Publications by authors named "Shinichi Tsutsui"

55 Publications

Prognostic Impact of Lymphocyte-C-Reactive Protein Ratio in Patients Who Underwent Surgical Resection for Hepatocellular Carcinoma.

J Gastrointest Surg 2021 Jul 13. Epub 2021 Jul 13.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, 730-0052, Japan.

Background: Systemic inflammation-related factors, either independently or in combination, are recognized as prognostic factors for various cancers. The ratio of lymphocyte count to C-reactive protein concentration (lymphocyte-CRP ratio; LCR) is a recently identified prognostic marker for several cancers. Here, we examined the prognostic value of the LCR in patients with hepatocellular carcinoma (HCC).

Methods: This was a single-center retrospective study of patients who underwent surgical resection for HCC between 2004 and 2017. Patients were divided into high- and low-LCR status groups, and the relationships between LCR status, prognosis, and other clinicopathological characteristics were analyzed.

Results: A total of 454 patients with HCC were enrolled and assigned to the high- (n=245) or low- (n=209) LCR groups. Compared with the high-LCR group, patients in the low-LCR group had a significantly lower serum albumin level (median 4.1 vs. 3.9 g/dL, P <0.0001), lower platelet count (median 14.0 vs. 12.0 ×10/μL, P=0.0468), lower prothrombin time (median 93.2 vs. 89.6 %, P=0.0006), and larger tumor size (median 2.3 vs. 2.5 cm, P=0.0056). Patients with low-LCR status had significantly worse outcomes of overall survival and disease-free survival than patients with high-LCR status (P=0.0003 and P=0.0069, respectively). Low-LCR status was significantly associated with worse overall survival in multivariate analysis (hazard ratio 1.57, 95% confidence interval 1.14-2.17, P=0.0058).

Conclusions: Low-LCR status may predict worse outcomes in patients with HCC. Measurement of LCR is routine and can easily be applied for risk stratification in the assessment of patients with HCC.
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http://dx.doi.org/10.1007/s11605-021-05085-zDOI Listing
July 2021

Risk Factors for and Outcomes of Intraoperative Blood Loss in Liver Resection for Hepatocellular Tumors.

Am Surg 2021 Mar 29;87(3):376-383. Epub 2020 Sep 29.

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Intraoperative blood loss (IBL) during liver resection is a predictor of morbidity, mortality, and tumor recurrence after hepatectomy; however, there have been few reports on patient factors associated with increased IBL. We enrolled consecutive patients who underwent liver resection for primary liver malignancies, and evaluated the predictors of IBL using a data set in which factors that might influence IBL, such as surgical devices, methods and anesthetic technique, were all standardized. We studied 244 patients. A multivariate analysis revealed that higher IBL was an independent risk factor for post-hepatectomy liver failure grade ≥B and overall survival. Multiple linear regression analyses showed serum creatinine, clinically significant portal hypertension (CSPH), tumor size, and major hepatectomy were all significant predictors of IBL. In conclusion, higher IBL was significantly associated with increased morbidity and mortality in patients with primary HCC who underwent liver resection. The risk of IBL was related to several factors including tumor size, serum creatinine, CSPH, and major hepatectomy.
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http://dx.doi.org/10.1177/0003134820949995DOI Listing
March 2021

Hepatic resection for recurrent hepatocellular carcinoma during pregnancy: a case report.

Surg Case Rep 2020 Sep 29;6(1):229. Epub 2020 Sep 29.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Hepatocellular carcinoma (HCC) during pregnancy is extremely rare. Treatment strategies for cancers detected during pregnancy have been controversial. We herein report a case of recurrent HCC detected at 20 weeks of pregnancy, which subsequently prompted hepatic resection after abortion.

