 | 吉田 雄太 （ヨシダ ユウタ）
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Last Updated :2024/05/15
コミュニケーション情報 byコメンテータガイド
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患者様1人1人に寄り添い、最善の治療を見出すことを心がけています。
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- Shuzo Imamura; Fumimaru Niwano; Naru Babaya; Yoshihisa Hiromine; Ippei Matsumoto; Keiko Kamei; Yuta Yoshida; Yasunori Taketomo; Sawa Yoshida; Yoshifumi Takeyama; Shinsuke Noso; Norikazu Maeda; Hiroshi IkegamiThe Journal of Clinical Endocrinology & Metabolism 109 3 619 - 630 2023年10月Abstract Context Glucose tolerance worsens after distal pancreatectomy (DP); however, the long-term incidence and factors affecting interindividual variation in this worsening are unclear. Objective To investigate the changes in diabetes-related traits before and after DP and to clarify the incidence of diabetes and its predictors. Methods Among 493 registered patients, 117 underwent DP. Among these, 56 patients without diabetes before surgery were included in the study. Glucose and endocrine function were prospectively assessed using a 75-g oral glucose tolerance test preoperatively, 1 month after DP, and every 6 months thereafter for up to 36 months. Pancreatic volumetry was performed using multidetector row computed tomography before and after surgery. Results Insulin secretion decreased and blood glucose levels worsened after DP. Residual pancreatic volume was significantly associated with the reserve capacity of insulin secretion but not with blood glucose levels or the development of diabetes. Among 56 patients, 33 developed diabetes mellitus. The cumulative incidence of diabetes at 36 months after DP was 74.1%. Multivariate Cox regression analysis showed that impaired glucose tolerance as a preoperative factor as well as a decreased insulinogenic index and impaired glucose tolerance at 1 month postoperatively were identified as risk factors for diabetes following DP. Conclusion Impaired glucose tolerance and reduced early-phase insulin response to glucose are involved in the development of new-onset diabetes after DP; the latter is an additional factor in the development of diabetes and becomes apparent when pancreatic beta cell mass is reduced after DP.
- Atsushi Oba; Marco Del Chiaro; Tsutomu Fujii; Keiichi Okano; Thomas F Stoop; Y H Andrew Wu; Aya Maekawa; Yuta Yoshida; Daisuke Hashimoto; Toshitaka Sugawara; Yosuke Inoue; Minoru Tanabe; Masayuki Sho; Takashi Sasaki; Yu Takahashi; Ippei Matsumoto; Naoki Sasahira; Yuichi Nagakawa; Sohei Satoi; Richard D Schulick; Yoo-Seok Yoon; Jin He; Jin-Young Jang; Christopher L Wolfgang; Thilo Hackert; Marc G Besselink; Kyoichi Takaori; Yoshifumi TakeyamaPancreatology : official journal of the International Association of Pancreatology (IAP) ... [et al.] 23 6 712 - 720 2023年06月Locally advanced pancreatic cancer (LAPC), which progresses locally and surrounds major vessels, has historically been deemed unresectable. Surgery alone failed to provide curative resection and improve overall survival. With the advancements in treatment, reports have shown favorable results in LAPC after undergoing successful chemotherapy therapy or chemoradiation therapy followed by surgical resection, so-called "conversion surgery", at experienced high-volume centers. However, recognizing significant regional and institutional disparities in the management of LAPC, an international consensus meeting on conversion surgery for LAPC was held during the Joint Congress of the 26th Meeting of the International Association of Pancreatology (IAP) and the 53rd Annual Meeting of Japan Pancreas Society (JPS) in Kyoto in July 2022. During the meeting, presenters reported the current best multidisciplinary practices for LAPC, including preoperative modalities, best systemic treatment regimens and durations, procedures of conversion surgery with or without vascular resections, biomarkers, and genetic studies. It was unanimously agreed among the experts in this meeting that "cancer biology is surpassing locoregional anatomical resectability" in the era of effective multiagent treatment. The biology of pancreatic cancer has yet to be further elucidated, and we believe it is essential to improve the treatment outcomes of LAPC patients through continued efforts from each institution and more international collaboration. This article summarizes the agreement during the discussion amongst the experts in the meeting. We hope that this will serve as a foundation for future international collaboration and recommendations for future guidelines.
