (RNF43) and 34-kDa translocase of the outer mitochondrial membrane (TOMM34) combined with uracil-tegafur (UFT)/LV for patients with metastatic colorectal cancer (CRC), and demonstrated the safety and immunological responsiveness of this combination therapy. In this study, we evaluated vaccination-induced immune responses to clarify the survival benefit of the combination therapy as adjuvant treatment. We enrolled 44 patients initially in an HLA-masked fashion. After the disclosure of HLA, 28 patients were in the HLA-A*2402-matched and 16 were in the unmatched group. In the HLA-matched group, 14 patients had positive CTL responses specific for the RNF43 and/or TOMM34 peptides after 2 cycles of treatment and 9 had negative responses in the HLA-unmatched group, 10 CTL responses were positive and 2 negative. In the HLA-matched group, 3-year relapse-free survival (RFS) was significantly better in the positive CTL subgroup than in the negative-response subgroup. Patients with negative vaccination-induced CTL responses showed a significant trend towards shorter RFS than those with positive responses. Moreover, in the HLA-unmatched group, the positive CTL response subgroup showed an equally good 3-year RFS as in the HLA-matched group. In conclusion, vaccination-induced CTL response to peptide vaccination could predict survival in the adjuvant setting for stage III CRC.
  • Junichiro Kawamura; Fumiaki Sugiura; Yasushi Sukegawa; Yasumasa Yoshioka; Jin-Ichi Hida; Shoichi Hazama; Kiyotaka Okuno
    Oncology Letters 15 4 4241 - 4247 2018年04月 [査読有り]
     
    The safety and immunological responsiveness of a peptide vaccine of ring finger protein 43 and 34-kDa trans-locase of the outer mitochondrial membrane combined with uracil-tegafur/leucovorin (UFT/LV) was previously demonstrated in metastatic colorectal cancer (CRC) in a phase I clinical trial. To clarify the survival benefit of a peptide vaccine combined with UFT/LV as adjuvant treatment, a phase II clinical trial was conducted involving patients with stage III CRC. All enrolled patients, whose human leukocyte antigen (HLA)-A status was double-blinded, were administered the same regime of a peptide vaccine and UFT/LV chemotherapy. The primary objective of the study was to compare relapse-free survival (RFS) in patients with HLA-A*2402 vs. those without HLA-A*2402. Secondary objectives included comparisons between the two groups regarding overall survival, safety, tolerability and peptide-specific activities of cytotoxic T lymphocytes (CTLs) as measured by the ELISPOT assay. Between December 2009 and December 2014, a total of 46 patients were enrolled to the present study. Three-year RFS was not significantly different between HLA-A*2402 matched and unmatched groups [67.8 vs. 73.6%, respectively hazard ratio (HR)=1.254, 95% confidence interval (CI): 0.48-4.63 P=0.706]. Three-year RFS was significantly better in patients with positive CTL responses in the HLA-A*2402 matched group compared with those without (85.7 and 33.3%, respectively HR=0.159, 95% CI: 0.023-0.697 P=0.011). In conclusion, vaccination-induced immune responses combined with UFT/LV were positively associated with survival benefit in patients with HLA-A*2402-positive stage III CRC. Further study is required to clarify whether vaccination-induced immune responses shortly following the initiation of therapy can predict the therapeutic effect and help develop a promising therapeutic strategy for patients with stage III CRC.
  • Michihiro Yamamoto; Masazumi Zaima; Hidekazu Yamamoto; Hideki Harada; Junichiro Kawamura; Masahiro Yamada; Tekefumi Yazawa; Junya Kawasoe
    WORLD JOURNAL OF SURGICAL ONCOLOGY 15 1 213 - 213 2017年12月 [査読有り]
     
    Background: For left-sided pancreatic ductal adenocarcinoma (PDAC), radical antegrade modular pancreatosplenectomy (RAMPS) is a reasonable surgical approach for tumor-free margin resection and systemic lymph node clearance. In pancreaticoduodenectomy for PDAC, the superior mesenteric artery (SMA)-first approach (or the "artery-first approach") has become the standard procedure. With improvements in laparoscopic instruments and techniques, some surgeons attempted to apply laparoscopic RAMPS (L-RAMPS) for carefully selected patients with left-sided PDAC. However, owing to several technical difficulties in this procedure, its application remains uncommon. Moreover, the artery-first approach in L-RAMPS has not been reported. Here, we developed the artery-first approach L-RAMPS for left-sided PDAC and have presented the same in this report. Case presentation: Between June 2014 and July 2015, 16 patients with left-sided PDAC were referred to our division for pancreatic resection. The following technique was used for performing L-RAMPS on 3 of the 16 patients (19%). Six trocars were placed. After opening the omental bursa, only the middle segment of the pancreas was initially separated from both the left renal vein and the SMA. We termed this procedure as the "artery-first approach using a dome-shaped dorsomedial dissection (3D) technique." This 3D technique enabled the interruption of the entire arterial supply to the specimen while preserving the venous drainage through the splenic vein for preventing venous congestion. The technique also contributed to the early detection of no tumor infiltration into the SMA and the early determination of posterior dissection plane. After pancreatic neck transection, the splenic artery and vein were divided. Finally, the pancreatic tail and spleen were dissected in a right-to-left direction. All operations were completed without any intraoperative complications. The median blood loss and retrieved lymph node count were 75 mL and 37, respectively, which were superior to those reported by other previous studies on L-RAMPS. All resection margins were free of carcinoma. No severe postoperative complications were observed. Conclusions: The artery-first approach L-RAMPS using 3D technique is safe and feasible to perform. The significance of our proposed procedure is minimal blood loss and precise lymphadenectomy. Therefore, this novel technique may become the preferred treatment for left-sided PDAC in selected cases.
  • 冠状動脈バイパス術後に発症した進行胃癌に対して右胃大網動脈温存の胃全摘術を施行した1例
    本庄 真彦; 山本 秀和; 財間 正純; 四元 文明; 原田 英樹; 川村 純一郎; 山本 道宏; 矢澤 武史; 中川 淳; 中村 直彦; 木田 裕也; 宇野 伊津美; 尾川 諒太郎
    日本臨床外科学会雑誌 78 11 2580 - 2580 日本臨床外科学会 2017年11月
  • 当院にて経験したFibrolamellar Hepatocellular carcinomaの1切除例
    尾川 諒太郎; 住田 公亮; 木田 裕也; 本庄 真彦; 宇野 伊津美; 川添 准矢; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純; 寺嶋 剛; 武内 英二
    日本臨床外科学会雑誌 78 11 2584 - 2584 日本臨床外科学会 2017年11月
  • 下大静脈再建に用いた人工血管が腸管内に迷入し腸閉塞を発症した1例
    矢澤 武史; 住田 公亮; 木田 裕也; 本庄 真彦; 尾川 諒太郎; 谷 昌樹; 川添 准矢; 中川 淳; 山本 道宏; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 78 11 2587 - 2587 日本臨床外科学会 2017年11月
  • Yoshioka Y; Tokoro T; Ushijima H; Daito K; Kawamura J; Ueda K; Hida J; Okuno K
    Gan to kagaku ryoho. Cancer & chemotherapy 44 12 1997 - 1999 2017年11月 [査読有り]
  • Suguru Hasegawa; Saori Goto; Takuya Matsumoto; Koya Hida; Kenji Kawada; Ryo Matsusue; Takashi Yamaguchi; Ryuta Nishitai; Dai Manaka; Shigeru Kato; Yoshio Kadokawa; Satoshi Yamanokuchi; Junichiro Kawamura; Masazumi Zaima; Takahisa Kyogoku; Akiyoshi Kanazawa; Yukiko Mori; Masashi Kanai; Shigemi Matsumoto; Yoshiharu Sakai
    ANNALS OF SURGICAL ONCOLOGY 24 12 3587 - 3595 2017年11月 [査読有り]
     
    Background. This prospective multicenter phase 2 study aimed to evaluate the feasibility and efficacy of neoadjuvant chemotherapy (NAC) without radiotherapy for locally advanced rectal cancer (LARC). Methods. Patients with LARC (cStage II and III) were included in the study. Those with cT4b tumor were excluded. Six cycles of modified FOLFOX6 (mFOLFOX6) plus either bevacizumab or cetuximab, depending on KRAS status, were administered before surgery. The primary end point of the study was the R0 resection rate. The secondary end points were adverse effect, rate of NAC completion, postoperative complications, and pathologic complete response (pCR) rate. Results. The study enrolled 60 patients from eight institutions. For the study, mFOLFOX6 was administered with cetuximab to 40 patients who had wild-type KRAS and with bevacizumab to 20 patients who had KRAS mutations. The completion rate for NAC was 88.4%. Sphincter-preserving surgery was performed for 43 patients and abdominoperineal resection for 17 patients. The median operation time was 335 min, and the median blood loss was 40 g. The R0 resection rate was 98.3%, and the pCR rate was 16.7%. The overall postoperative complication rate (>= grade 2) was 21.7%. The complications included anastomotic leakage (11.6%), surgical-site infection (6.7%), and urinary dysfunction (3.3%). The patients with wild-type KRAS did not differ significantly from those with KRAS mutations in terms of response rate, postoperative complication rate, and pCR rate. Conclusion. The findings show that NAC is a feasible and promising treatment option for LARC (This study is registered with UMIN-CTR, UMIN000005654).
  • 吉岡 康多; 所 忠男; 牛嶋 北斗; 大東 弘治; 川村 純一郎; 上田 和毅; 肥田 仁一; 奥野 清隆
    癌と化学療法 44 12 1997 - 1999 (株)癌と化学療法社 2017年11月 [査読有り]
     
    症例は67歳、女性。主訴は血便。直腸診で、AV 3cmに表面平滑、弾性硬、径5cm大の腫瘤を触知した。生検結果はgastrointestinal stromal tumor(GIST)で、画像診断では肛門挙筋への浸潤が疑われた。肛門温存の希望が強く、術前補助療法としてメシル酸イマチニブ(IM)400mg/dayを投与した。投与開始23日目には、腫瘍は2cm大に縮小したが、紅斑型薬疹(Grade 3)を認めたためIMの休薬およびステロイド療法を施行した。薬疹消退の後、IMを200mg/日で再開し、36日目に経肛門的局所切除術を施行した。術後1年の時点で無再発生存中であり、ステロイド併用IM投与を継続している。術前IM療法に関する適応や至適投与期間は現時点で明確ではなく、今後も引き続き症例を蓄積する必要があると考えられる。(著者抄録)
  • S状結腸間膜窩ヘルニアの1例
    木田 裕也; 尾川 諒太郎; 本庄 真彦; 宇野 伊津美; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 78 10 2379 - 2379 日本臨床外科学会 2017年10月
  • Yasushi Sukegawa; Junichiro Kawamura; Kiyotaka Okuno
    Japanese Journal of Cancer and Chemotherapy 44 10 896 - 899 2017年10月 [査読有り]
     
    Cyclophosphamide (CY) was intraperitoneal^ administered once a week to C57BL/10 mice that had received Rous sarcoma virus (RSV)-induced S1018B10 syngeneic tumor transplantation and in whom tumor diameter exceeded 4.5 mm. Survival was prolonged in a group of mice that also received a mixture of LEM and MAK orally. When splenic cells were cultured under mitomycin C-treated S1018B10 stimulation and the S1018B10-directed cell killing ability was examined, the effector cells were found to be F4/80- DC/Mφ cells. Flow cytometric analysis showed that the proportion of F4/80- DC/Mφ cells in the splenic cell culture of the CY+LEM+MAK treatment group was higher than that in the untreated group. The ratio of F4/80+ CD8a+ cells in the CY+LEM+MAK treatment group was lower than that in the untreated group.
  • Michihiro Yamamoto; Masazumi Zaima; Hidekazu Yamamoto; Hideki Harada; Junichiro Kawamura; Masahiro Yamada; Tekefumi Yazawa; Junya Kawasoe
    WORLD JOURNAL OF SURGICAL ONCOLOGY 15 1 77 - 77 2017年04月 [査読有り]
     