Case Presentation: A 36-year-old woman underwent laparoscopic partial hepatectomy for HCC (20 mm in diameter) in segment 5 of the liver during follow-up after being determined as a hepatitis B virus carrier two and a half years ago. Post-surgery follow-up abdominal ultrasonography revealed a 36-mm tumor in segment 7 of the liver. Abdominal contrast-enhanced computed tomography revealed a well-enhanced tumor with a 40-mm diameter in segment 7 adjacent to the inferior vena cava and right hepatic vein, suggesting HCC recurrence. Laboratory data revealed total bilirubin (0.4 mg/dL), aspartate aminotransferase (28 IU/L), alanine aminotransferase (30 IU/L), glutamyltransferase (16 IU/L), prothrombin time (115.3%), and indocyanine green retention rate at 15 min (7.0%). α-Fetoprotein (AFP) (12,371.5 ng/mL; normal range < 10 ng/mL) and PIVKA-II (208 mAU/mL; normal range < 40 mAU/mL) were both significantly elevated. After discussions with a cancer board consisting of experts from the departments of gastroenterology, obstetrics and gynecology, and surgery, as well as obtaining appropriate informed consent from the patient and her family, we decided to perform a hepatic resection after abortion. Subsequently, abortion surgery was performed at 21 weeks and 2 days of pregnancy. After 6 days, subsegmentectomy of liver segment 7 was performed under general and epidural anesthesia, with a pathological diagnosis which was moderately differentiated HCC being established. Given the good postoperative course, without particular complications, the patient was subsequently discharged 10 days after the operation. Approximately 2 years after the surgery, the patient remains alive without recurrence, while both AFP and PIVKA-II were within normal limits.

Conclusions: Treatment strategies for HCC detected during pregnancy remain controversial. As such, decisions should be made based on HCC growth and fetal maturity after thorough multidisciplinary team discussions and obtaining appropriate informed consent from the patient and her family.
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http://dx.doi.org/10.1186/s40792-020-00985-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7524929PMC
September 2020

Large surgically resected leiomyosarcoma of the liver: a case report.

Surg Case Rep 2020 Jul 9;6(1):168. Epub 2020 Jul 9.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, Japan.

Background: Primary hepatic leiomyosarcoma (PHL) is an extremely rare type of tumor. We herein report a case of a large surgically resected leiomyosarcoma of the liver.

Case Presentation: A 69-year-old man with a feeling of epigastric compression was referred for examination of an abdominal mass. He had no history of liver disease or alcohol abuse. Liver function tests indicated Child-Pugh class A. Tumor markers were negative. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed a relatively well-contrasted 12 × 11 × 8 cm tumor with well-defined boundary replacing the lateral segment of the liver alongside multiple intrahepatic metastases. Several nodules up to 12 mm were found in both lungs, suggestive of metastasis. SUVmax of the liver mass and lung tumor in positron emission tomography were 10.4 and 1.5, respectively. Hepatocellular carcinoma was primarily suspected. Lateral segmentectomy of the liver was performed to confirm diagnosis and prevent tumor rupture. Macroscopically, the lateral segment of the liver had been replaced by a lobular or multinodular tumor with a maximum diameter of 15 cm. In pathological findings, the tumor consisted of bundle-like proliferation of complicated banding spindle-like cells with clear cytoplasm, accompanied by storiform pattern and compressed blood vessels. Nuclear fission images were observed in 8/10 HPF. Partial necrosis was present, with associated venous invasion and intrahepatic metastasis. Immunohistochemical staining for tumor cells revealed desmin, α-smooth muscle actin (αSMA), and h-caldesmon were all positive, informing a final diagnosis of PHL. The postoperative course was uneventful, and he was discharged on the 12th postoperative day.

Conclusions: PHL is a rare malignant disease with relatively poor prognosis. To confirm a diagnosis of PHL, immunohistochemical analysis as well as histopathological findings is important. The preferred treatment is surgical resection, sometimes in combination with adjuvant chemotherapy and radiotherapy. Further studies are needed to elucidate and better understand this uncommon clinical entity.
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http://dx.doi.org/10.1186/s40792-020-00934-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7347740PMC
July 2020

Mixed adenoneuroendocrine carcinoma of the distal bile duct: a case report.

Surg Case Rep 2020 Jul 6;6(1):160. Epub 2020 Jul 6.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Mixed adenoneuroendocrine carcinoma (MANEC) of the common bile duct (CBD) is very rare, with only 10 reported cases. Here, we report a case of MANEC of the distal bile duct (DBD) that was surgically resected under a diagnosis of cholangiocarcinoma (CCA).

