Publications by authors named "Hiroyuki Ishizu"

25 Publications

  • Page 1 of 1

Portal Annular Pancreas With Common Hepatic Artery Trajectory Abnormality: A Case Report and Review of the Literature.

Pancreas 2021 04;50(4):639-644

From the Department of Surgery, Sapporo Kosei General Hospital, Sapporo, Japan.

Abstract: Portal annular pancreas (PAP) is a rare congenital pancreatic anomaly, in which the uncinate process of the pancreas fuses to the body of pancreas behind the portal vein. Here, we report a case of PAP with common hepatic arterial anomaly, which was identified during surgery. A 57-year-old man who had branch type intraductal papillary mucinous neoplasm in the head of the pancreas developed a nodule in the cystic lesion. We planned pylorus preserving pancreaticoduodenectomy. The common hepatic artery from the celiac artery passing behind the portal vein was revealed in preoperative examinations. During surgery, we discovered that the uncinate process of the pancreas was fused with the body of the pancreas behind the portal vein. We divided the pancreas at the anterior and posterior of the portal vein. The main pancreatic duct was present in the anterior pancreatic stump. We performed pancreaticojejunostomy in the anterior stump and closed the posterior stump by interrupted suture. Forty-four surgical cases of PAP have been reported in the English medical literature. There are few previous reports of PAP which involved an arterial anomaly. Clinicians should consider PAP preoperatively to ensure that the surgeon can appropriately plan pancreatic resection to avoid postoperative complications.
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http://dx.doi.org/10.1097/MPA.0000000000001766DOI Listing
April 2021

Short-term and Long-term Outcomes Following Laparoscopic Gastrectomy for Advanced Gastric Cancer Compared With Open Gastrectomy.

Surg Laparosc Endosc Percutan Tech 2019 Aug;29(4):297-303

Department of Gastroenterologic Surgery, Hokkaido University Hospital.

Introduction: To investigate the oncological feasibility and technical safety of laparoscopic gastrectomy with D2 lymphadenectomy for advanced gastric cancer.

Methods: A total of 186 advanced gastric cancer patients treated by gastrectomy with D2 lymphadenectomy were eligible for inclusion including those with invasion into the muscularis propria, subserosa, and serosa without involvement of other organs, and stages N0-2 and M0. We retrospectively compared the short-term and long-term outcomes between laparoscopic gastrectomy and open gastrectomy.

Results: We analyzed short-term outcomes by comparing distal with total gastrectomy results. We found no significant difference for distal gastrectomy for postoperative morbidity [laparoscopic vs. open: n=4 (4.6%) vs. n=1 (3.6%); P=1.00]. We also found no significant difference in postoperative morbidity for total gastrectomy [laparoscopic vs. open: n=2 (4.0%) vs. n=1 (4.0%); P=1.00]. No deaths occurred in any group.The entire cohort analysis revealed no statistically significant differences in overall-free or recurrence-free survival between the laparoscopic and open groups. For overall survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III (P=0.29 and 0.27, respectively), and for pathologic stage II or III (P=0.88 and 0.86, respectively). For recurrence-free survival, there were no significant differences between open and laparoscopic groups for clinical stage II or III (P=0.63 and 0.60, respectively), and for pathologic stage II or III (P=0.98 and 0.72, respectively).

Conclusion: Laparscopic gastrectomy for advanced gastric cancer compared favorably with open gastrectomy regarding short-term and long-term outcomes.
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http://dx.doi.org/10.1097/SLE.0000000000000660DOI Listing
August 2019

[Laparoscopic Gastrectomy for Gastric Adenocarcinoma of the Fundic Gland Type].

Gan To Kagaku Ryoho 2019 Feb;46(2):303-305

Dept. of Surgery, Sapporo Kosei Hospital.

Case 1: A 66-year-old man underwent esophagogastroduodenoscopy(EGD), which showed a slightly elevated lesion at the greater curvature of the cardia. We diagnosed gastric adenocarcinoma(tub1, 2)as a result of the biopsy. Endoscopic submucosal dissection(ESD)was performed. The pathological examination revealed a gastric adenocarcinoma of the fundic type(GA-FG), with a tumor depth of SM2. Consequently, laparoscopic gastrectomy was additionally performed. Case 2: A 65-year-old woman underwent EGD, which revealed a slightly elevated lesion at the posterior wall of the upper body. We made a diagnosis of GA-FG as on the basis of biopsy resuit. ESD was performed. A pathological examination revealed that the tumor depth was SM2. Consequently, laparoscopic gastrectomy was additionally performed. GA-FG rarely demonstrates metastasis and recurrence. Most cases undergo ESD, few reports of surgical resection exist. We report our experience of laparoscopic gastrectomy for GA-FG.
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February 2019

Preoperative FOLFOX in resectable locally advanced rectal cancer can be a safe and promising strategy: the R-NAC-01 study.