    Background: Surgeons, in general, underestimate the replaced left hepatic artery (rLHA) that arises from the left gastric artery (LGA), compared with the replaced right hepatic artery (rRHA), especially in standard gastric cancer surgery. During pancreaticoduodenectomy (PD), preservation of the rRHA arising from the superior mesenteric artery (SMA) is widely accepted to prevent critical postoperative complications, such as liver necrosis, bile duct ischemia, and biliary anastomotic leakage. In contrast, details of complication onset following rLHA resection remain unknown. We report two cases of postoperative liver necrosis shortly after rLHA resection during PD for advanced gastric cancer. Case presentation: Both cases had advanced gastric cancer with infiltration of the pancreatic head. In case 1, the rLHA comprised segment 2/3 artery (A2 + A3), which arose from the LGA. The rRHA originated from the SMA, and the segment 4 artery (A4) was a branch of the rRHA. We conducted PD with combined en bloc resection of both the rLHA and rRHA, and anastomosis between the distal and proximal stumps of the rRHA and LGA, respectively. The divided A2 + A3 was not reconstructed. In case 2, the rLHA comprised segment 2 artery (A2) only, which arose from the LGA. The segment 3/4 artery and the RHAs originated from the proper hepatic artery. We undertook PD with combined en bloc resection of A2 without vascular reconstruction. In both patients, serious necrosis of the lateral segment of the liver occurred within 6 days after PD. Case 1 recovered with conservative management, whereas case 2 required lateral segmentectomy of the liver. Pathologically, the necrotic area in case 2 was apparently circumscribed and confined to segment 2 of the liver, potentially implicating rLHA resection during PD as causing hepatic necrosis. Conclusions: During PD, rLHA resection can cause serious liver necrosis. Therefore, this artery should be preserved as far as oncologically acceptable. In cases that require rLHA resection during PD due to tumor conditions, surgeons should carefully monitor postoperative course while keeping in mind the possible necessity of urgent hepatectomy.
  • Kawamura J; Tani M; Kida Y; Sumida K; Ogawa R; Kawasoe J; Yazawa T; Yamada M; Yamamoto M; Harada H; Yamamoto H; Zaima M
    Asian journal of endoscopic surgery 10 1 51 - 54 2017年02月 [査読有り]
     
    A solitary fibrous tumor is a ubiquitous mesenchymal fibroblastic tumor that was previously considered limited to the pleural cavity. Here, we report a rare case of a large solitary fibrous tumor of the mesorectum, which was successfully resected laparoscopically. A 56-year-old woman was referred to our hospital for a giant pelvic mass. Pelvic MRI showed a well-circumscribed mass, 12 cm in diameter, with heterogeneous signal intensity on T2 -weighted images. It was diagnosed as a benign mesorectal tumor of unknown origin. We successfully resected the entire tumor laparoscopically. Histological examination revealed it to be an extrapleural solitary fibrous tumor. For large tumors in the pelvis, the laparoscopic approach is preferable in terms of intraoperative hemorrhage, as long as they do not invade surrounding tissues.
  • Junichiro Kawamura; Masaki Tani; Kimiaki Sumida; Takefumi Yazawa; Junya Kawasoe; Michihiro Yamamoto; Hideki Harada; Hidekazu Yamamoto; Masazumi Zaima
    INTERNATIONAL JOURNAL OF COLORECTAL DISEASE 32 1 135 - 138 2017年01月 [査読有り]
     
    Cancerous involvement of a ureter is sometimes encountered in pelvic surgery for malignancy. We usually perform transureteroureterostomy (TUU) in cases of unilateral lower ureteral cancerous involvement. We report the outcomes in patients treated with TUU in our institute. We retrospectively reviewed the medical records of 11 patients who underwent TUU between June 2006 and September 2015. The primary disease was colon cancer in five patients, rectal cancer in four, and uterine cervical cancer and ovarian cancer in one patient each. Early postoperative complications relevant to TUU occurred in four patients; however, three patients were managed conservatively and recovered quickly. Only one patient developed ureteral obstruction, which resulted from anastomotic hematoma. Follow-up periods ranged from 5 to 78 months with a median of 28 months. The median estimated glomerular filtration rate before and after TUU was 59 ml/min (range, 31-90 ml/min) and 62.0 ml/min (range, 43-127 mL/min), respectively. No patients experienced worsening of their renal function or recurrent urinary tract infection. Short-term outcomes are good and long-term renal function is maintained following TUU. TUU is considered a feasible technique for ureteral reconstruction for pelvic malignancy, and TUU has great potential in the era of multimodal therapy.
  • Michihiro Yamamoto; Masazumi Zaima; Yuya Kida; Hidekazu Yamamoto; Hideki Harada; Junichiro Kawamura; Masahiro Yamada; Tekefumi Yazawa
    JOURNAL OF LAPAROENDOSCOPIC & ADVANCED SURGICAL TECHNIQUES 26 12 1003 - 1009 2016年12月 [査読有り]
     
    Background: Generally, single-incision laparoscopic cholecystectomy (SILC) requires the use of articulating devices or additional trocars because of the technical difficulties caused by the lack of ergonomics. We developed a novel procedure comprising mainly two simple ideas, the teres hanging technique combined with fundus-first, dome-down separation, which mainly uses conventional rigid laparoscopic instruments. In this study, we demonstrated our technique and retrospectively evaluated the clinical outcomes. Subjects and Methods: Three trocars were set through a 2.0-cm transumbilical minilaparotomy that was covered with an EZ Access combined with a lap protector. To create an adequate surgical field, the teres ligament was laparoscopically hung up with a suture on a straight needle. The gall bladder was then dissected through the fundus to the neck using rigid laparoscopic instruments without any additional trocars. At our institution, 18 consecutive patients underwent SILC using our technique from January 2014 to August 2015. Each patient had a symptomatic gallbladder (GB) stone or polyp. All operations were performed by surgeons who had never performed SILC until this study. Results: In all operations, our technique was successfully completed without GB perforation or other intraoperative complications. Additional trocars or open laparotomy were not required. The median operation time was 79 minutes, and blood loss was negligible. No postoperative complications were encountered. Conclusions: Our novel procedure is safe and feasible. Even for surgeons who have never performed SILC before, our technique may become a standard for benign GB disease without requiring the use of articulating devices or additional trocars.
  • Yukiko Mori; Satoshi Nagayama; Jun-ichiro Kawamura; Suguru Hasegawa; Eiji Tanaka; Hiroshi Okabe; Megumi Takeuchi; Makoto Sonobe; Shigemi Matsumoto; Masashi Kanai; Manabu Muto; Tsutomu Chiba; Yoshiharu Sakai
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 21 3 474 - 482 2016年06月 [査読有り]
     
    We have employed upper arm central venous ports (UACVPs) since 2006 for long-term intravenous chemotherapy (CTx) or fluid supplementation. We evaluated the long-term availability of CVPs implanted in the upper arm to determine whether UACVPs could be one of the treatment options besides chest CVPs in terms of CVP-related complications. We reviewed the medical records of all patients who underwent subcutaneous implantation of UACVPs at Kyoto University Hospital from 1 April, 2006 to 30 June, 2009. We assessed the indwelling duration of the UACVPs and the incidences of early and late UACVP-related complications. A total of 433 patients underwent subcutaneous implantation of UACVPs during this time period. The cumulative follow-up period was 251,538 catheter days, and the median duration of UACVP indwelling was 439.0 days (1-2, 24). There was no UACVP-related mortality throughout the study period. A total of 83 UACVP-related complications occurred (19.2 %), including 43 cases of infection (9.9 %, 0.17/1000 catheter days), ten cases of catheter-related thrombosis (2.3 %, 0.040/1000 catheter days), ten cases of occlusion (2.3 %, 0.040/1000 catheter days), nine cases of catheter dislocation (2.0 %, 0.036/1000 catheter days), five cases of port leakage (1.2 %, 0.019/1000 catheter days), four cases of skin dehiscence (0.9 %, 0.015/1000 catheter days) and two cases of port chamber twist (0.5 %, 0.008/1000 catheter days). The removal-free one-year port availability was estimated at 87.8 %. UACVPs were of long-term utility, with complication rates comparable to those of chest CVPs previously reported.
  • Yukari Hattori; Takashi Ikeuchi; Yoshihiro Kuroda; Kiyotomo Matsugi; Shunsuke Minami; Toshihiro Higuchi; Masazumi Zaima; Satoshi Ishitoya; Chikako Yamauchi; Hiroyuki Onishi; Junichiro Kawamura; Koichi Kitoh; Osamu Oshiro; Yosuke Yamamoto; Atsushi Utani; Noboru Hattori
    JOURNAL OF DERMATOLOGY 43 5 547 - 552 2016年05月 [査読有り]
     
    Preceding this study, we observed two cases of concurrent postoperative gluteal skin and muscle damage with extremely high serum creatine kinase (CK) levels, both of which were unrelated to pressure-induced tissue injury. However, postoperative gluteal skin damage accompanied by gluteal muscle damage has not been previously reported and the association between gluteal skin damage, gluteal muscle damage and pressure-induced tissue injury has not previously been investigated. Therefore, we conducted this study to determine the postoperative incidence of gluteal skin damage associated with gluteal muscle damage and assess associations with postoperative serum CK levels and pressure-induced tissue injury. We prospectively evaluated postoperative incidence of gluteal skin damage and measured serum CK levels in 929 consecutive patients who underwent abdominal, urological or gynecological surgery at our hospital. Magnetic resonance imaging (MRI) of the pelvis was performed in 67 patients who consented. As a result, two of 929 patients developed postoperative gluteal skin damage accompanied by gluteal muscle damage. Gluteal muscle damage without gluteal skin damage was observed in 23 of the 67 patients who underwent MRI, and volumes of damaged gluteal muscle and postoperative serum CK levels were positively correlated. Both gluteal skin and muscle damage were distinguishable from pressure-induced tissue injury. Based on the results of this study, we could confirm the occurrence of postoperative gluteal skin damage, distinct from pressure sores, accompanied by gluteal muscle damage. We also revealed latent development of postoperative gluteal muscle damage, distinguishable from compression-induced tissue injury, without accompanying gluteal skin damage.
  • Junichiro Kawamura; Takefumi Yazawa; Kimiaki Sumida; Yuya Kida; Ryotaro Ogawa; Masaki Tani; Junya Kawasoe; Michihiro Yamamoto; Hideki Harada; Hidekazu Yamamoto; Masazumi Zaima
    WORLD JOURNAL OF SURGICAL ONCOLOGY 14 56 - 56 2016年02月 [査読有り]
     
    Background: This study sought to clarify the clinical benefits of liver resection after downsizing systemic chemotherapy for initially unresectable colorectal liver metastases (CLM). Methods: Survival and clinical characteristics of CLM patients who underwent resection between January 2001 and December 2013 were retrospectively assessed. The study cohort of 88 patients with limited liver disease who underwent curative liver resection comprised 34 with initially resectable synchronous disease (synchronous group), 38 with initially resectable metachronous disease (metachronous group), and 16 with initially unresectable converted disease (conversion group). Results: The median duration of follow-up for the overall study population was 33 (1-98) months. Overall survival (OS) in the conversion group was not significantly different from that in the other groups. However, disease-free survival (DFS) in the conversion group was significantly shorter than that in the synchronous group. The median DFS was 19.1 months in the synchronous group, 16.6 months in the metachronous group, and 15.3 months in the conversion group. Most patients in the conversion group had recurrence shortly after liver resection in the remnant liver with or without metastases at other sites, but many could undergo repeat hepatectomy or resection of the metastases at other sites. Conclusions: Although the converted patients tended to have recurrence shortly after liver resection, survival could be prolonged by repeat hepatectomy or resection of metastases at other sites. Liver resection after downsizing chemotherapy appears to be efficacious for patients with initially unresectable CLM and may result in long-term outcomes equivalent to those of patients with initially resectable CLM.
    ダウンロード
  • Junichiro Kawamura; Kazuki Ueda; Haruhiko Imamoto; Kiyotaka Okuno
    Laparoscopic Surgery for Colorectal Cancer 31 - 52 2016年01月 [査読有り]
     