Case Presentation: A 60-year-old male had epigastric pain and was admitted to our hospital for the treatment of a suspected CBD stone. Upon admission, laboratory findings revealed elevated hepatobiliary enzymes including serum aspartate aminotransferase, serum alanine aminotransferase, serum glutamyltransferase, and serum alkaline phosphatase. Both carcinoembryonic antigen and carbohydrate antigen 19-9 were negative. Computed tomography (CT) showed dilation of the CBD. Endoscopic retrograde cholangiopancreatography (ERCP) showed circumferential stenosis and a 5-mm elevated lesion in the DBD. Brush cytology showed atypical ductal cells, indicating adenocarcinoma (AC) of the DBD. Under a diagnosis of CCA of the DBD, a subtotal stomach-preserving pancreaticoduodenectomy was performed. Neither peritoneal dissemination nor lymph node metastasis was found. Microscopically, the lesion was seen to be composed of predominantly well-differentiated tubular AC in the superficial layer of the tumor, admixed with neuroendocrine carcinoma (NEC) in the deeper portion, indicating a diagnosis of MANEC of the DBD. After immunohistochemical staining, NEC components were positive for synaptophysin and CD56 and were for SSTR2, SSTR5, and mammalian target of rapamycin (mTOR). Three months postsurgery, postoperative adjuvant chemotherapy with S-1 was started. More than 3 years postsurgery, he is alive without recurrence.

Conclusions: MANEC is highly malignant, progresses rapidly, and has a poor prognosis. Preoperative diagnosis is difficult; therefore, identifying NEC components by immunohistochemical staining using resected specimens is important.
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http://dx.doi.org/10.1186/s40792-020-00921-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338298PMC
July 2020

A case of perforation of Meckel's diverticulum with enterolith.

Surg Case Rep 2020 Jul 6;6(1):161. Epub 2020 Jul 6.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Perforation of Meckel's diverticulum with enteroliths is a rare complication. Here, we report a case of perforation of Meckel's diverticulum with one enterolith, which could not be accurately diagnosed by preoperative computed tomography.

Case Presentation: A 16-year-old male patient with acute onset of severe abdominal pain and a localized muscle guarding in the right hypochondrium had a solitary stone detected in the right abdomen by radiography. Abdominal computed tomography revealed a saclike outpouching of the small intestine, which contained fluid levels and an enterolith, with a mesenteric inflammatory change in the right paraumbilical area. He was diagnosed with peritonitis due to appendicitis or Meckel's diverticulitis with enterolith, and emergency operation was indicated. The perforated Meckel's diverticulum was identified approximately 30 cm proximal to the ileocecal valve. The diverticulum was transected at the base and removed. The patient's postoperative course was uneventful.

Conclusions: It is crucial for clinicians to thoroughly examine patients and appropriately request investigations that consider perforation of Meckel's diverticulum as a possible diagnosis to facilitate prompt treatment.
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http://dx.doi.org/10.1186/s40792-020-00926-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7338335PMC
July 2020

Acute median arcuate ligament syndrome after pancreaticoduodenectomy.

Surg Case Rep 2018 Nov 26;4(1):137. Epub 2018 Nov 26.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6, Sendamachi, Naka-ku, Hiroshima City, Hiroshima, 730-0052, Japan.

Background: Median arcuate ligament syndrome (MALS) can cause severe complications after pancreaticoduodenectomy (PD). Most of the reported cases of MALS have been diagnosed perioperatively and can be treated efficiently by interventional radiology or division of the median acute ligament (MAL) fibers.

Case Report: A 69-year-old woman underwent PD with resection of the SMV for pancreatic head cancer. Intraoperative exploration showed normal anatomy of the celiac trunk. Intraoperative digital palpation revealed normal pulsation of the common hepatic artery after resection of the gastroduodenal artery. On postoperative day (POD) 3, her liver function tests were abnormal, and bloody fluids were found in the drain. Abdominal CT showed necrosis of the pancreatic body and ischemia in the liver secondary to MALS which was not detected in the preoperative CT. Interventional radiology was tried first but failed. Division of the MAL fibers markedly increased the blood flow in the hepatic artery. Resection of the remnant pancreas and spleen was also performed simultaneously. Abdominal CT on POD 20 showed re-occlusion of the celiac artery. She experienced rupture of the gastrojejunostomy site, severe hepatic cytolysis, and choledochojejunostomy stricture thereafter.

Conclusions: This is the third case of MALS that has developed acutely after PD. MALS can cause refractory complications even after MAL release.
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http://dx.doi.org/10.1186/s40792-018-0545-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6261092PMC
November 2018

Evaluation of Drain Amylase Level after Pancreaticoduodenectomy with Special Reference to Delayed Pancreatic Fistula.