- Shumpei Satoi; Yutaka Kimura; Rie Shimizu; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Takaaki Murase; Keiko Kamei; Ippei Matsumoto; Takuya Nakai; Yoshifumi TakeyamaSurgery today 2023年04月PURPOSE: Although reports suggest that the pancreatic volume decreases after gastrectomy for gastric cancer, the relationship between the pancreatic volume and secretory function after gastrectomy remains unclear. In this study, we examined the relationship between the pancreatic volume and exocrine and endocrine functions after total gastrectomy. METHODS: The pancreatic volumes of 18 distal gastrectomy and 15 total gastrectomy patients were retrospectively measured using computed tomography volumetry up to 5 years postoperatively. Ten low anterior resection patients were selected as controls. In addition, the pancreatic volume and exocrine function evaluated by fecal elastase and the insulin secretory function evaluated by glucagon tolerance testing were prospectively examined before and one year after surgery in nine cases of total gastrectomy. RESULTS: After low anterior resection, the pancreatic volume did not change, but after distal and total gastrectomy, the pancreatic volume decreased continuously until the fifth year. After total gastrectomy, fecal elastase decreased significantly from 865.8 μg/g to 603.2 μg/g in the first year (p = 0.0316), and the insulin secretion capacity also decreased significantly from 3.83 ng/mL to 2.26 ng/mL (p = 0.0019). CONCLUSIONS: The pancreatic volume decreases continuously after gastrectomy for gastric cancer, and the pancreatic exocrine and endocrine functions decrease along with pancreatic atrophy after total gastrectomy.
- Ippei Matsumoto; Keiko Kamei; Kohei Kawaguchi; Yuta Yoshida; Masataka Matsumoto; Dongha Lee; Takaaki Murase; Shumpei Satoi; Atsushi Takebe; Yoshifumi TakeyamaAnnals of gastroenterological surgery 6 3 412 - 419 2022年05月AIM: Pancreaticodigestive tract anastomotic stricture is a long-term complication of pancreticoduodenectomy (PD). However, optimal treatment has not yet been defined. We conducted longitudinal pancreaticojejunostomy (LPJ) in symptomatic patients with anastomotic stricture after PD. This study aimed to evaluate the efficacy of this procedure. METHODS: Pancreticoduodenectomy was performed in 605 patients at our institution between January 2005 and April 2020. Of these, 15 patients (2.5%) developed symptomatic pancreaticodigestive tract anastomotic stricture after PD. Three patients were referred to our institution owing to recurrent pancreatitis with anastomotic stricture after PD. LPJ was indicated for these 18 patients, and they were enrolled in this study. RESULTS: The median time from the initial operation to LPJ was 2.0 y. Preoperative clinical presentations included obstructive pancreatitis in 10 patients, a rapid deterioration of glucose tolerance in nine, and severe steatorrhea in two. Surgical morbidity ≥grade III defined by the Clavien-Dindo classification was not observed. After LPJ, preoperative symptoms improved in 16 patients (89%) during a median follow-up of 39 mo. Nine of the 10 patients with obstructive pancreatitis achieved complete pain relief. All nine patients with a rapid deterioration of glucose tolerance showed improved endocrine function. Daily insulin requirement was significantly decreased after LPJ (11.6 ± 3.3 vs 3.4 ± 4.3 units, P = .0239). Four of the seven patients who required insulin injections were free of insulin after LPJ. CONCLUSION: LPJ is a safe and effective surgical procedure for symptomatic patients with stricture of the pancreaticodigestive tract anastomosis after PD.
- Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Lee Dongha; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaSurgery today 52 2 260 - 267 2022年02月PURPOSE: Postoperative pancreatic fistula (POPF) remains the most clinically relevant complication of laparoscopic distal pancreatectomy (LDP). The present study evaluated the efficacy of the "slow firing method" using a reinforced triple-row stapler (Covidien, Tokyo, Japan) during LDP. METHODS: This retrospective single-center study included 73 consecutive patients who underwent LDP using the slow firing method. A black cartridge was used in all patients. The primary endpoint was the rate of clinically relevant POPF (CR-POPF) after LDP. Secondary endpoints included perioperative outcomes and factors associated with CR-POPF as well as the correlation between the transection time and thickness of the pancreas. RESULTS: Four patients (5.5%) developed CR-POPF (grade B). Overall morbidity rates, defined as grade ≥ II and ≥ III according to the Clavien-Dindo classification, were 21 and 11%, respectively. The median postoperative hospital stay was 10 days. Preoperative diabetes (13.6 vs. 0.2%, P = 0.044) and thickness of the pancreas ≥ 15 mm (13.8% vs. 0%, P = 0.006) were identified as independent risk factors for CR-POPF. The median transection time was 16 (8-29) min. CONCLUSION: The slow firing method using a reinforced triple-row stapler for pancreatic transection is simple, safe, and effective for preventing CR-POPF after LDP.
- Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Dongha Lee; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaSurgery today 51 1 70 - 78 2021年01月PURPOSE: The purpose of this study was to determine the factors influencing conversion from laparoscopic distal pancreatectomy (LDP) to open surgery, and the effect of such conversion on the outcome. METHODS: This retrospective single-center study included 70 consecutive patients undergoing LDP. The primary endpoint was the rate of conversion to open surgery during LDP. The secondary endpoints were determining the reasons for conversion to open surgery, with detailed analyses of these cases and a comparison of the surgical outcome with and without conversion. RESULTS: Seven patients (10%) required conversion to open surgery during LDP. Pancreatic ductal adenocarcinoma (PDAC) was identified as a risk factor for conversion (p = 0.010). The reasons for conversion included technical difficulty (two bleeding, one severe adhesion) and pancreatic stump-related issues (two margin-positive, two stapling failures). Although the overall morbidity rate (29 vs. 11%, p = 0.48) and the rate of clinically relevant postoperative pancreatic fistula (14 vs. 5%, p = 0.82) were no different for the patients with or without open conversion, the postoperative hospital stay was significantly longer in the former (median 15 vs. 10 days, p = 0.03). CONCLUSIONS: Careful preoperative assessment is required when planning LDP for PDAC. Although conversion to open surgery does not result in failure of LDP, efforts to reduce the duration of postoperative hospital stay and the occurrence of complications are desirable to improve the outcome of LDP.
- Yuta Yoshida; Ippei Matsumoto; Tomonori Tanaka; Kentaro Yamao; Akihiro Hayashi; Keiko Kamei; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Mamoru Takenaka; Yoshifumi TakeyamaSurgical case reports 6 1 222 - 222 2020年09月BACKGROUND: Pancreatic pleural effusion and ascites are defined as fluid accumulation in the thoracic and abdominal cavity, respectively, due to direct leakage of the pancreatic juice. They usually occur in patients with acute or chronic pancreatitis but are rarely associated with pancreatic neoplasm. We present here an extremely rare case of pancreatic neuroendocrine tumor with stenosis of the main pancreatic duct, leading to pancreatic pleural effusion. CASE PRESENTATION: A 51-year-old man complained of dyspnea. Left-sided pleural effusion was detected on the chest X-ray. Pleural puncture was performed, and the pleural fluid indicated a high amylase content (36,854 IU/L). Hence, the patient was diagnosed with pancreatic pleural effusion. Although no tumor was detected, the computed tomography (CT) scan showed a pseudocyst and dilation of the main pancreatic duct in the pancreatic tail. Magnetic resonance cholangiopancreatography showed a fistula from the pseudocyst into the left thoracic cavity. Endoscopic retrograde pancreatic drainage was attempted; however, it failed due to stenosis in the main pancreatic duct in the pancreatic body. Endoscopic ultrasound revealed a hypoechoic mass measuring 15 × 15 mm in the pancreatic body that was not enhanced in the late phase of contrast perfusion and was thus suspected to be an invasive ductal carcinoma. The patient underwent distal pancreatectomy with splenectomy and the postoperative course was uneventful. Histopathological examination confirmed a neuroendocrine tumor of the pancreas (NET G2). The main pancreatic duct was compressed by the tumor. Increased pressure on the distal pancreatic duct by the tumor might have caused formation of the pseudocyst and pleural effusion. To the best of our knowledge, this is the first case report of pancreatic pleural effusion associated with a neuroendocrine tumor. CONCLUSIONS: Differential diagnosis of a pancreatic neoplasm should be considered, especially when a patient without a history of pancreatitis presents with pleural effusion.