    The most common disease for right-sided colectomy is right-sided colon cancer. Although transverse colon cancer has been excluded from most of the major prospective randomized controlled trials due to technical concerns, laparoscopic surgery for right-sided colon cancer has been well established. The procedure of right-sided colectomy is divided into four parts: (1) mobilization of the right colon and its mesentery (2) division of the vascular pedicles (3) division of the lateral attachments, hepatic flexure, and omental attachments and (4) specimen extraction and anastomosis. There are four commonly used approaches to a laparoscopic right-sided colectomy, namely, the medial, inferior, lateral, and superior approaches. The most important thing in all approaches is to create and maintain proper tension during the procedure by corporation between both hands of the assistant and the surgeon’s one hand. We will present a safe and steady procedure for right-sided colectomy with the regional lymph node dissection along the superior mesenteric vein.
  • Kosuke Toda; Kenji Kawada; Suguru Hasegawa; Masahiro Yamada; Junichiro Kawamura; Yoshiharu Sakai
    WORLD JOURNAL OF SURGICAL ONCOLOGY 13 337  2015年12月 [査読有り]
     
    Background: Intramural metastasis (IM) is extremely rare in colorectal cancer, although it often occurred in esophageal cancer. Case Presentation: We report a rare case of T1 rectal cancer with IM which was successfully resected by laparoscopic surgery. A 62-year-old man was admitted to our institution for the treatment of rectal cancer detected by medical examination. Colonoscopy revealed two tumors in the rectum: a type II rectal cancer of 2 cm in diameter located 5 cm proximal to the anal verge and a submucosal tumor of 1 cm in diameter located approximately 1.5 cm proximal to the rectal cancer. Abdominal computed tomography (CT), magnetic resonance imaging (MRI), and transrectal ultrasonography indicated the rectal cancer invaded into the submucosal layer with no metastasis to regional lymph nodes or distant organs. The patient underwent laparoscopic intersphincteric resection. Histopathological analysis revealed that the rectal cancer was moderately differentiated adenocarcinoma (stage I; pT1N0M0 according to the 7th edition of UICC) with severe lymphovascular invasion (ly1, v3) and that the submucosal tumor was composed of moderately differentiated adenocarcinoma proliferating within the muscularis propria. A number of features of the submucosal tumor indicated that this was an IM of the rectal cancer: clearly distinct location from the rectal cancer, growth predominantly within the muscularis propria, similar structural and cellular heterogeneity, and the presence of tumor emboli within vascular vessels. The patient was postoperatively followed for more than 4 years without any sign of recurrence. Conclusions: To the best of our knowledge, this is the first report of the T1 rectal cancer with IM.
  • Michihiro Yamamoto; Masazumi Zaima; Hidekazu Yamamoto; Hideki Harada; Junichiro Kawamura; Tetsuya Yamaguchi
    HEPATO-GASTROENTEROLOGY 62 139 752 - 757 2015年05月 [査読有り]
     
    Background/Aims: In cases of remnant gastric cancer (RGC) with previous lymphadenectomy, laparoscopic total gastrectomy (LTG) is still uncommon because of the technical difficulties associated with adhesions from previous gastric cancer surgery and variations in anastomotic reconstruction. Here we demonstrate our procedure of LTG for RGC following distal gastrectomy (DG) with radical lymphadenectomy and review its clinical results. Methodology: From October 2008 to June 2014, we carried out three consecutive LTGs for RGC with previous lymphadenectomy. All cases had a past history of primary gastric cancer that had required open or laparoscopic DG with D2 radical lymphadenectomy. The preoperative TNM statuses of RGC were all cT1N0M0. Results: All patients successfully underwent LTG without open conversion or intraoperative complications. The median operative duration was 360 min; the median blood loss was 45 mL. The median number of retrieved lymph nodes was 23. No complications occurred postoperatively, and the median length of postoperative hospitalization was 20 days. The pathological TNM statuses of the RGC were all T1N0M0. Resection margins were negative in all cases (R0). Conclusions: Our novel procedure of LTG for RGC following DG with radical lymphadenectomy is technically acceptable, safe, and feasible.
  • Kenji Kawada; Suguru Hasegawa; Koya Hida; Kenjiro Hirai; Kae Okoshi; Akinari Nomura; Junichiro Kawamura; Satoshi Nagayama; Yoshiharu Sakai
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 28 10 2988 - 2995 2014年10月 [査読有り]
     
    Background Laparoscopic rectal surgery involving rectal transection and anastomosis with stapling devices is technically difficult. The aim of this study was to evaluate the risk factors for anastomotic leakage (AL) after laparoscopic low anterior resection (LAR) with double-stapling technique (DST) anastomosis. Methods This was a retrospective single-institution study of 154 rectal cancer patients who underwent laparoscopic LAR with DST anastomosis between June 2005 and August 2013. Patient-, tumor-, and surgery-related variables were examined by univariate and multivariate analyses. The outcome of interest was clinical AL. Results The overall AL rate was 12.3 % (19/154). In univariate analysis, tumor size (P = 0.001), operative time (P = 0.049), intraoperative bleeding (P = 0.037), lateral lymph node dissection (P = 0.009), multiple firings of the linear stapler (P = 0.041), and precompression before stapler firings (P = 0.008) were significantly associated with AL. Multivariate analysis identified tumor size (odds ratio [OR] 4.01; 95 % confidence interval [CI] 1.25-12.89; P = 0.02) and precompression before stapler firings (OR 4.58; CI 1.22-17.20; P = 0.024) as independent risk factors for AL. In particular, precompression before stapler firing tended to reduce the AL occurring in early postoperative period. Conclusions Using appropriate techniques, laparoscopic LAR with DST anastomosis can be performed safely without increasing the risk of AL. Important risk factors for AL were tumor size and precompression before stapler firings.
  • H. Kawada; N. Kurita; F. Nakamura; J. Kawamura; S. Hasegawa; K. Kotake; K. Sugihara; S. Fukuhara; Y. Sakai
    BRITISH JOURNAL OF SURGERY 101 9 1143 - 1152 2014年08月 [査読有り]
     
    Background: The node classification outlined in the seventh edition of the TNM classification is based solely on the number of metastasized lymph nodes. This study examined the prognostic value of apical lymph node (ALN) metastasis and the additional value of incorporating ALN status into a risk model based on the seventh edition. Methods: This was a cohort study of patients with stage III colonic cancer who underwent tumour resection with dissection of regional (including apical) lymph nodes at 71 hospitals across Japan between 2000 and 2002. The main exposure was pathologically confirmed ALN metastasis, and the primary endpoint was cancer-specific death. Results: ALN metastasis was present in 113 (8.3 per cent) of 1355 patients. During 5356 patient-years of follow-up (median 5.0 years), 221 instances (16.3 per cent) of cancer-specific death were observed. After adjustment for tumour and node classification (as described in the seventh edition of the TNM classification) and other prognostic factors, ALN metastasis was found to be independently associated with cancer-specific death (hazard ratio 2.29, 95 per cent confidence interval (c.i.) 1.49 to 3.52). Incorporation of ALN metastasis into the prognostic model based on the seventh edition of the TNM classification significantly improved discriminative performance for cancer-specific death (difference in concordance index 0.0146, 95 per cent c.i. 0.0030 to 0.0262) and risk reclassification for cancer-specific death at 5 years (category-free net reclassification improvement 19.4 (95 per cent c.i. 5.0 to 33.4) per cent). Conclusion: Assessment of ALN metastasis provided independent prognostic information beyond that achievable with the seventh edition of the TNM classification in patients with stage III colonic cancer.
  • 転移性肝がんに対するALPPSの試み
    山本 道宏; 財間 正純; 本庄 真彦; 木田 裕也; 尾川 諒太郎; 川添 准矢; 中川 淳; 矢澤 武史; 川村 純一郎; 原田 英樹; 山本 秀和
    日本肝胆膵外科学会・学術集会プログラム・抄録集 26回 547 - 547 (一社)日本肝胆膵外科学会 2014年06月
  • 胆汁細胞診で診断され肝切除を行った肝内胆管癌(CIS)の3例
    川添 准矢; 住田 公亮; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本肝胆膵外科学会・学術集会プログラム・抄録集 26回 684 - 684 (一社)日本肝胆膵外科学会 2014年06月
  • 当センターにおける大腸癌同時性肝転移に対する治療成績
    川村 純一郎; 中川 淳; 住田 公亮; 本庄 真彦; 尾川 諒太郎; 木田 裕也; 川添 准矢; 矢澤 武史; 山本 道広; 原田 英樹; 山本 秀和; 財間 正純
    日本大腸肛門病学会雑誌 67 3 222 - 222 (一社)日本大腸肛門病学会 2014年03月
  • Bevacizumabが奏功した進行再発大腸癌の3例
    矢澤 武史; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 中村 直彦; 中川 淳; 山本 道宏; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    滋賀医学 36 104 - 105 (一社)滋賀県医師会 2014年03月
  • 腹臥位胸腔鏡および腹腔鏡による食道がん手術
    山本 道宏; 原田 英樹; 財間 正純; 山本 秀和; 川村 純一郎; 矢澤 武史; 中川 淳; 川添 准矢; 本庄 真彦; 尾川 涼太郎; 木田 裕也; 住田 公亮
    滋賀医学 36 126 - 126 (一社)滋賀県医師会 2014年03月
  • 当センターにおける下部直腸癌に対する腹腔鏡下側方リンパ節郭清術の手術手技
    木田 裕也; 川村 純一郎; 住田 公亮; 本庄 真彦; 尾川 諒太郎; 川添 准矢; 中川 淳; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    滋賀医学 36 128 - 128 (一社)滋賀県医師会 2014年03月
  • Michihiro Yamamoto; Masazumi Zaima; Hidekazu Yamamoto; Hideki Harada; Junichiro Kawamura; Tetsuya Yamaguchi
    HEPATO-GASTROENTEROLOGY 61 130 543 - 548 2014年03月 [査読有り]
     