Surg Today 2019 Aug 5;49(8):712-720. Epub 2019 Mar 5.

Department of Gastroenterological Surgery I, Graduate School of Medicine, Hokkaido University, N-15, W-7, Kita-ku, Sapporo, 060-8638, Japan.

Purpose: The aim of this study was to assess the safety of rectal surgery after 5-fluorouracil-leucovorin-oxaliplatin chemotherapy (FOLFOX6).

Methods: This was a prospective, multicenter study in 11 Japanese hospitals. We included patients with rectal cancer who received 4 courses of modified FOLFOX6 (mFOLFOX6) before rectal surgery and examined the postoperative complication rate, the clinicopathological response, and the rate of chemotherapy-related adverse events (UMIN 000012559).

Results: The study population included 36 men and 5 women. The average age of the patients was 60.8 years and the average body mass index was 23.1 kg/m. After 4 courses of chemotherapy, grade 2 peripheral nerve disorder and other grade 3 adverse events were seen in 3 patients each (7.3%). Twenty-eight (73.7%) and 8 (21.1%) patients underwent low anterior resection and abdominoperineal resection, respectively. The pelvic nerves were preserved in 35 patients. Surgical morbidity (grade ≥ 3) occurred in 4 patients (10.5%). Anastomotic leakage occurred after surgery in 2 patients (7.1%). No patients achieved pathologically complete remission. However, downstaging of the clinical stage and N stage was seen in 17 (41.5%) and 22 (53.7%) patients, respectively.

Conclusions: Surgery after four courses of mFOLFOX6 chemotherapy can be a safe and promising strategy for patients with locally advanced rectal cancer.
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http://dx.doi.org/10.1007/s00595-019-01788-8DOI Listing
August 2019

[The Clinical Effect of Ramucirumab in the Treatment of Advanced Gastric Cancer in Our Hospital].

Gan To Kagaku Ryoho 2018 Jan;45(1):79-81

Dept. of Surgery, Sapporo Kosei Hospital.

Ramucirumab(RAM)was approved for unresectable advanced gastric cancer in March 2015. Recent Japanese gastric cancer treatment guidelines recommended RAM plus paclitaxel(PTX)and RAM alone in the treatment of patients with advanced gastric cancer who had been previously treated with chemotherapy. In this retrospective study, we evaluated the safety and efficacy of RAM alone and PTX plus RAM in these patients. Patients who were administered RAM or PTX plus RAM between March 2015 and December 2016 were enrolled in this study. We compared the clinical outcome of RAM alone(RAM group, n=11)with that of PTX plus RAM(PTX plus RAM group, n=10). The RAM group contained more patients with poor performance status than the PTX plus RAM group. More cases of Grade 3 or 4 adverse events were found in the PTX plus RAM group than in the RAM group. The response rate was 9% in the RAM group and 30% in the PTX plus RAM group. The progression-free survival was 2 months in the RAM group and 3.75 months in the PTX plus RAM group. The overall survival was not reached in the RAM and PTX plus RAM groups. We considered that RAM and PTX plus RAM are safe and effective therapies for advanced gastric cancer patients.
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January 2018

Comparison of anatomic and non-anatomic hepatic resection for hepatocellular carcinoma.

J Hepatobiliary Pancreat Sci 2017 Nov 19;24(11):616-626. Epub 2017 Oct 19.

Department of Surgery, Tokyo Women's Medical University, Tokyo, Japan.

Background: The aim of the present study was to compare the prognostic impact of anatomic resection (AR) versus non-anatomic resection (NAR) on patient survival after resection of a single hepatocellular carcinoma (HCC).

Methods: To control for confounding variable distributions, a 1-to-1 propensity score match was applied to compare the outcomes of AR and NAR. Among 710 patients with a primary, solitary HCC of <5.0 cm in diameter that was resectable by either AR or NAR from 2003 to 2007 in Japan and Korea, 355 patients underwent NAR and 355 underwent AR of at least one section with complete removal of the portal territory containing the tumor.