- Ippei Matsumoto; Keiko Kamei; Takaaki Murase; Yuta Yoshida; Kohei Kawaguchi; Masataka Matsumoto; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaJournal of hepato-biliary-pancreatic sciences 27 9 632 - 639 2020年09月BACKGROUND/PURPOSE: To determine the short- and long-term results of surgical treatments for chronic pancreatitis (CP) at a high-volume center in Japan. METHODS: The records of 151 consecutive patients undergoing surgery for CP were retrospectively reviewed. Selection of surgical procedures used had been according to the Japanese Clinical Practice Guidelines for CP 2015. Long-term (≥1 year) follow-up was performed in 100 patients (median of 37 months). RESULTS: Surgical drainage procedures were performed in 107 patients (Frey operation in 81, longitudinal pancreaticojejunostomy in 26), pancreatic resection in 37 (subtotal stomach-preserving pancreaticoduodenectomy in 11, distal pancreatectomy in 26), and other procedures in six. The rates of postoperative mortality and morbidity were 1% and 26%, respectively. The rates of complete and partial pain relief were 62% and 37%. The frequency of occurrence of severe morbidity was significantly higher after pancreatic resection than in patients receiving drainage procedures (13% vs 2%, P = .019). The rate of new-onset diabetes was also significantly higher after resection than drainage (60% vs 25%, P = .017). CONCLUSIONS: Surgical treatment for painful chronic pancreatitis can be safe and effective. An optimal procedure should guarantee pain relief and preserve a maximum of pancreatic function.
- Masataka Matsumoto; Ippei Matsumoto; Keiko Kamei; Yuta Yoshida; Kohei Kawaguchi; Takaaki Murase; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaGan to kagaku ryoho. Cancer & chemotherapy 47 1 108 - 110 2020年01月A 62 year-old female presenting with shortness of breath and severe anemia(Hb level 4.4 g/dL)was diagnosed with tumor bleeding and duodenal cancer by gastrointestinal endoscopy.Computed tomography scan revealed multiple liver metastases.After admission, the Hb level dropped from 9.1 g/dL to 5.1 g/dL in one night, and emergency pancreaticoduodenectomy( PD)was performed to control the bleeding.The postoperative course was uneventful, and the patient was discharged on postoperative day(POD)16.Systemic chemotherapy was initiated 1 month after surgery, but the patient died from the disease 13 months after surgery.Emergency PD could be a treatment option in patients with uncontrolled tumor bleeding and fatal conditions.
- Yuta Yoshida; Ippei Matsumoto; Masataka Matsumoto; Kohei Kawaguchi; Takaaki Murase; Keiko Kamei; Shumpei Satoi; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaJournal of hepato-biliary-pancreatic sciences 26 11 510 - 516 2019年11月BACKGROUND: Postoperative pancreatic fistula (POPF) after distal pancreatectomy (DP) remains the most common surgical complication. We have developed a novel stump closure technique after DP using transpancreatic mattress suture with Vicryl mesh (TMV) and reported our initial findings. The purpose of this study is to evaluate the efficacy of TMV compared to the conventional handsewn stump closure technique (CHS). METHODS: This retrospective single-center study included 165 consecutive patients who underwent open DP from January 2010 to May 2018. Of these, 71 patients underwent DP using TMV after September 2014 and 94 patients underwent DP with CHS. The surgical outcomes were compared between the two groups. RESULTS: Clinically relevant POPF rate in the TMV group was significantly lower than that in the CHS group (5.6% vs. 17.2%, P = 0.027). Morbidity rate was higher in the CHS group than that in the TMV group (16.9% vs. 27.7%, P = 0.104). In the multivariate analysis, absence of additional organ resection (OR 3.57; 95% CI 1.18-10.43; P = 0.025) and TMV (OR 0.24; 95% CI 0.07-0.73; P = 0.010) were identified as independent preventing factors for clinically relevant POPF. CONCLUSION: TMV can be an effective stump closure technique for preventing POPF after DP.