    Background/Aims: Intracorporeal esophagojejunostomy represents the most difficult step during laparoscopic total gastrectomy (LTG). A novel technique for intracorporeal esophagojejunostomy was recently developed and named the "overlap method." However, this procedure is thought to have some technical disadvantages. To facilitate intracorporeal esophagojejunostomy, we developed some modifications for the overlap method. Methodology: From October 2009 to July 2013, 63 consecutive patients with gastric cancer underwent LTG at our institution. Our modified overlap method was used for 54 patients with the following modifications. First, the esophagus was transected while being rotated by approximately 90 in the clockwise direction. Second, an endoscopic linear stapler was used through the right lower trocar to create a side-to-side esophagojejunostomy. Third, the entry hole of the linear stapler was closed with intracorporeal hand-sewn continuous suturing. This procedure was termed the "modified overlap method!' Results: In 53 patients with the exception of one case, the modified overlap method was successfully completed (98.1%). Only one patient developed esophagojejunal anastomotic leakage (1.9%), which recovered well with conservative management. No postoperative anastomotic stricture or bleeding occurred. Conclusions: Our modified overlap method for intracorporeal esophagojejunostomy provides amazingly satisfactory outcomes. We believe this procedure could become a standard method for intracorporeal esophagojejunostomy after LTG.
  • Kawada K; Hasegawa S; Hida K; Hirai K; Okoshi K; Nomura A; Kawamura J; Nagayama S; Sakai Y
    Surgical Endoscopy and Other Interventional Techniques 28 10 2996 - 2997 2014年 [査読有り]
  • 当センターでの腹腔鏡下結腸左半切除術における結腸脾彎曲授動の手技の工夫
    川村 純一郎; 中川 淳; 住田 公亮; 本庄 真彦; 木田 裕也; 尾川 諒太郎; 川添 准矢; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    日本内視鏡外科学会雑誌 18 7 448 - 448 (一社)日本内視鏡外科学会 2013年11月
  • 当センターでの中結腸動脈周囲リンパ節郭清における工夫
    中川 淳; 川村 純一郎; 住田 公亮; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 川添 准矢; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    日本内視鏡外科学会雑誌 18 7 455 - 455 (一社)日本内視鏡外科学会 2013年11月
  • Kawamura J; Hasegawa S; Kawada K; Yamaguchi T; Nagayama S; Matsusue R; Nomura A; Sakai Y
    Asian journal of endoscopic surgery 6 4 271 - 278 4 2013年11月 [査読有り]
  • 内視鏡下大腸切除術の手術手技 当センターにおける下部直腸癌に対する腹腔鏡下ISRの工夫
    川村 純一郎; 中川 淳; 住田 公亮; 本庄 真彦; 木田 裕也; 尾川 諒太郎; 川添 准矢; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    日本臨床外科学会雑誌 74 増刊 348 - 348 日本臨床外科学会 2013年10月
  • 当センターでの膵癌術前検査におけるPETの役割
    中川 淳; 山本 秀和; 住田 公亮; 木田 裕也; 尾川 諒太郎; 本庄 真彦; 川添 准矢; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 財間 正純
    日本臨床外科学会雑誌 74 増刊 534 - 534 日本臨床外科学会 2013年10月
  • 食道癌術後右鎖骨下動脈瘤に対して右鎖骨下動脈切除、非解剖学的動脈バイパス手術により救命しえた1例
    木田 裕也; 財間 正純; 四元 文明; 山本 秀和; 原田 英樹; 川村 純一郎; 山本 道宏; 矢澤 武史; 中川 淳; 川添 准矢; 尾川 諒太郎; 本庄 真彦; 山田 知行; 勝山 和彦; 藤原 靖恵
    日本臨床外科学会雑誌 74 増刊 586 - 586 日本臨床外科学会 2013年10月
  • 食道癌手術時の空腸瘻に起因する全小腸捻転に対し、2期的手術により全小腸切除を回避しえた1例
    住田 公亮; 山本 秀和; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 川添 准矢; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 74 増刊 836 - 836 日本臨床外科学会 2013年10月
  • 膵頭部領域疾患に対する腹腔鏡下膵頭十二指腸切除術
    山本 道宏; 財間 正純; 豊田 英二; 山本 秀和; 原田 英樹; 川村 純一郎; 矢澤 武史; 中川 淳; 中村 直彦; 尾川 諒太郎; 木田 裕也; 本庄 真彦
    日本肝胆膵外科学会・学術集会プログラム・抄録集 25回 176 - 176 (一社)日本肝胆膵外科学会 2013年06月
  • 当センターでの大腸癌同時性肝転移に対する治療戦略
    川村 純一郎; 本庄 真彦; 尾川 諒太郎; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道広; 原田 英樹; 山本 秀和; 財間 正純
    日本肝胆膵外科学会・学術集会プログラム・抄録集 25回 478 - 478 (一社)日本肝胆膵外科学会 2013年06月
  • 胃癌肝転移に対して肝切除を施行し5年無再発生存が得られた4症例
    本庄 真彦; 財間 正純; 四元 文明; 山本 秀和; 原田 英樹; 川村 純一郎; 山本 道宏; 矢澤 武史; 中川 淳; 中村 直彦; 木田 裕也; 尾川 諒太郎; 宇野 伊津美
    日本肝胆膵外科学会・学術集会プログラム・抄録集 25回 524 - 524 (一社)日本肝胆膵外科学会 2013年06月
  • Okoshi K; Masano Y; Hasegawa S; Hida K; Kawada K; Nomura A; Kawamura J; Nagayama S; Yoshimura T; Sakai Y
    Asian journal of endoscopic surgery 6 2 90 - 95 2 2013年05月 [査読有り]
  • 切除不能大腸癌肝転移症例に対するCetuximab併用化学療法の治療成績
    矢澤 武史; 川村 純一郎; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 中村 直彦; 中川 淳; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    日本大腸肛門病学会雑誌 66 4 313 - 313 (一社)日本大腸肛門病学会 2013年04月
  • 胃切除後にトラスツズマブ療法でCRが得られた進行胃癌の1例
    本庄 真彦; 尾川 諒太郎; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 木曾 末厘乃; 川村 純一郎; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    滋賀医学 35 133 - 133 (一社)滋賀県医師会 2013年03月
  • 腹腔鏡下胃全摘術後早期に小腸間膜欠損孔への内ヘルニアが生じた1例
    尾川 諒太郎; 山本 秀和; 本庄 真彦; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 財間 正純
    日本臨床外科学会雑誌 74 3 856 - 856 日本臨床外科学会 2013年03月
  • K. Hida; S. Hasegawa; Y. Kataoka; S. Nagayama; K. Yoshimura; A. Nomura; K. Kawada; J. Kawamura; Y. Kinjo; Y. Sakai
    COLORECTAL DISEASE 15 2 244 - 251 2013年02月 [査読有り]
     
    Aim The aim of this prospective study was to clarify the frequency of male sexual dysfunction after laparoscopic total mesorectal excision (LTME) and to examine the relationship between pelvic autonomic nerve (PAN) preservation status and functional outcomes. Method Candidates for LTME were included in this study. PAN preservation status after LTME was examined in detail by video review. Patients completed a functional questionnaire (the International Index of Erectile Function) before and 3, 6 and 12 months after the operation. Results Twenty-six patients who underwent LTME were assessable. Detailed video reviews identified inadvertent PAN damage during surgery. PAN injury was observed in 11 cases (41%), including eight cases (32%) of inadvertent PAN damage (incomplete preservation group). There was a trend toward increasing inadvertent PAN injury rate in patients with high body mass index and large tumours. The results from all patients who underwent LTME showed no deterioration in total International Index of Erectile Function or its domain scores 12 months after surgery. In the incomplete preservation group, these scores temporarily decreased (3 and 6 months after surgery), but such deterioration was not observed in the complete preservation group. Most of the 12 patients with potentially active erectile function before the operation recovered this function, and only one patient (7%) with PAN injury was still judged as inactive 12 months after surgery. Conclusion The proportion of patients with sexual dysfunction after LTME is low. With the enhanced visibility of the laparoscope, inadvertent PAN injury was detected in a significant number of cases and associated with transient deterioration of sexual function.
  • 当センターにおける直腸切離・吻合手技の定型化について ステープリングデバイスの適切な選択と使用方法
    川村 純一郎; 本庄 真彦; 尾川 諒太郎; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 財間 正純
    日本内視鏡外科学会雑誌 17 7 347 - 347 (一社)日本内視鏡外科学会 2012年12月
  • 異時性残胃癌に対する腹腔鏡下残胃全摘術の現状
    山本 道宏; 稲木 紀幸; 財間 正純; 山本 秀和; 原田 英樹; 川村 純一郎; 矢澤 武史; 中川 淳; 中村 直彦; 本庄 真彦; 木田 裕也; 尾川 諒太郎
    日本内視鏡外科学会雑誌 17 7 470 - 470 (一社)日本内視鏡外科学会 2012年12月
  • 術中膵体尾部欠損症と診断した早期胃癌の1切除例
    尾川 諒太郎; 山本 秀和; 木田 裕也; 本庄 真彦; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 財間 正純
    日本内視鏡外科学会雑誌 17 7 474 - 474 (一社)日本内視鏡外科学会 2012年12月
  • 大腸癌肝・肺転移治療の新展開 切除不能大腸癌肝転移症例に対する分子標的薬併用化学療法の治療成績
    矢澤 武史; 川村 純一郎; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 中村 直彦; 中川 淳; 山本 道宏; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 73 増刊 351 - 351 日本臨床外科学会 2012年10月
  • Cetuximab併用全身化学療法後に切除し得た大腸癌肺転移症例の検討
    尾川 諒太郎; 川村 純一郎; 木田 裕也; 本庄 真彦; 宇野 伊津美; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 73 増刊 677 - 677 日本臨床外科学会 2012年10月
  • 冠動脈3枝病変に対しPCIを先行させた腸重積緊急手術の一例
    尾川 諒太郎; 山本 秀和; 木田 裕也; 本庄 真彦; 宇野 伊津美; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 原田 英樹; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 73 増刊 680 - 680 日本臨床外科学会 2012年10月
  • 鼠径管内異所性子宮内膜症の1手術例
    本庄 真彦; 原田 英樹; 寺島 剛; 武内 英二; 三木 通保; 尾川 諒太郎; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 川村 純一郎; 山本 秀和; 財間 正純
    日本臨床外科学会雑誌 73 増刊 731 - 731 日本臨床外科学会 2012年10月
  • CA19-9高値を示した脾嚢胞に対して腹腔鏡下脾臓摘出術を行った1例
    木田 裕也; 川村 純一郎; 尾川 諒太郎; 本庄 真彦; 宇野 伊津美; 中村 直彦; 中川 淳; 矢澤 武史; 山本 道宏; 原田 英樹; 山本 秀和; 四元 文明; 財間 正純
    日本臨床外科学会雑誌 73 増刊 889 - 889 日本臨床外科学会 2012年10月
  • Shigeru Kato; Junichiro Kawamura; Kenji Kawada; Suguru Hasegawa; Yoshiharu Sakai
    JOURNAL OF SURGICAL RESEARCH 176 2 430 - 436 2012年08月 [査読有り]
     