Results: Overall survival (OS) was better in the AR than NAR group (hazard ratio 1.67, 95% confidence interval 1.28-2.19, P < 0.001) while disease-free survival showed no significant difference. Significantly fewer patients in the AR than NAR group developed intrahepatic HCC recurrence and multiple intrahepatic recurrences. Patients with poorly differentiated HCC who underwent AR had improved disease-free survival and OS.

Conclusions: Anatomic resection decreases the risk of tumor recurrence and improves OS in patients with a primary, solitary HCC of <5.0 cm in diameter.
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http://dx.doi.org/10.1002/jhbp.502DOI Listing
November 2017

[A Case of Goblet Cell Carcinoid of the Appendix Invading Directly into the Sigmoid Colon].

Gan To Kagaku Ryoho 2016 Nov;43(12):1611-1613

Dept. of Surgery, Hokkaido P. W. F. A. C Sapporo-Kosei General Hospital.

A 73-year-old man underwent a screening colonoscopy, and a depressed lesion in the sigmoid colon was detected. Biopsy revealed a Group V lesion, and he was diagnosed with sigmoid colon cancer. During surgery, there was dense adhesion of the appendix to the sigmoid colon, and sigmoidectomy combined with appendectomy was performed. However, pathological examination revealed goblet cell carcinoid of the appendix with direct invasion into the sigmoid colon. To the best of our knowledge, no similar cases have been reported in Japan. Additional surgery with lymph node dissection was recommended, but it was rejected by the patient. For adjuvant chemotherapy, a total of 8 courses of capecitabine plus oxaliplatin therapy were administered. To date, the patient is alive without recurrence 2 years postoperatively. Postoperative adjuvant chemotherapy for goblet cell carcinoid of the appendix is a useful option for cases in which additional surgery cannot be performed.
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November 2016

[Analysis of Oxaliplatin Combination Therapy for Unresectable or Recurrent Gastric Cancer].

Gan To Kagaku Ryoho 2016 Nov;43(12):1579-1581

Dept. of Surgery, Hokkaido P. W. F. A. C. Sapporo-Kosei General Hospital.

We analyzed 26 cases of unresectable or recurrent gastric cancer treated with oxaliplatin(OX)combination therapy between September 2014 and January 2016. The number of unresectable gastric cancer cases was 14 and there were 12 recurrent cases. The number of patients receiving S-1 plus OX(SOX), SOX plus trastuzumab(Tmab), capecitabine(Cape)plus OX(CapeOX), and CapeOX plus Tmab was 17, 1, 6, and 2, respectively. The starting dose of OX was 130mg/m2 in 12 patients and 100mg/m2 in 14. The median follow-up duration from the first treatment was 6 months(1-14). The median number of treatment cycles was 5(1-19). Dose reductions occurred in 14 cases, and treatment delay occurred in 13 cases. Grade 3 adverse events occurred in 2 cases(8%); thrombocytopenia and stomatitis occurred in 1 case. The response rate was 23%, the disease control rate was 69%, and the median relapse-free survival time was 4 months(1-14). OX combination therapy for unresectable or recurrent gastric cancer was feasible in terms of safety and might be effective for disease control.
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November 2016

ZEB1 expression is associated with prognosis of intrahepatic cholangiocarcinoma.

J Clin Pathol 2016 Jul 15;69(7):593-9. Epub 2015 Dec 15.

Departments of Gastroenterology and Hepatology, Hokkaido University Hospital, Sapporo, Japan.

Background/aim: Intrahepatic cholangiocarcinoma (ICC) is one of the most aggressive malignant tumours, so the identification of molecular targets for ICC is an important issue. Zinc finger E-box binding homeobox 1 (ZEB1) is a key inducer of epithelial-mesenchymal transition (EMT). The aim of the present study was to clarify the clinical significance of ZEB1 in ICC and the associations between ZEB1 expression and EMT-related proteins.

Methods: We immunohistochemically examined the expression of EMT-related proteins, namely ZEB1, vimentin and E-cadherin, in ICC specimens from 102 patients. The clinicopathological and prognostic values of these markers were evaluated.