- Ippei Matsumoto; Keiko Kamei; Shumpei Satoi; Takaaki Murase; Masataka Matsumoto; Kohei Kawaguchi; Yuta Yoshida; Toshimitsu Iwasaki; Atsushi Takebe; Takuya Nakai; Yoshifumi TakeyamaSurgery today 49 5 394 - 400 2019年05月PURPOSE: The purpose of the study was to compare the outcomes of laparoscopic distal pancreatectomy (LDP) and open distal pancreatectomy (ODP) for benign and low-grade malignant lesions to determine the safety and efficacy of LDP. METHODS: This retrospective comparative study included 67 consecutive patients who underwent LDP (n = 32) and ODP (n = 35) for benign or low-grade malignant lesions of the pancreas from January 2012 to March 2017. Thirty-five patients who were eligible for LDP in the ODP group were carefully selected. The clinical outcomes were compared in an intention-to-treat analysis. RESULTS: LDP was associated with significantly less operative blood loss (182 ± 232 vs. 505 ± 376 ml, P < 0.001) but a longer operation time (327 ± 89 vs. 173 ± 48 min, P < 0.001), than ODP. There were no significant differences between the 2 groups in the overall morbidity rates defined by Clavien-Dindo classification ≥ grade II (13% vs. 11%), clinically relevant postoperative pancreatic fistula rates (6% vs. 9%), and lengths of postoperative hospital stay (11 vs. 11 days). CONCLUSION: The study showed that LDP was safe and feasible. LDP should be considered as the first-line treatment for benign and low-grade malignant lesions in the left side of the pancreas.
- Toshimitsu Iwasaki; Yoshifumi Takeyama; Yuta Yoshida; Kohei Kawaguchi; Masataka Matsumoto; Takaaki Murase; Keiko Kamei; Atsushi Takebe; Ippei Matsumoto; Takuya NakaiInternational journal of surgery case reports 61 115 - 118 2019年INTRODUCTION: Aberrant subvesical bile ducts are rare structural anomaly located in the peri-hepatic gallbladder fossa. This duct poses the risk for intraoperative bile duct injury resulting in clinically relevant bile leakage. PRESENTATION OF CASE: Aberrant subvesical bile duct was detected by preoperative magnetic resonance cholangiopancreatography in a 52-year old woman with gallbladder polypoid tumor harboring the risk to be gallbladder cancer. During open cholecystectomy with full thickness dissection, the aberrant duct was identified by intraoperative fluorescent cholangiography (IFC), and dissected safely. DISCUSSION: Aberrant subvesical bile ducts are mostly found unexpectedly as intra and/or postoperative bile leakage, and remain an important cause of bile duct injuries after laparoscopic cholecystectomy. IFC, which offers real-time imaging of biliary anatomy, has a potential to overcome these problems. CONCLUSION: We performed cholecystectomy by using IFC to identify the aberrant subvesical bile duct. To the best of our knowledge, this is the first report showing the fluorescence image of an aberrant subvesical bile duct in a state of nature.