    Background. Lymph node metastasis is one of the most critical prognostic factors in patients with colorectal cancer. Although regional lymph nodes should be surgically resected and pathologically examined, techniques for the intraoperative diagnosis of lymph node metastasis remain to be well established. Fluorescence diagnosis using 5-aminolevulinic acid (5-ALA) is a promising technique for evaluating various malignancies. After exogenous administration of 5-ALA, protoporphyrin IX (PPIX) accumulates in malignant cells and can be detected as red fluorescence. In this study, we investigated the usefulness of fluorescence diagnosis using 5-ALA for the detection of lymph node metastasis in a mouse model of colon cancer. Materials and Methods. An orthotopic colon cancer model was prepared by inoculating the cecal wall of nude mice with HCA7, a human colon adenocarcinoma cell line. After 3 wk, 40 mg/kg of 5-ALA was administered intraperitoneally (IP) or orally (PO). Fluorescence diagnosis with a D-Light System (Karl Storz) was then performed after 3 or 6 h. Results. In the IP group, PPIX fluorescence was detected in metastatic lymph nodes as well as in other malignant lesions, including primary tumors and abdominal implantations, while non-metastatic nodes were fluorescence-negative. In contrast, no obvious fluorescence was detected in cancerous tissues in the PO group. Conclusions. PPIX fluorescence induced by intraperitoneal injection of 5-ALA allows metastatic lymph nodes to be accurately diagnosed in this mouse model. This technique may facilitate the intraoperative diagnosis of lymph node metastases from colon cancer in a clinical setting. (C) 2012 Elsevier Inc. All rights reserved.
  • 腹腔鏡下直腸低位前方切除術における切離・吻合の工夫
    川村 純一郎; 本庄 真彦; 尾川 諒太郎; 木田 裕也; 中村 直彦; 中川 淳; 矢澤 武史; 原田 英樹; 山本 秀和; 財間 正純
    日本消化器外科学会総会 67回 1 - 1 (一社)日本消化器外科学会 2012年07月
  • 肝門浸潤肝内胆管癌に対する血行再建を伴う左肝切除の経験
    中村 直彦; 尾川 涼太郎; 木田 裕也; 本庄 真彦; 中川 淳; 矢澤 武史; 川村 純一郎; 原田 英樹; 山本 秀和; 財間 正純
    日本消化器外科学会総会 67回 2 - 2 (一社)日本消化器外科学会 2012年07月
  • 左胃動脈を用いて左肝動脈再建を行った胆嚢癌に対する肝膵切除の1例
    中村 直彦; 尾川 諒太郎; 木田 裕也; 本庄 真彦; 中川 淳; 矢澤 武史; 川村 純一郎; 原田 英樹; 山本 秀和; 財間 正純
    日本肝胆膵外科学会・学術集会プログラム・抄録集 24回 492 - 492 (一社)日本肝胆膵外科学会 2012年05月
  • 長谷川 傑; 篠原 尚; 松末 亮; 大越 香江; 山田 理大; 河田 健二; 川村 純一郎; 坂井 義治
    臨床外科 67 5 676 - 684 (株)医学書院 2012年05月
  • 長谷川 傑; 篠原 尚; 松末 亮; 大越 香江; 山田 理大; 河田 健二; 川村 純一郎; 坂井 義治
    臨床外科 67 4 532 - 542 (株)医学書院 2012年04月
  • 腹腔鏡下直腸低位前方切除術(Lap-LAR) 良好な術野展開における骨盤内解剖を中心に
    川村 純一郎; 中村 直彦; 本庄 真彦; 尾川 諒太郎; 木田 裕也; 中川 淳; 矢澤 武史; 原田 英樹; 山本 秀和; 財間 正純
    滋賀医学 34 137 - 137 (一社)滋賀県医師会 2012年03月
  • 長谷川 傑; 篠原 尚; 松末 亮; 大越 香江; 山田 理大; 河田 健二; 川村 純一郎; 坂井 義治
    臨床外科 67 3 382 - 390 (株)医学書院 2012年03月
  • 長谷川 傑; 篠原 尚; 松末 亮; 大越 香江; 山田 理大; 河田 健二; 川村 純一郎; 坂井 義治
    臨床外科 67 2 238 - 245 (株)医学書院 2012年02月
  • 長谷川 傑; 篠原 尚; 松末 亮; 大越 香江; 山田 理大; 河田 健二; 川村 純一郎; 坂井 義治
    臨床外科 67 1 74 - 83 (株)医学書院 2012年01月
  • Jeffrey Milsom; Koiana Trencheva; Raghava Pavoor; Joseph DiRocco; Parul J. Shukla; Junichiro Kawamura; Toyooki Sonoda
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 25 11 3691 - 3697 2011年11月 [査読有り]
     
    Background In recent years, there has been considerable interest in developing technology as well as techniques that could widen the therapeutic horizons of endoscopy. Rectal prolapse, a benign localized condition causing considerable morbidity, could be an excellent focus for new endoscopic therapies. The aim of this study was to assess the feasibility and safety of endoluminal fixation of the rectum to the anterior abdominal wall, after pushing it up inside the body, using an in vivo animal model. Methods We performed an in vivo comparative surgical study in a porcine model, including laparoscopic mobilization of the rectum and posterior rectopexy (standard surgical method) or endoluminal tacking of the rectum. After proving feasibility in ex vivo and acute studies, we performed a survival study to evaluate the safety of endoluminal tacking of the mobilized rectum to the anterior abdominal wall. The main outcome measures were successful completion of the tasks, maintenance of the fixation, complications associated with the methods, and survival studies including histopathological examinations of the fixation sites. Results There were two groups: laparoscopic rectopexy (8 animals) and endoluminal fixation of the rectum to the anterior abdominal wall (10 animals). There were no differences between these two groups in their postoperative recovery. The group with the endoluminal fixation was found to have adequate attachment of the rectum to the anterior abdominal wall (measured attachment pressure in the endoluminal group = 6.06 +/- 0.52 ft-lb, in the control group = 4.86 +/- 2.00 ft-lb) on both gross and microscopic evaluation. Conclusion Endoscopic fixation of the mobilized rectum is feasible and safe in this model and in the future may provide an effective alternative to current treatment options for rectal prolapse.
  • Kenji Kawada; Suguru Hasegawa; Teppei Murakami; Yoshiro Itatani; Hisahiro Hosogi; Masahiro Sonoshita; Takanori Kitamura; Teruaki Fujishita; Masayoshi Iwamoto; Takuya Matsumoto; Ryo Matsusue; Koya Hida; Gaku Akiyama; Kae Okoshi; Masahiro Yamada; Junichiro Kawamura; Makoto Mark Taketo; Yoshiharu Sakai
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 16 5 464 - 472 2011年10月 [査読有り]
     
    Colorectal cancer is the second most common cancer, and is the third leading cause of cancer-related death in Japan. The majority of these deaths is attributable to liver metastasis. Recent studies have provided increasing evidence that the chemokine-chemokine receptor system is a potential mechanism of tumor metastasis via multiple complementary actions: (a) by promoting cancer cell migration, invasion, survival and angiogenesis; and (b) by recruiting distal stromal cells (i.e., myeloid bone marrow-derived cells) to indirectly facilitate tumor invasion and metastasis. Here, we discuss recent preclinical and clinical data supporting the view that chemokine pathways are potential therapeutic targets for liver metastasis of colorectal cancer.
  • Juan Luis Calisto; Junichiro Kawamura; Koiana Trencheva; Olival Oliveira; Vanessa Ho; Jun Yan; Wen Lei; Jeffrey Milsom
    SURGICAL INNOVATION 18 1 44 - 47 2011年03月 [査読有り]
     
    Introduction: The purpose of this study was to assess the utility and strength of a novel endoscopic fixation device, Brace-Bar, in the large intestine and compare the strength with other currently available techniques. The primary outcome was the strength of fixation using 3 endoscopic methods: BraceBar, suture, and commercially available tackers. The hypothesis is that the use of the BraceBar will result in fixation strength similar to the strength of the other methods. Materials and methods: An ex vivo porcine model was used to test 3 fixation methods: Group 1, BraceBar (Prototype); Group 2, ProTack (AutoSuture); and Group 3, TI-CRON suture (Syneture). Large-bowel segments were fixed to abdominal wall tissue at 20 cm from the distal end of the rectum. Primary endpoint was pull away strength. A total of 45 trials of each method were performed. Comparison between the groups was done using JMP 7.0. Results: There was no significant difference in strength between the BraceBar group and the suture group ( P = .1236). The BraceBar method demonstrated significantly higher strength compared with the tacker group (P = .003). Conclusion: Use of the BraceBar for fixation of the large bowel is at least comparable with suture fixation, making clinical use of BraceBar a reasonable consideration. Use of this device may make endoscopic repair of certain intestinal conditions feasible.
  • 野村明成; 長山聡; 長谷川傑; 川村純一郎; 河田健二; 肥田侯矢; 磯田裕義; 坂井義治
    消化器外科 33 6 1075 - 1088 2010年05月
  • Yoshihisa Okuchi; Satoshi Nagayama; Yukiko Mori; Junichiro Kawamura; Shigemi Matsumoto; Takafumi Nishimura; Akihiko Yoshizawa; Yoshiharu Sakai
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 40 5 476 - 481 2010年05月 [査読有り]
     
    We present a case of pseudo-meigs' syndrome caused by a metastatic ovarian tumor of rectal cancer origin, and examine the possible involvement of vascular endothelial growth factor (VEGF) in the pathogenesis of refractory fluid retention. A 42-year-old woman with advanced rectal cancer underwent a laparoscopic anterior resection of the rectum. During systemic chemotherapy treatment, she complained of severe abdominal distension 16 months following the operation. We failed to improve massive ascites by diuretics and repeated abdominocenteses. Without any definite evidence of carcinomatous peritonitis, we chose to extirpate an enlarged ovarian tumor on the presumptive diagnosis of pseudo-meigs' syndrome. Ascites disappeared promptly after resecting the ovarian tumors and the subject resumed systemic chemotherapy. Preoperative high levels of serum VEGF were normalized promptly after the operation. Levels of VEGF expression in metastatic ovarian tumors were as weak as in the primary tumor upon immunohistochemical staining. In contrast, increased VEGF expression was evident in epithelial cells of oviducts. For patients with massive and refractory ascites, we need to keep in mind the disease entity of pseudo-meigs' syndrome, since surgical intervention possibly improves conditions. Furthermore, the hypersecretion of VEGF from oviducts may play a role in the pathogenesis of clinical manifestations of pseudo-meigs' syndrome.
  • Hiroshi Okabe; Kazutaka Obama; Eiji Tanaka; Akinari Nomura; Jun-ichiro Kawamura; Satoshi Nagayama; Atsushi Itami; Go Watanabe; Seiichiro Kanaya; Yoshiharu Sakai
    SURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES 23 9 2167 - 2171 2009年09月 [査読有り]
     
    To facilitate acceptance of laparoscopic total gastrectomy (LTG) for patients with upper gastric cancer, a simple, secure technique of reconstruction is necessary. The authors developed a new technique for intracorporeal esophagojejunal anastomosis that does not require hand sewing. From September 2006 to January 2008, 16 patients (11 men and 5 women) with gastric cancer underwent LTG at the authors' institution. Laparoscopic esophagojejunal anastomosis using the following method was attempted for all patients. The esophagus was transected while being rotated by about 45A degrees counterclockwise to make the subsequent anastomosis easier. After the Y-anastomosis was created, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb. The entry hole was first closed roughly with hernia staplers. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed and the closure completed. Laparoscopic esophagojejunal anastomosis was successfully performed for 15 patients. Intracorporeal anastomosis failed for one patient because a nasogastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications occurred. Using the new technique, intracorporeal linear-stapled esophagojejunal anastomosis can be performed easily and securely. This technique could become one of the standard methods for reconstruction after LTG, facilitating the acceptance of LTG as a surgical option for patients with upper gastric cancer.
  • Shigeo Hisamori; Satoshi Nagayama; Sadahiko Kita; Jun-ichiro Kawamura; Akihiko Yoshizawa; Yoshiharu Sakai
    JAPANESE JOURNAL OF CLINICAL ONCOLOGY 39 6 399 - 405 2009年06月 [査読有り]
     
    A 71-year-old woman presented with hematochezia and narrowing of the stool. She suffered from progressive systemic sclerosis for 12 years and underwent home oxygen therapy due to pulmonary fibrosis and moderate pulmonary hypertension. Colonoscopy revealed a pedunculated, cauliflower-like polyp with a depressed surface in the sigmoid colon. The polyp was regarded as early colon cancer with possible submucosal invasion, and subsequent computed tomographic (CT) scans showed no evidence of lymph node involvement or distant metastases. Because of perioperative risks due to moderate pulmonary hypertension, she underwent an endoscopic resection of the early colon cancer. Pathological examination of the resected specimen of 20 mm diameter revealed the peculiar morphology of an adenocarcinoma with moderate lymphatic invasion. Immunohistochemical analysis for epithelial membrane antigen showed the specific 'inside-out growth pattern' indicative of invasive micropapillary carcinoma (IMPC). Taking the perioperative risks into consideration, she opted to undergo close follow-ups without an additional sigmoidectomy. At 6 months after the resection, the follow-up colonoscopy revealed a local recurrence of the colon cancer, and subsequent CT scans revealed multiple distant metastases including the lung, liver, lymph nodes and spleen. This is a rare case of a pure, submucosal IMPC of the colon. Furthermore, pure IMPC of the colon may represent a reliable predictor of lymphogenous and/or hematogenous metastases. Therefore, one should recommend an additional colectomy after endoscopic mucosal resection treatment when pathological findings confirmed IMPC of the colon and should continue a close follow-up for IMPC patients even when curative resections were performed at an early stage.
  • Seiji Satoh; Hiroshi Okabe; Kan Kondo; Eiji Tanaka; Atsushi Itami; Junichiro Kawamura; Akinari Nomura; Satoshi Nagayama; Go Watanabe; Yoshiharu Sakai
    Surgical endoscopy 23 2 436 - 7 2009年02月 [査読有り]
     