Results: ZEB1 and vimentin were expressed in 46.1% and 43.1% of tumours, respectively, and E-cadherin expression was lost in 44.1% of tumours. ZEB1 expression showed a significant inverse correlation with E-cadherin expression (p=0.004) and a positive correlation with vimentin expression (p=0.022). Altered expression of ZEB1 was associated with aggressive tumour characteristics, including advanced tumour stage (p=0.037), undifferentiated-type histology (p=0.017), lymph node metastasis (p=0.024) and portal vein invasion (p=0.037). Moreover, overall survival rates were significantly lower for patients with high ZEB1 expression than for patients with low ZEB1 expression (p=0.027). Kaplan-Meier analysis also identified E-cadherin expression (p=0.041) and vimentin expression (p=0.049) as prognostic indicators for overall survival.

Conclusions: ZEB1 expression is associated with tumour progression and poor prognosis in patients with ICC through positive correlations with vimentin and negative correlations with E-cadherin. ZEB1 expression is associated with a poor prognosis and might be an attractive target for the treatment of ICC.
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http://dx.doi.org/10.1136/jclinpath-2015-203115DOI Listing
July 2016

[A case of an elderly patient with recurrent GIST, which was effectively treated with low-dose imatinib mesylate].

Gan To Kagaku Ryoho 2014 Nov;41(12):2405-7

Dept. of Surgery, Hokkaido P. W. F. A. C Sapporo-Kosei General Hospital.

The recommended dose of imatinib for recurrent gastrointestinal stromal tumors (GIST) is 400mg/day. However, adverse effects limit the use of the standard dose in elderly patients. We report a case of an elderly patient with recurrent GIST, where long-term control of the disease was achieved with low-dose imatinib therapy. An 86-year-old man presenting with tarry stool was admitted to the hospital; upper GI endoscopy revealed a gastric submucosal tumor of the stomach at the posterior wall of the cardia. Partial gastrectomy was performed laparoscopically. The submucosal lesion was histopathologically diagnosed as malignant GIST. Administration of imatinib was initiated 17 months after surgery because of recurrence of GIST. The initial dose of imatinib was 400mg/day, which was later adjusted to 200mg or 300 mg/day because of adverse effects. Though imatinib was withdrawn several times due to strong side effects, the disease was well controlled for 6 years after surgery.
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November 2014

[Adjuvant chemotherapy with capecitabine for colon cancer - a case series].

Gan To Kagaku Ryoho 2014 Nov;41(12):1752-4

Dept. of Surgery, Hokkaido P. W. F. A. C Sapporo-Kosei General Hospital.

We examined the treatment condition; adverse events, especially hand-foot syndrome (HFS); and prognosis in 65 patients with colon cancer who received adjuvant chemotherapy with capecitabine. The treatment completion rate was 75.4%; however, only 15.4% of patients completed treatment without dose reduction or treatment interruption. HFS occurred in 78.5% of all cases. The 3-year relapse-free survival rate was 73.8% for all cases, 80.8% for treatment-completed cases, and 51.1% for treatment-discontinued cases; however, there were no differences in relapse-free survival rates for cases that required dose reduction or treatment interruption. We conclude that adjuvant chemotherapy with capecitabine is effective in colon cancer and that completing treatment (even with dose reduction or dose interruption) improves prognosis.
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November 2014

Dramatic resolution of bullous pemphigoid after surgery for gastric cancer: A case report.

Int J Surg Case Rep 2014 26;5(4):212-4. Epub 2014 Feb 26.

Department of Surgery, Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo 060-0033, Japan. Electronic address:

Introduction: An association between bullous pemphigoid (BP) and internal malignancy has been suggested. However, no reports have documented a dramatic improvement in BP after surgery for gastric cancer.

Presentation Of Case: An 82-year-old Japanese woman was admitted to a local hospital for severe fatigue. On examination, she was diagnosed with BP and gastric cancer. Her BP was resistant to steroid treatment; however, it improved dramatically after surgery for gastric cancer.

Discussion: In this case, a strong relationship appeared to exist between BP and gastric cancer.

Conclusion: This is the first report of a dramatic improvement in BP after surgery for gastric cancer.
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http://dx.doi.org/10.1016/j.ijscr.2014.02.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3980412PMC
April 2014

Background suppression in synthesized pulse waveform by feedback control optimization for flatly broadened supercontinuum generation.

Opt Express 2013 Feb;21(3):3001-9

Department of Electrical and Electronic Engineering, Graduate School of Engineering, Tokyo University of Agriculture and Technology, 2-24-16, Nakacho, Koganei, Tokyo 184-8588, Japan.