- Yuki Ohzato; Masahiro Murakami; Junzo Shimizu; Chikato Koga; Daiki Marukawa; Yuta Yoshida; Akinobu Yasuyama; Tae Matsumura; Akihiro Takada; Chizu Kameda; Ryohei Kawabata; Masaki Hirota; Shingo Noura; Hideaki Miwa; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 44 12 1638 - 1640 2017年11月An 81-year-old woman was followed up for hepatitis C from 1994. Sheh ad a previous history of hypertension and appendicitis. In October 2014, the patient underwent subsegmentectomy(S8)and cholecystectomy for hepatocellular carcinoma (HCC)(T2N0M0, Stage II ). From December 2015, the patient had taken ledipasvir-sofosbuvir orally for hepatitis C virus (HCV). In January 2016, we confirmed HCV-RNA shade transformation. In September 2016, enhanced CT showed a mass in theright lower quadrant of her abdomen. Shehad a hard 3 cm mass in thesameplaceon physical exam. PET-CT showed no significant abnormality except for the mass in the right lower quadrant of her abdomen. Therefore, we identified the differential diagnosis as a lymph node metastasis of HCC, an abdominal wall primary tumor, or a malignant lymphoma. We resected theinguinal malignant lymphoma to confirm thediagnosis. Examination of tissuefrom theinguinal malignant lymphoma indicated diffuselargeB -cell lymphoma. We report an interesting case of an inguinal malignant lymphoma in a patient with chronic HCV who had experienced hepatectomy.
- Shingo Noura; Takashi Shuto; Arisa Muratsu; Yuta Yoshida; Akinobu Yasuyama; Tae Matsumura; Chikato Koga; Chizu Kameda; Masahiro Murakami; Ryohei Kawabata; Masaki Hirota; Masato Yoshikawa; Junzo Shimizu; Junichi Hasegawa; Hideaki MiwaGan to kagaku ryoho. Cancer & chemotherapy 43 12 1742 - 1744 2016年11月The patient was a 56-year-old woman who had synchronous multiple liver metastases and underwent laparoscopic-assisted high anterior resection for rectal cancer. According to the Japanese classification of colorectal carcinoma(8th edition), the tumor was considered to be pStage IV (pT4bN2M1a[H3]). Following resection of the primary tumor, she received XELOX plus bevacizumab(Bev)therapy. After 5 courses, the tumors were markedly reduced in size. According to the RECIST criteria, the tumor response was determined to be a partial response(-44%). Therefore, on the basis of the morphologic response criteria, the patient had Group 1 disease. Because the chemotherapy seemed to be effective, we performed partial hepatectomies. Histologically, no cancer cells were detected in any of the resected tumors. After the partial hepatectomies, she received no additional chemotherapy. Her CEA levels decreased to a normal range and no tumor recurrence was detected over 2 and a half years. XELOX plus Bev therapy may be effective for unresectable multiple liver metastasis from rectal cancer.
- Arisa Muratsu; Shingo Noura; Tae Matsumura; Masaki Hirota; Yuta Yoshida; Takashi Shuto; Akinobu Yasuyama; Chikato Koga; Masahiro Murakami; Chizu Kameda; Ryohei Kawabata; Junzou Shimizu; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 43 12 1866 - 1868 2016年11月Patients with short bowel syndrome experience malabsorption and digestive disorders. They are unable to maintain adequate nutrition by the oral or enteral route alone, and their requirements for liquids, electrolytes, nutrients, microelements, vitamins, etc., are not completely met. Managing the nutritional needs of these patients is important. Another concern is these patients' inability to absorb medication, because the small intestine that is shortened in short bowel syndrome is the principal site of drug absorption. Here, we report a case of a 74-year-old woman with a 30 cm residual jejunum after surgery for acute occlusion of the superior mesenteric artery and the clinical management of nutrition and anticoagulant medication in this patient.
- Yukihiro Yoshikawa; Masato Yoshikawa; Ryohei Kawabata; Yuta Yoshida; Masahiro Kawada; Akinobu Yasuyama; Chikashi Watase; Chikato Koga; Toshiki Hitora; Masahiro Murakami; Masaki Hirota; Masakazu Ikenaga; Junzo Shimizu; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 42 12 1917 - 9 2015年11月A 68-year-old man underwent esophagectomy for early esophageal cancer. Postoperative upper gastrointestinal series and esophagogastroduodenoscopy showed gastric tube stenosis. To improve passage, a removable self-expandable metallic stent (SEMS) was placed across the stenotic lesion. Two weeks later, the stent was removed, and passage through the gastric tube improved. The patient has no symptoms of stenosis. A removable SEMS could be an option for the treatment of gastric tube stenosis after esophagectomy.