    BACKGROUND: Lymph node dissection is a crucial procedure for curative resection of gastric cancer [1]. To avoid portal vein injury during laparoscopic extended lymph node dissection for gastric cancer, taping of the common hepatic artery and subsequent confirmation of the portal vein have been recommended [2, 3]. This taping method, however, makes laparoscopic nodal dissection technically complicated. This study introduces a novel procedure for safe and simple laparoscopic suprapancreatic nodal dissection without taping of the common hepatic artery. METHODS: The authors' novel, simplified method consists of four steps: (1) dissection along the cranial edge of the pancreas from right to left, (2) dissection along the splenic artery with exposure of the left renal fascia, (3) dissection along the left gastric and the common hepatic arteries, and (4) retraction of the lymph nodes surrounding the common and proper hepatic arteries and their complete dissection from the portal vein. This procedure is reversely directed compared with conventional open gastrectomy (i.e., the nodal dissection is from left to right). For this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The described procedures were performed for 58 consecutive patients with gastric cancer. The indication for this operation is primary T1/T2 gastric cancer without clinical nodal metastasis. RESULTS: In all cases, safely extended suprapancreatic lymph node dissection was successfully accomplished using the described technique. A total of 43.5 +/- 18 lymph nodes were retrieved, including 14.4 +/- 6.3 second-tier lymph nodes. The overall number of retrieved lymph nodes in this study was similar to that reported previously [4]. Postoperative morbidity occurred at a rate of 22.3%, and the mortality rate was 0%. There was no conversion to open surgery. The mean blood loss was 127 ml (range, 0-490 ml), and the mean operative time was 289 min (range, 104-416 min) in the last 20 consecutive cases. To date, no tumor recurrence has been observed. The median postoperative observation period was 1.4 years (range, 0.4-2.4 years). CONCLUSION: The described novel procedure would be sufficient and convenient for dissection of the suprapancreatic lymph nodes.
  • SAKAI Y
    Asian Journal of Endoscopic Surgery 2 8 - 12 2009年 [査読有り]
  • Suguru Hasegawa; Satoshi Nagayama; Akinari Nomura; Junnichiro Kawamura; Yoshiharu Sakai
    DISEASES OF THE COLON & RECTUM 51 8 1279 - 1282 2008年08月 [査読有り]
     
    Although technically demanding, laparoscopy may be advantageous in magnifying the anatomy of the pelvic autonomic nervous system when performing total mesorectal excision for rectal cancer. We present our method for laparoscopic total mesorectal excision for men. We performed laparoscopic total mesorectal excision for 36 men with middle or low rectal cancer. The rectum was mobilized through a medial approach down to the pelvic floor without minilaparotomy or hand assist. Anteriorly, the dissection plane was in front of Denonvilliers fascia. Anterolaterally, to preserve the pelvic plexus and neurovascular bundle, Denonvilliers fascia must be cut at its lateral continuity. We found that the most important factor in obtaining a good surgical view is keeping adequate tension in the dissection plane by coordination between the surgeon and assistant. Dissection was performed by using only electrocautery without an ultrasonic dissector or vessel sealing device. No case was converted to open surgery. The short-term feasibility was acceptable. Our method of laparoscopic total mesorectal excision is a feasible approach and may be beneficial for the standardization and popularization of laparoscopic total mesorectal excision. Long-term results, including survival data and urogenital function, are needed to evaluate the true efficacy of this procedure.
  • Junichiro Kawamura; Satoshi Nagayama; Akinari Nomura; Atsushi Itami; Hiroshi Okabe; Seiji Sato; Go Watanabe; Yoshiharu Sakai
    INTERNATIONAL JOURNAL OF CLINICAL ONCOLOGY 13 4 349 - 354 2008年08月 [査読有り]
     
    Background. Venous ports are mandatory for chemotherapy in cancer patients because prolonged infusions are required. The aim of this study was to assess the safety of peripheral arm ports for chemotherapy in patients with colorectal cancer. Methods. A peripheral venous access port was placed in the upper arm in 113 consecutive patients with metastatic colorectal cancer (MCRC). All patients received modifi ed FOLFOX (5-fl uorouracil [5-FU]/l-leucovorin [LV]/oxaliplatin [L-OHP]) 6 or FOLFIRI (5-FU/LV/irinotecan hydrochloride [CPT-11]) regimens at least once via the venous access port. All patients were followed up at least once every 2 weeks. Results. Puncture of the basilic veins was successfully completed under real-time sonographic guidance or radiographic guidance in all patients. The median operative time was 30 min. The cumulative follow-up period was 29 886 catheter days (range, 9-560 days; mean, 264 days). No procedural complications, such as pneumothorax, hemothorax, arterial puncture, or cardiovascular problems, occurred in our series. A total of nine patients (8.0%) had complications. Port-site infection occurred in six patients (5.3%; 0.20 infections per 1000 catheter-days). One patient (0.9%) had an episode of ultrasound-documented deep vein thrombosis in the ipsilateral upper extremity (0.03/1000 catheter-days). Dislocation or migration of the catheter tip occurred in two patients (0.07/1000 catheter-days). A second port was placed in six patients (5.3%) after removal of the fi rst port. Conclusion. Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC.
  • Shigemi Matsumoto; Takafumi Nishimura; Masashi Kanai; Yukiko Mori; Satoshi Nagayama; Jun'ichiro Kawamura; Akinari Nomura; Shin'ichi Miyamoto; Toshiyuki Kitano; Hiroshi Ishiguro; Kazuhiro Yanagihara; Satoshi Teramukai; Yoshiharu Sakai; Tsutomu Chiba; Masanori Fukushima
    CHEMOTHERAPY 54 5 395 - 403 2008年 [査読有り]
     
    Background: Although a variety of FOLFOX regimens (5-fluorouracil and L-leucovorin combined with oxaliplatin) are widely used for the treatment of advanced colorectal cancer, the neurotoxicity caused by oxaliplatin is often problematic. The aim of this observational study was to assess the safety and efficacy of a modified version of the FOLFOX6 regimen (mFOLFOX6) when administered using the 'stop-and-go' strategy. Patients and Methods: A total of 112 eligible patients treated between June 2005 and July 2007 were identified using the prospective cohort database system of Kyoto University Hospital. Results: The median follow-up was 16.3 months (range 1.6-33.9), and the response rate was 33.3% (95% CI 14.5-52.2), 40.0% (95% CI 22.5-57.5) and 14.0% (95% CI 3.6-24.3) for patients who received mFOLFOX6 as first-line therapy, second-line therapy and third-or later-line therapy, respectively. The estimated median progression-free survival was 8.7 months (95% CI 2.3-15.1) and 8.2 months (95% CI 7.3-9.1) for patients on first-line and second-line therapy, respectively. The median overall survival was not reached as of April 2008 for the patients on first-line therapy, while it was 27.1 months (95% CI 22.0-32.2) for those on second-line therapy. Severe neurotoxicity occurred in only 4 patients (3.6%). Conclusion: mFOLFOX6 administered using the stop-and-go strategy significantly reduced oxaliplatin-induced neurotoxicity relative to conventional FOLFOX treatment, without compromising efficacy. Copyright (C) 2008 S. Karger AG, Basel.
  • Hisahiro Hosogi; Satoshi Nagayama; Junichiro Kawamura; Yasushi Koshiba; Akinari Nomura; Atsushi Itami; Hiroshi Okabe; Seiji Satoh; Go Watanabe; Yoshiharu Sakai
    JOURNAL OF GASTROENTEROLOGY 43 6 492 - 497 2008年 [査読有り]
     
    LKB1 encodes a serine/threonine protein kinase that is defective in patients with Peutz-Jeghers syndrome (PJS), a hereditary disorder characterized by gastrointestinal hamartomatous polyposis and an increased risk of cancer development. Although a tentative molecular classification of PJS patients was recently made according to their LKB1 mutation status, it is difficult to clarify the genotype-phenotype relationship because of the rarity and genetic heterogeneity of this disease. Here we report on two proband's with PJS whose intestinal hamartomatous polyposis was treated by laparoscopy-assisted polypectomy. Direct sequencing analyses revealed a nonsense mutation at codon 240 in exon 5 in one patient, and a mutation at a splicing donor site in intron 5 in the other patient. No additional somatic mutations were detected in the resected hamartomas in either case. Immunohistochemical analysis revealed an elevated expression of cyclooxygenase-2, and almost complete loss of LKB1 expression in the polyps, suggesting that a biallelic inactivation of the LKB1 gene was responsible for the hamartoma formation. Methylation-specific polymerase chain reaction analysis revealed no hypermethylation of the LKB1 promoter. Mutation analysis is useful in making a precise diagnosis of PJS in candidate probands, and may in the near future provide valuable information for predicting cancer risk based on genotype-phenotype correlations.
  • Hiroshi Okabe; Seiji Satoh; Harutaka Inoue; Masato Kondo; Jun-Ichiro Kawamura; Akinari Nomura; Satoshi Nagayama; Suguru Hasegawa; Atsushi Itami; Go Watanabe; Yoshiharu Sakai
    GASTRIC CANCER 10 3 176 - 180 2007年09月 [査読有り]
     
    Although laparoscopic distal gastrectomy (LDG) has been accepted as a surgical option for the treatment of early gastric cancer, laparoscopic total gastrectomy (LTG) has been adopted less often, because a more difficult surgical technique is required for reconstruction. To reduce the technical difficulties, we made some modifications to the functional end-to-end anastomosis technique and performed esophagojejunal anastomosis through a minilaparotomy. First, for easier handling of the esophagus, the first application of the linear stapler to create the esophagojejunal anastomosis was performed before transection of the esophagus. Second, the jejunal limb was anastomosed to the left side of the esophagus, which, compared with the right side, made available more free space, sufficient to operate the stapling device. Third, to close the entry hole and complete the gastrectomy concurrently, a linear stapler was applied through the left lower trocar. With this technique, the closure of the access opening was performed easily and was monitored directly through the minilaparotomy. We successfully performed LTG with Roux-en-Y reconstruction using our modified procedure in seven patients without any anastomotic complications. We believe our procedure is a secure and reliable method for reconstruction after LTG and will facilitate adoption of LTG as a surgical option for patients with early upper gastric cancers.
  • Suguru Hasegawa; Junichiro Kawamura; Satoshi Nagayama; Akinari Nomura; Kan Kondo; Yoshiharu Sakai
    Surgical endoscopy 21 9 1657 - 1657 2007年09月 [査読有り]
     