We demonstrate a method of background component suppression of synthesized pulses for flatly broadened supercontinuum (SC) generation. An adaptive pulse shaping in frequency domain achieved a 26 dB contrast between pulse center and background level in auto-correlation trace by combining two fitness functions during feedback-controlled pulse shaping. The pulse was used as a SC pump, and the spectral peak of the SC at the pump wavelength was suppressed by 5 dB using the combination scheme. Simulation results show that the phase spectra control is required to be within ± π/100 rad to suppress the spectral peak below 3 dB. The results show that adaptive pulse shaping is required to improve SC flatness due to the small mismatch tolerance.
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http://dx.doi.org/10.1364/OE.21.003001DOI Listing
February 2013

[A case report of goblet cell carcinoid tumor of the appendix].

Gan To Kagaku Ryoho 2012 Nov;39(12):2286-8

Dept. of Surgery, Hokkaido P. W. F. A. C Sapporo-Kosei General Hospital, Japan.

Goblet cell carcinoid (GCC) tumor of the appendix is rare, and the prognosis is considered poor compared to classical carcinoid tumor. We present a case of a 60-year old woman who underwent appendectomy for acute appendicitis. Histopathological studies revealed a GCC tumor with submucosal invasion. Based on the malignancy of this tumor and the possible risk of regional lymph node metastases, we performed laparoscopic ileocecectomy with lymph node dissection. Histologically, no residual tumor or lymph node metastases were found. The patient remains well without any sign of recurrence.
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November 2012

[A case in which a mucin-producing papillary adenocarcinoma of the gallbladder was resected].

Gan To Kagaku Ryoho 2012 Nov;39(12):2128-30

Dept. of Surgery, Hokkaido P. W. F. A. C Sapporo-Kosei General Hospital, Japan.

An 81-year-old man complaining of abdominal pain underwent ultrasonography at another hospital that revealed gallbladder swelling, and he was admitted to our hospital for further examination. CT and ERCP revealed a papillary tumor extending from the body to the fundus, leading to the diagnosis of gallbladder cancer. Other examinations showed no sign of invasion or lymph node metastases. We performed full-thickness cholecystectomy. The histopathological diagnosis was mucin-producing papillary adenocarcinoma(T1N0M0, Stage I) of the gallbladder.
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November 2012

[A resected case of recurrent intrahepatic cholangiocellular carcinoma with a cholangiocellular carcinoma component after transcatheter arterial embolization and radiofrequency ablation].

Gan To Kagaku Ryoho 2012 Nov;39(12):2003-5

Dept. of Surgery, Hokkaido P.S.F.A.C Sapporo-Kosei Hospital, Japan.

We report a resected case of intrahepatic cholangiocarcinoma (ICC) with a cholangiolocellular carcinoma (CoCC) component. A 77-year-old man had been followed up regularly for chronic hepatitis C for 20 years. In April 2008, a hepatic tumor of 30-mm diameter was detected in segment 2 by computed tomography scan. The tumor was enhanced in the early phase and the enhancement was prolonged. He was treated with transcatheter arterial embolization following the diagnosis of hepatocellular carcinoma (HCC). He had a local recurrence in the same segment (S2) in March 2009, and transcatheter arterial embolization and radiofrequency ablation were performed. In March 2011, abdominal dynamic computed tomography and magnetic resonance imaging showed a sectoral lesion in S2/4 with early and prolonged enhancement. Following the preoperative diagnosis of local recurrence of HCC, he underwent left lobectomy of the liver. Histopathologically, strongly atypical glandular epithelial cells and mucin production were observed, and these cells grew invasively into the liver parenchyma. Furthermore, tumor cells in the peripheral area grew and replaced adjacent hepatic cells, and anastomosing cavities of glands were found on the gitter stein. For these reasons, the histopathological diagnosis was ICC with a CoCC component.
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November 2012

Nonfunctional retroperitoneal paraganglioma simulating pancreatic tumor: report of a case.

Am Surg 2012 Apr;78(4):E244-5

Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

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April 2012

Operative procedure for pancreatoduodenectomy in a patient who had previously undergone total gastrectomy, distal pancreatectomy, and splenectomy.

Am Surg 2012 Feb;78(2):103-5

Department of General Surgery, Hokkaido University Graduate School of Medicine, Sapporo, Hokkaido, Japan.

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February 2012

[A case report of long-term survival in the patient with anorectal malignant melanoma].

Gan To Kagaku Ryoho 2011 Nov;38(12):2045-7

Dept. of Surgery, Hokkaido P.S.F.A.C Sapporo Kosei Hospital.