- Yuta Yoshida; Ryohei Kawabata; Masato Yoshikawa; Chizu Kameda; Chikato Koga; Masahiro Murakami; Toshiki Hitora; Masaki Hirota; Masakazu Ikenaga; Junzo Shimizu; Hideaki Miwa; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 42 12 1935 - 7 2015年11月An 80-year-old man was seen by his family doctor with chief complaints of fatigue and loss of appetite. Upper gastrointestinal endoscopy showed a type 2 tumor of the lower thoracic esophagus, and the patient was referred to our hospital. Squamous cell carcinoma was diagnosed on biopsy, and computed tomography (CT) showed multiple pulmonary metastases. The patient was diagnosed with Stage Ⅳ thoracic esophageal carcinoma, and was started on combined chemotherapy with 5-FU plus CDDP. Seven days after the start of chemotherapy, the patient developed mild intermittent pain. By day 18, the blood tests showed a marked inflammatory response, and a CT scan showed an abscess in the small bowel mesentery. We suspected an intra-abdominal abscess caused by small bowel perforation, and performed a partial resection of the small bowel and abscess drainage. Postoperatively, pathology tests revealed a diagnosis of a small intestinal diverticulum, which had penetrated the mesentery. We report our experience of a rare case of penetrating diverticulum of the small intestine that occurred during chemotherapy for esophageal cancer, and review the literature.
- Chikashi Watase; Ryohei Kawabata; Masato Yoshikawa; Yuta Yoshida; Masahiro Kawada; Akinobu Yasuyama; Yukihiro Yoshikawa; Chikato Koga; Toshiki Hitora; Masahiro Murakami; Masaki Hirota; Masakazu Ikenaga; Junzo Shimizu; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 42 12 2063 - 5 2015年11月We report a case of almost 9-year survival of a patient with unresected gastric cancer with peritoneal metastasis. A 76-year-old Japanese man was admitted to the hospital for resection of gastric cancer, but it was not resected because of peritoneal metastasis. After discharge, the patient was treated with combination chemotherapy of S-1 and paclitaxel (PTX). After 8 cycles of chemotherapy, the tumor disappeared. We recommended surgical therapy, but he did not agree. The chemotherapy was continued for almost 9 years with 8 regimens including S-1 plus PTX (21+8+5 cycles), S-1 plus CPT-11 (11+2 cycles), S-1 plus docetaxel (DOC) (25 cycles), S-1 plus CDDP plus trastuzumab (1 cycle), PTX (5 cycles), PTX plus trastuzumab (1 cycle), DOC (6 cycles), and nab-PTX (1 cycle). With nutrition support provided through an enterocutaneous fistula and home parenteral nutrition, he has taken chemotherapy throughout without severe complications.
- Yuta Yoshida; Masahiro Murakami; Junzo Shimizu; Masahiro Kawada; Akinobu Yasuyama; Yukihiro Yoshikawa; Chikashi Watase; Takahiko Nishigaki; Ho Min Kim; Toshiki Hitora; Naofumi Oda; Masaki Hirota; Masato Yoshikawa; Hirotaka Morishima; Masakazu Ikenaga; Shoki Mikata; Nobuteru Matsunami; Junichi HasegawaGan to kagaku ryoho. Cancer & chemotherapy 41 12 2122 - 3 2014年11月An 81-year-old man treated with chronic hepatitis C virus (HCV)-related hepatitis and hepatocellular carcinoma (HCC) was diagnosed in 2010 with HCC recurrence (subclass S2) on computed tomography (CT). He refused surgery and was followed up without treatment. In 2012, he was admitted to our hospital because of hematemesis. Gastrointestinal endoscopy revealed a large tumor in the upper gastric corpus, and pathological examination of the tumor revealed HCC; hence, we diagnosed the patient with direct HCC invasion to the stomach. Although active bleeding from the tumor was controlled, he experienced repeated episodes of hematemesis, and the tumor increased in size. Therefore, partial hepatectomy and gastrectomy were performed. It was confirmed that the tumor invaded the stomach wall. Although surgery was effective for gastrointestinal bleeding caused by HCC invasion, the patient died 12 months after surgery because of multiple liver metastases and exacerbated liver failure.