    Although laparoscopic surgery is one of the treatment options for colorectal cancer, certain technical problems remain unresolved for the radical dissection of regional lymph nodes (LNs), which is essential to improve treatment outcome. We present a safe procedure for laparoscopic right hemicolectomy to dissect the regional LNs along the superior mesenteric vein (SMV). The key characteristic of our procedure is that all right and middle colic vessels are cut along the surgical trunk using only a medial approach. First, the pedicle of ileocolic vessels is identified and the mesocolon is dissected between the pedicle and the periphery of the SMV to expose the second portion of the duodenum. The ileocolic vessels are then cut at their roots. The ascending mesocolon is separated from the retroperitoneal tissues, duodenum, and pancreatic head up to the hepatocolic ligament cranially. The important detail in this procedure is the wide separation between the pancreatic head and the transverse mesocolon. This procedure uncovers the course of the right colic artery, veins, and the gastrocolic trunk. The right colic artery and veins can then be safely cut at their roots. For an extended right hemicolectomy, the middle colic vessels can easily be identified below the lower edge of the pancreas and cut at their roots. We performed curative resections in this manner for 16 consecutive patients with advanced right-sided colon cancer without any serious intraoperative complications. The median number of retrieved lymph nodes was 31 (range = 9-57). The median operative time and intraoperative blood loss were 274 min (range = 147-431 min) and 45 g (range = 0-120 g), respectively. The postoperative course of all patients was uneventful. Four of 16 patients had node-positive disease. With a median follow-up period of 272 days, all patients are alive without recurrence. We consider this a safe method for radical LN dissection during laparoscopic right hemicolectomy. Electronic supplementary material The online version of this article (doi:10.1007/s00464-007-9305-x) contains supplementary material, which is available to authorized users.
  • Suguru Hasegawa; Akinari Nomura; Junichiro Kawamura; Satoshi Nagayama; Hiroaki Hata; Takashi Yamaguchi; Hiroya Kuroyanagi; Yoshiharu Sakai
    DISEASES OF THE COLON & RECTUM 50 8 1152 - 1156 2007年08月 [査読有り]
     
    PURPOSE: Laparoscope-assisted restorative proctocolectomy is an alternative to conventional surgery for the treatment of ulcerative colitis. We present our approach of laparoscopic dissection and transection of rectum combined with transanal rectal mucosectomy. METHODS: A total of 21 patients underwent laparoscopic total proctocolectomy with transanal rectal mucosectomy for ulcerative colitis. The rectum was mobilized and transected by using a combination of laparoscopic dissection and transanal mucosectomy without hand-assist or mini-aparotomy. The extent of laparoscopic dissection and the transection method varied according to the difficulty of pelvic dissection or the surgeons experience (early-phase method: laparoscopic transection of the muscular- cuff after transanal mucosectomy; intermediate- phase method: transection of the posterior side transanally and anteriolateral side laparoscopically; and recent- phase method: laparoscopic dissection down to the pelvic outlet and transanal circumferential transection of the rectum after mucosectomy). RESULTS: Using this approach, the median operative time was 404 minutes and the median operative blood loss was 120 g. There was no operative mortality, and no patients reported sexual or urinary complications during short- term follow-up. CONCLUSIONS: Laparoscopic total proctocolectomy for the treatment of ulcerative colitis is a feasible approach that demonstrates excellent views of the pelvis, which could be advantageous compared with conventional surgery. A stepbystep approach according to the surgeons experience and the difficulty of pelvic dissection may help minimize the risk of pelvic autonomic nerve injury.
  • Junichiro Kawamura; Yutaka Shimada; Hidenori Kitaichi; Izumi Komoto; Yosuke Hashimoto; Junichi Kaganoi; Masayuki Miyake; Seiji Yamasaki; Kan Kondo; Masayuki Imamura
    HEPATO-GASTROENTEROLOGY 54 73 36 - 40 2007年01月 [査読有り]
     
    Background/Aims: Aminopeptidase N (APN)/CD13 is a transmembrane ectoenzyme occurring in a wide variety of cells. Recently, APN/CD13 has been reported to be involved in tumor invasion and metastasis. However, precise functions in tumor cells, and its role in gastric carcinoma remain unclear. Methodology: To evaluate the role of APN/CD13 in gastric carcinoma, we conducted immunohistochemical staining for APN/CD13 in 121 gastric carcinoma specimens, using anti-APN monoclonal antibody. The relationship between APN/CD13 expression and various prognostic factors of gastric carcinoma were investigated. Results: Of the 121 patients with gastric carcinoma studied, 48 were strongly positive, 36 were weakly positive, and 37 were negative. Overall survival rate of the patients with negative APN/CD13 expression was significantly lower than that of the patients with positive APN/CD13 expression. APN/CD13 expression was negatively associated with lymph node metastasis. Multivariate analysis showed APN/CD13 expression to be a significant prognostic factor. Conclusions: Decreased expression of APN/CD13 was associated with a poor prognosis. Hence, our results demonstrate that the immunohistochemical detection of APN/CD13 could provide useful information as one of the prognostic factors in gastric cancer.
  • T Tomita; H Masuzuaki; H Iwakura; J Fujikura; M Noguchi; T Tanaka; K Ebihara; J Kawamura; Komoto, I; Y Kawaguchi; K Fujimoto; R Doi; Y Shimada; K Hosoda; M Imamura; K Nakao
    DIABETOLOGIA 49 5 962 - 968 2006年05月 [査読有り]
     
    Aims/hypothesis G protein-coupled receptor 40 (GPR40) is abundantly expressed in pancreatic beta cells in rodents, where it facilitates glucose-induced insulin secretion in response to mid- to long-chain fatty acids in vitro. However, GPR40 gene expression in humans has not been fully investigated, and little is known about the physiological and pathophysiological roles of GPR40 in humans. The aim of this study, therefore, was to examine GPR40 expression and its clinical implications in humans. Methods :mRNA expression in the human pancreas, pancreatic islets and islet cell tumours was analysed using TaqMan PCR. Results: mRNA was detected in all human pancreases collected intraoperatively. It was enriched approximately 20-fold in isolated islets freshly prepared from the pancreases of the same individuals. The estimated mRNA copy number for the GPR40 gene in pancreatic islets was comparable to those for genes encoding sulfonylurea receptor 1, glucagon-like peptide 1 receptor and somatostatin receptors, all of which are known to be expressed abundantly in the human pancreatic islet. A large amount of GPR40 mRNA was detected in insulinoma tissues, whereas mRNA expression was undetectable in glucagonoma or gastrinoma. The GPR40 mRNA level in the pancreas correlated with the insulinogenic index, which reflects beta cell function (r=0.82, p=0.044), but not with glucose levels during the OGTT, the insulin area under the OGTT curve or the index for the homeostasis model assessment of insulin resistance (HOMA-IR). Conclusions/interpretation: The present study provides evidence for GPR40 gene expression in pancreatic beta cells and implicates GPR40 in insulin secretion in humans.
  • T Tomita; H Masuzaki; M Noguchi; H Iwakura; J Fujikura; T Tanaka; K Ebihara; J Kawamura; Komoto, I; Y Kawaguchi; K Fujimoto; R Doi; Y Shimada; K Hosoda; M Imamura; K Nakao
    BIOCHEMICAL AND BIOPHYSICAL RESEARCH COMMUNICATIONS 338 4 1788 - 1790 2005年12月 [査読有り]
     
    To assess gene expression of a membrane-bound G-protein-coupled fatty acid receptor, GPR40, in the human pancreas and islet cell tumors obtained at surgery were analyzed. The mRNA level of the GPR40 gene in isolated pancreatic islets was approximately 20-fold higher than that in the pancreas, and the level was comparable to or rather higher than that of the sulfonylurea receptor 1 gene, which is known to be expressed abundantly in human pancreatic beta cells. A large amount of GPR40 mRNA was detected in tissue extracts from two cases of insulinoma, whereas the expression was undetectable in glucagonoma or gastrinoma. The present study demonstrates that GPR40 mRNA is expressed predominantly in pancreatic islets in humans and that GPR40 mRNA is expressed solely in human insulinoma among islet cell tumors. These results indicate that GPR40 is probably expressed in pancreatic beta cells in the human pancreas. (c) 2005 Elsevier lnc. All rights reserved.
  • J Kawamura; Y Shimada; Komoto, I; H Okamoto; A Itami; R Doi; K Fujimoto; S Kosugi; M Imamura
    ONCOLOGY REPORTS 14 1 47 - 52 2005年07月 [査読有り]
     
    The molecular mechanisms responsible for the development and/or progression of gastrinomas are largely unknown. Studies involving sporadic enteropancreatic neuroendocrine tumors suggest that mutations in the MEN1 gene occur in some tumors and probably play an important role in their pathogenesis. In this study, we examined whether somatic mutations in the MEN1 gene are also responsible for sporadic gastrinomas and correlate with clinical manifestations of gastrinomas in Japanese patients. Genomic DNA was extracted from paraffin-embedded gastrinoma tissues from 12 patients. Nucleotide sequences in the MEN1 genes were determined by direct sequencing. We identified 6 mutations in 7 out of 12 examined gastrinomas (58%). The identified mutations were 1 non-sense, 2 missense, 1 deletion leading to frame shifts, 1 insertion and 1 splicing mutation. Identical mutations were found in three gastrinoma tissues. The age at surgery, the rate of hepatic metastasis, and tumor status were not significantly different in the 2 groups. This study demonstrates that alterations in the MEN1 gene are involved in about half of all sporadic gastrinomas, although no correlation between the presence of mutations and location and clinical phenotype or severity of disease has been found.
  • Y Shimada; G Watanabe; J Kawamura; T Soma; M Okabe; T Ito; H Inoue; M Kondo; Y Mori; E Tanaka; M Imamura
    ONCOLOGY 68 2-3 285 - 292 2005年 [査読有り]
     
    Objective: Osteopontin (OPN) is a secreted integrin-binding glycophosphoprotein that may have a role in head and neck squamous cell carcinoma (SCC). To evaluate the clinical significance of OPN in esophageal squamous cell carcinoma (ESCC), we compared plasma OPN levels with those of common tumor markers. Methods: Preoperative plasma OPN levels were measured by enzyme immunoassay in 103 ESCC patients. Serum SCC antigen, Cyfra 21-1, and carcinoembryonic antigen (CEA) levels were also measured routinely at admission by radioimmunoassay. Results: Plasma OPN levels ranged from 82.8 to 1,980 ng/ml. High OPN level was associated with lymph node metastasis (p=0.05), but not with tumor histology or depth of invasion. The overall survival of the patients with high OPN levels was worse than that of those with low OPN levels (p=0.02). SCC antigen and Cyfra 21-1 levels were associated with the depth of tumor invasion, the tumor diameter, lymph node metastasis, and the overall survival, but CEA was not associated with these clinicopathological factors. Combined evaluation of OPN plus Cyfra 21-1 or OPN plus SCC antigen was useful as an independent prognostic indicator. Conclusion: Measurement of the plasma OPN level, as well as serum SCC antigen and Cyfra 21-1, may help to predict the progression of ESCC. Copyright (C) 2005 S. Karger AG, Basel.
  • Y Shimada; S Yamasaki; Y Hashimoto; T Ito; J Kawamura; T Soma; Y Ino; Y Nakanishi; M Sakamoto; S Hirohashi; M Imamura
    CLINICAL CANCER RESEARCH 10 8 2818 - 2823 2004年04月 [査読有り]
     
    Purpose: Dysadherin, a cancer-associated cell membrane glycoprotein, has been reported to down-regulate E-cadherin expression and promote metastasis. To evaluate the role of dysadherin in gastric cancer, we examined dysadherin and E-cadherin expression in gastric cancer patients. Experimental Design: Dysadherin and E-cadherin expression were evaluated in 276 gastric cancer patients by immunohistochemistry, and the results were compared with the clinicopathological findings of the subjects. Results: Dysadherin was not expressed in normal gastric epithelium. Both dysadherin and E-cadherin were localized to the cell membrane. Dysadherin expression was sometimes largely localized to infiltrating tumor cells or cells dissociating. Ninety gastric cancer patients (32.6%) were positive for dysadherin, and 151 patients (54.7%) showed preservation of E-cadherin expression. Expression of dysadherin was associated with moderately differentiated carcinoma and hematogenous metastasis, whereas reduced expression of E-cadherin showed an association with poorly differentiated carcinoma and peritoneal dissemination. As a result, dysadherin positivity and reduced E-cadherin expression were associated with a poor prognosis. In addition, patients with both dysadherin positivity and reduced E-cadherin had the worst prognosis. Multivariate analysis revealed that reduced E-cadherin expression was an independent prognostic factor, but dysadherin expression was not. Conclusion: Combined analysis of dysadherin and E-cadherin expression may help to predict the prognosis and the mode of metastasis in gastric cancer patients. Patients with dysadherin positivity have a higher risk of hematogenous metastasis, whereas patients with reduced E-cadherin expression have an increased risk of peritoneal dissemination.
  • R Doi; Komoto, I; Y Nakamura; J Kawamura; K Fujimoto; M Wada; T Saga; M Imamura
    PANCREAS 28 3 247 - 252 2004年04月 [査読有り]
     