Malignant melanoma of the anorectal region is rare, and the prognosis is considered to be poor. We present a case of long-term survival in a 56-year-old patient with primary malignant melanoma in the anorectal area, who complained of anal bleeding. Barium enema showed an elevated lesion in the anorectal region. Colonoscopy revealed a 3 cm sessile tumor with focal pigmentation, and a satellite nodule, 1 cm in diameter. Based on diagnosis of malignant melanoma by biopsy, abdominoperineal resection with lateral node dissection was performed. Pathologically the tumor remained in the mucosa, and no lymph node metastasis was found. This patient refused any adjuvant chemotherapy after the operation, and remains well without any sign of recurrence for seven years.
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November 2011

[Thymic basaloid carcinoma].

Kyobu Geka 2010 Sep;63(10):857-61

Department of Surgery, Sapporo-Kosei General Hospital, Sapporo, Japan.

This is a case of a 72-year-old male whose chest computed tomography (CT) revealed a 2.0 x 1.6 cm anterior mediastinal solid tumor during follow-up of an abnormal shadow of the lung. The tumor increased its size during preoperative follow-up, and multilocular cyst was also observed. Radical thymectomy was performed, and histopathologically the tumor was diagnosed as thymic basaloid carcinoma. Thymic basaloid carcinoma is a rare tumor and is often associated with multilocular thymic cyst. There are only 32 cases reported both locally and internationally. Surgical resection is the general treatment for this disease. Adjuvant radiotherapy can be considered in cases of incomplete resection and invasive tumor. In our case, no recurrence of the tumor was noted 12 months post-operative. Generally, the malignancy of thymic basaloid carcinomas are regarded as low-grade compared with other thymic carcinomas, however, since mortality and recurrence have been reported, careful follow-up is required.
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September 2010

[Third-line CPT-11 chemotherapy for gastric cancer cases of non-curative gastrectomy or recurrence].

Gan To Kagaku Ryoho 2010 Jun;37(6):1051-4

Department of Surgery, Sapporo Kosei Hospital.

Background: There have been few case reports of 3rd-line chemotherapy for gastric cancer. So we reported the results of CPT-11 therapy as the 3rd-line chemotherapy for gastric cancer.

Patients And Methods: 549 cases underwent gastrectomy from Jan. 2004 to Aug. 2007 in our hospital. In 76 of these cases, which underwent non-curative resection or evidenced a recurrence until July 2009, were analyzed in this study. CPT -11 3rd-line chemotherapy was administered to 11 cases.

Results: The mean survival time of non-curative or recurrent cases was 16.9 months. Mean survival times of the non-chemotherapy group, the group administered only 1st-line chemotherapy, the group administered until 3rd-line chemotherapy, the group administered 3rd-line chemotherapy were 7.9 , 11.3 , 21.4 and 28.9 months, respectively(p=0.000 ). Adverse effects occurred in 90.9% of 3rd-line CPT-11, however, all cases were categorized in GradeI.

Conclusion: The group administered 3rd-line chemotherapy survived the longest. It is probably correct to administer 3rd-line chemotherapy, if the patient maintains a good performance status.
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June 2010

A sodium hyaluronate carboxymethylcellulose bioresorbable membrane prevents postoperative small-bowel adhesive obstruction after distal gastrectomy.

Surg Today 2010 Mar 24;40(3):223-7. Epub 2010 Feb 24.

Department of Surgery, JA Sapporo Kosei Hospital, N3, E8, Chuo-ku, Sapporo, 060-0033, Japan.

Purpose: It is predictable that since distal gastrectomy (DG) with Billroth I anastomosis involves no procedures caudal to transverse colon, the effects of the surgical wound are the main cause of adhesive obstruction. Thus, it is an appropriate operation to test the efficiency of a synthetic absorbable adhesion barrier (Seprafilm).

Methods: The subjects were 282 patients diagnosed with gastric cancer who underwent open DG with Billroth I anastomosis between 2001 and August, 2005. Seprafilm was not used in any patients operated on before April, 2003 (n = 169), but it was used in all patients operated on from May 2003 onward (n = 113). We retrospectively compared the incidences of adhesive obstruction in the Seprafilm group and the non-Seprafilm group.

Results: The cumulative incidence of adhesive obstruction was significantly lower in the Seprafilm group than in the non-Seprafilm group (P = 0.021). The respective incidences of adhesive obstruction 2 years after surgery were 0.9% and 6.5%. Multivariate analysis of the occurrence of adhesive obstruction revealed no significant differences in sex, age, body mass index, operation time, blood loss, or degree of lymph-node dissection; however, it revealed a significant difference in relation to the use of Seprafilm (P = 0.049).

Conclusion: In this series, Seprafilm reduced the incidence of adhesive obstruction after DG significantly; however, a prospective randomized study will be necessary to confirm this result.
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http://dx.doi.org/10.1007/s00595-008-4059-1DOI Listing
March 2010

Inferior mesenteric venous thrombosis that required operations: report of two cases.

Hepatogastroenterology 2009 May-Jun;56(91-92):687-91

Department of Surgery, Sapporo Kosei General Hospital, Chuo-ku, Sapporo, Japan.

Inferior mesenteric venous thrombosis (IMVT) is a very rare disease of colon ischemia. We experienced two cases of IMVT that required operations. The first patient was a 74-year-old male, who was admitted to our hospital because of melena and diarrhea. He was diagnosed with IMVT by angiography. As no improvement was seen after the conservative therapy for a month, left colectomy and transverse colostomy were performed. There was a small ulcer in the resected colon mucosa. The findings of histopathological examination revealed that mild and repeated ischemia of the colon had been caused. The second patient was a 70-year-old male, who was admitted to our hospital with the chief complaint of constipation, lower abdominal pain and nausea. He was diagnosed as IMVT by angiography. As no improvement was seen after the conservative therapy for a month, an operation was performed. The operative findings confirmed severe swelling of mesenteric fatty tissue and vascular ectasia of mesocolon. Left colectomy and transverse colostomy were performed. Histopathological examination of surgical specimens disclosed the multiple thrombi and almost complete occlusion of the inferior mesenteric vein, the invasion of lipid-filled macrophages as mesenteric panniculitis, and ischemic change in the sigmoid colon mucosa.
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September 2009

Distant peritoneal metastasis to a mesh-plug prosthesis in a gastrointestinal cancer patient: report of a case.

Surg Today 2003 ;33(11):864-6

Department of Surgery, Sapporo Kosei General Hospital, K 3, H 8-5, Chuo-ku, 060-0033 Sapporo, Japan.

A case of distant metastasis to mesh-plug prosthesis in gastrointestinal cancer is presented herein. An 88-year-old man had received mesh-plug repair with high ligation for a recurrence of a right inguinal hernia. Six months later, advanced gastric cancer and advanced transverse colon cancer were detected, and therefore a distal gastrectomy and partial colectomy were performed. Two weeks after the operation, the patient complained of right groin tenderness, and the mesh-plug prosthesis was removed to control any infection. A histopathological investigation demonstrated adenocarcinoma in the plug prosthesis. The patient died of carcinomatosis peritonei 45 days after the last operation.
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http://dx.doi.org/10.1007/s00595-003-2597-0DOI Listing
March 2004

Clinicopathological characteristics of superficial spreading type early gastric cancer.

J Surg Oncol 2003 Jun;83(2):94-8

Department of Surgery, Sapporo Kosei General Hospital, Sapporo, Japan.

Background And Objectives: Superficial spreading type early gastric cancer is characterized by its atypical growth pattern and occasionally indistinct tumor margin. Because it is a rare form of early gastric cancer, the clinicopathological details are not apparent. The aim of this study was to clarify the clinicopathological features of the superficial spreading type of early gastric cancer.

Methods: A retrospective study was conducted in 1,062 surgically resected patients with early gastric cancer. Hospital records were compared between patients with superficial spreading type early gastric cancer and those with more common types of early gastric cancer.

Results: Sixty-nine patients (6.9%) had superficial spreading lesions. The male to female ratio was 1.2:1. The most frequent histological type was signet-ring cell carcinoma (32%). The distinguishing histopathological features were submucosal invasion (67%), lymphatic invasion (32%), and lymph node metastasis (30%). There were discrepancies in tumor area between surgical findings and pathological diagnosis in 24 patients (35%) with superficial spreading type. More extensive lymph node dissection was performed and all patients survived in the group with superficial spreading lesions.

Conclusions: The most appropriate treatment for the superficial spreading type of early gastric cancer is wide surgical resection with extensive lymph node dissection.
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http://dx.doi.org/10.1002/jso.10229DOI Listing
June 2003
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