    Japanese clinicians and scientists have contributed significantly to reporting, investigating, and managing patients with pancreatic endocrine tumors and other multiple endocrine neoplasias for the past several decades. This article summarizes the latest progress in this field in Japan. Particularly, our contribution to the development of diagnostic and localization methods is reviewed. Further, the present use of somatostatin receptor scintigraphy and the application of the laparoscopic surgery for pancreatic endocrine tumor in Japan are discussed.
  • Y Shimada; Y Hashimoto; T Kan; J Kawamura; T Okumura; T Soma; K Kondo; N Teratani; G Watanabe; Y Ino; M Sakamoto; S Hirohashi; M Imamura
    ONCOLOGY 67 1 73 - 80 2004年 [査読有り]
     
    Objective: Dysadherin is a cancer-associated cell membrane glycoprotein that has been reported to downregulate E-cadherin expression and promote metastasis. To evaluate the role of dysadherin in metastasis of esophageal squamous cell carcinoma (ESCC), we examined dysadherin and E-cadherin expression in patients with this cancer. Methods: Dysadherin and E-cadherin expression was evaluated in 117 ESCC patients (pT1, 31; pT2, 30; pT3, 39; pT4, 17) by immunohistochemistry. The findings were compared with the clinicopathological data of the patients. Results: Both dysadherin and E-cadherin were localized to the cell membrane. Thirty patients (29.1%) had tumors positive for dysadherin and 41 patients (35.0%) had tumors positive for E-cadherin. Tumors showing dysadherin positivity and negative E-cadherin expression had a significantly worse prognosis than other tumors. When the patients with dysadherin-positive tumors were combined with E-cadherin-negative patients, this group had a worse prognosis (p < 0.0001). Cox multivariate analysis revealed that dysadherin expression was an independent prognostic factor for ESCC (p = 0.003), but E-cadherin expression was not. Conclusion: Combined analysis of dysadherin and E-cadherin expression may help to predict the prognosis of patients with ESCC. Our results suggested that expression of dysadherin by this cancer may partly explain the poor prognosis of patients with preservation of E-cadherin expression. Copyright (C) 2004 S. Karger AG, Basel.
  • Komoto I; Shimada Y; Fujimoto K; Itami A; Kawamura J; Doi R; Imamura M
    Nihon Naika Gakkai zasshi. The Journal of the Japanese Society of Internal Medicine 93 77 - 83 1 2004年01月 [査読有り]
  • Y Hashimoto; Y Shimada; J Kawamura; S Yamasaki; M Imamura
    ONCOLOGY 67 3-4 262 - 270 2004年 [査読有り]
     
    Objective: Fascin, an actin-bundling protein that is found in membrane ruffles, microspikes, and stress fibers, induces membrane protrusions and increases cell motility in various transformed cells. The expression of fascin in epithelial neoplasms has been described only recently, and its role in gastric cancer is still unknown. Methods: Paraffin sections of gastric carcinoma from 214 patients were immunohistochemically investigated using monoclonal antifascin antibody. Staining more than 5% of tumor cells was recorded as positive immunoreactivity. Results: Overall, fascin immunoreactivity was detected in 54 out of a total of 214 patients (25%). 26 patients were classified as 1+ (5-25% immunoreactive tumor cells) and 28 were 2+ (>25%). In these patients, 7 tumors showed high (>75%) fascin immunoreactivity. Increased immunoreactivity of fascin was sometimes seen at the edge of the tumor. Fascin immunoreactivity was increased according to the extent of primary tumor (p=0.026). Fascin expression was correlated with age (p=0.005), serosal invasion (p=0.013), positive lymph node metastasis (p=0.006), histopathological grading (p=0.019), TNM stage (p=0.003) and recurrence (p=0.006); however, it was not correlated with distant metastasis (p=0.108), Lauren's type (p=0.205), or R classification (p=0.056). Among 166 patients with T1, T2, T3 or T4, those with fascin-positive tumors had a significantly poorer prognosis than those with fascin-negative tumors (p=0.029). Multivariate analysis showed that fascin expression was not an independent poor prognostic factor. Conclusion: Our findings suggest that the immunohistochemical detection of fascin could provide useful information as one of the prognostic factors in gastric cancer patients. Copyright (C) 2004 S. Karger AG, Basel.
  • Y Hashimoto; Y Shimada; A Itami; T Ito; J Kawamura; A Kawabe; J Kaganoi; M Maeda; G Watanabe; M Imamura
    EUROPEAN JOURNAL OF CANCER 39 15 2239 - 2246 2003年10月 [査読有り]
     
    Peroxisome proliferator-activated receptor 7 (PPARgamma) heterodimerises with retinoid X receptor alpha (RXRalpha) Lind is thought to be a novel therapeutic target for human malignancies. We evaluated the ability of troglitazone (TRO) alone or in combination with 9-cis retinoic acid (9CRA), ligands of PPARgamma and RXRalpha, respectively, to inhibit the growth of oesophageal squamous cell carcinoma (OSCC). All 10 tested OSCC cell lines of a KYSE series expressed PPARgamma and RXRalpha at both the mRNA and protein levels. In four tested cell lines, TRO inhibited growth, and a synergistic effect was observed with simultaneous 9CRA application. In KYSE 270 cells, a luciferase reporter assay showed that the simultaneous application of TRO and 9CRA to the cells increased the relative luciferase activity approximately 20-fold compared with the controls without TRO or 9CRA application. In this cell line, flow cytometry demonstrated that combined treatment with TRO and 9CRA greatly increased the sub-G1 phase, and Hoechst 33342/ propidium iodide (PI) staining showed that apoptotic cell death was mainly induced through ligand treatment. In addition, implanted tumours in nude mice showed significant inhibition of tumour growth when treated with TRO. These results suggest that the PPARgamma/RXRalpha heterodimer may be a new therapeutic target for OSCC. (C) 2003 Elsevier Ltd. All rights reserved.
  • A Itami; G Watanabe; Y Shimada; Y Hashimoto; J Kawamura; M Kato; R Hosotani; M Imamura
    INTERNATIONAL JOURNAL OF CANCER 94 3 370 - 376 2001年11月 [査読有り]
     
    Peroxisome proliferator-activated receptor gamma (PPAR gamma) is expressed largely in adipose tissues and plays an important role in adipocyte differentiation. Several studies have recently shown that ligands of PPAR gamma could lead to growth inhibition in some malignancies. In our study, we focused on pancreatic cancers, because the prognosis of advanced pancreatic cancer has not significantly improved due to its resistance to various chemotherapeutic regimens, so that a novel strategy should be required. We show here that PPAR gamma is expressed in 5 pancreatic cancer cell lines detected in both mRNA and protein level as well as in human primary and metastatic pancreatic carcinomas examined by immunohistochemical studies. A specific ligand of PPAR gamma, troglitazone, led to G1 accumulation with the increase in p27(KipI), but not p21(Waf1/Cip1) and inhibited cellular proliferation in a pancreatic cancer cell line, Panc-1. The overexpression of PPAR gamma in a pancreatic cancer cell line, KMP-3, caused lipid accumulation, which suggested cell growth in some cancers might be inhibited, at least in part, through terminal differentiation in the adipogenic lineage. In addition, implanted Panc-1 tumors in nude mice showed significant inhibition of tumor growth, when treated with pioglitazone, another specific ligand of PPAR gamma. Our results suggest that ligands of PPAR gamma may be a novel therapeutic agent for the treatment of pancreatic carcinomas. (C) 2001 Wiley-Liss, Inc.

MISC

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 : 2022年04月 -2025年03月 
    代表者 : 川村 純一郎; 大東 弘治; 幕谷 悠介; 和田 聡朗; 坂井 和子; 家根 由典; 所 忠男; 吉岡 康多; 上田 和毅; 牛嶋 北斗; 岩本 哲好
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2021年04月 -2025年03月 
    代表者 : 椎名 毅; 西條 芳文; 杉本 直三; 佐藤 いまり; 瀬尾 智; 川村 純一郎
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2015年04月 -2018年03月 
    代表者 : 川村 純一郎; 杉浦 史哲; 奥野 清隆
     
    StageIII大腸癌根治術患者に対する経口抗がん剤(UFT/LV)併用ペプチドワクチン療法の臨床的有効性、安全性を検証する第2相臨床研究を行った。主要評価項目である無再発生存期間(RFS)は、HLA-A24陽性・陰性群で有意差を認めなかったが、細胞障害性T細胞(CTL)反応陽性群で有意に予後良好との結果を得た。ペプチドワクチン投与後のCTL反応は、治療効果を予測する良い指標になりうる
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2011年 -2013年 
    代表者 : 西村 貴文; 西田 直生志; 岡部 寛; 川村 純一郎
     
    転移性大腸癌に対する化学療法としてFOLFOX(5-FU, ロイコボリン、オキサリプラチン)療法が広く用いられているが、本研究はがん細胞における特定の領域の染色体異常が効果予測因子となるか否かを検討した。原発巣を切除され、残る転移巣に対しFOLFOX療法を施行した大腸癌18例について、マイクロアレイを用いてDNAコピー数の変化を解析した。第8染色体長碗に異常がなく、第18染色体長碗の欠失を伴う症例ではそれ以外の症例に対し有意に予後が不良であった。異常を伴う染色体数が10以上の症例は明らかに予後が不良であった。複雑な染色体異常を有する症例ではFOLFOX治療後の予後が不良であると考えられた。
  • 日本学術振興会：科学研究費助成事業
    研究期間 : 2006年 -2007年 
    代表者 : 川村 純一郎
     
    本研究は膵・消化管内分泌腫瘍の腫瘍起源細胞・腫瘍幹細胞を同定することと、膵・消化管内分泌腫瘍の腫瘍化メカニズムの解明を目的としたものであった。今年度の研究成果を以下に記載する。 (1)消化管内分泌腫瘍における腫瘍幹細胞の同定:PDX-1, somatostatin, serotonin, gastrinの発現を免疫染色、蛍光多重染色により検討した結果、より分化度の低い腫瘍幹細胞を含む細胞集団を同定することができた。現在、これまでの結果をまとめた論文を執筆中である。(2)消化管内分泌腫瘍の腫瘍化の検討:膵ガストリノーマの起源細胞は膵管上皮に存在するとの仮説に基づき、siRNAによるMEN1 geneノックダウン膵上皮細胞株を作成し、検討を行った。MEN1 geneノックダウン株と野性株との間に、細胞増殖・細胞形態などの点で明らかな変化を認めず、gastrin、Insulin, glucagons、E-cadherin、b-catenin, chromograninA, CDX2の発現においても差を認めなかった。そこで、新たにPDX-1を導入することで内分泌腫瘍化が誘導される可能性があると考え、現在PDX-1遺伝子の導入を試みている。(3)ヒト膵・消化管内分泌腫瘍の長期培養株の樹立:われわれの施設ではガストリノーマの腫瘍株化に成功している。ヒト膵・消化管内分泌腫瘍に対する研究には長期培養株は不可欠で、その樹立により、基礎研究分野に大きな伸展が期待できる。しかし、昨年度より標本からの培養を試みているが、長期培養株の樹立に至っていない。ガストリノーマは非常に稀な疾患で、細胞培養可能な適格症例が今年度はなかった。引き続き細胞培養の試みを継続する。

その他のリンク

researchmap


Copyright © MEDIA FUSION Co.,Ltd. All rights reserved.