Am Surg 2018 Mar;84(3):403-409

Postoperative pancreatic fistula (PF) is a relatively frequent and occasionally fatal complication of pancreatoduodenectomy (PD). Several risk factors for PF have been reported, including high drain amylase level (D-AMY). Among the 140 consecutive patients who underwent PD, we analyzed 110 cases with D-AMY measurements over time after PD. According to the D-AMY change, we divided patients into five patterns and defined delayed PF cases. We analyzed clinical characteristics, including serum amylase and D-AMY, and examined the correlation between the period of drain insertion and PF grade. In 15 delayed PF cases, 12 cases were grade B or C, pancreatic cancer was less frequent, pancreatic ducts were smaller, and soft pancreas texture was more commonly observed. The D-AMY on postoperative day (POD) 1 was higher in cases of delayed PF compared with non-PF cases (P < 0.0001). In 28 cases with drain removal before POD 7, grade B or C PF was not observed afterward. The average D-AMY on POD 1 in cases with drain removal before POD 1 was significantly lower than in delayed PF cases. Although further studies are required to determine the most appropriate timing of drain removal, it is thought that intra-abdominal drains should be removed within seven days of PD in cases without signs of PF. On the other hand, delayed PF should be considered in cases of soft pancreas texture and/or high D-AMY on POD 1, even if D-AMY levels are low on POD 3 or decreasing on POD 5.
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March 2018

Diagnostic laparoscopy for pneumatosis intestinalis in a very elderly patient: A case report.

Ann Med Surg (Lond) 2017 Sep 29;21:109-113. Epub 2017 Jul 29.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Introduction: Pneumatosis intestinalis is rare but may be associated with life-threatening intra-abdominal conditions such as intestinal ischemia or perforation. However, it can be difficult, particularly in the very elderly, to identify candidates for immediate surgical intervention.

Presentation Of Case: A 94-year-old man with abdominal distension underwent abdominal computed tomography, which demonstrated accumulation of air bubbles within the intestinal wall and some free intraperitoneal air, suggestive of pneumatosis intestinalis. His vital signs showed evidence of systemic inflammatory response syndrome, and laboratory examination revealed inflammation and hypoxia. As the patient was frail, with his age and concomitant conditions which may have masked the symptoms and severity of his illness, immediate diagnostic laparoscopy was performed, which confirmed the diagnosis of pneumatosis intestinalis, with multiple gas-filled cysts seen within the subserosa of the small intestine. No additional surgical procedure was performed. His symptoms improved postoperatively.

Discussion: Optimal management of pneumatosis intestinalis in a timely manner requires a comprehensive evaluation of factors in each individual. In patients with severe symptoms, PI might be a sign of a life-threatening intra-abdominal emergency. Despite the contrast-enhanced CT and prediction markers in previous reports, it considered to be difficult to completely rule out these fatal conditions without surgery, especially in very elderly patients with poor performance status.

Conclusion: Diagnostic laparoscopy may be a useful option for definitively ruling out the lethal conditions associated with pneumatosis intestinalis in frail elderly patients with severe conditions in the emergency setting.
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http://dx.doi.org/10.1016/j.amsu.2017.07.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5567747PMC
September 2017

Undifferentiated carcinoma of the liver: a case report with immunohistochemical analysis.

Surg Case Rep 2017 Dec 10;3(1):12. Epub 2017 Jan 10.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Undifferentiated carcinoma (UC) of the liver is extremely rare, and its clinicopathological characteristics have not been fully elucidated.

Case Presentation: The present study reports the case of a 56-year-old male with UC of the liver. At 16 days post-admission, the patient suddenly succumbed due to intra-abdominal bleeding resulting from a ruptured liver. Macroscopic examination revealed that the hepatic parenchyma was almost completely replaced by innumerable minute nodules. Microscopically, the tumor demonstrated a diffuse proliferation of anaplastic cells that were positive for epithelial membrane antigen and neuron-specific enolase, suggesting neuroendocrine differentiation. Grimelius and Fontana-Masson staining were negative. Neuroendocrine markers were also negative, including chromogranin A, synaptophysin, and S-100 protein. Cytokeratin markers and mesenchymal markers were all negative. Tumor markers, such as α-fetoprotein and carcinoembryonic antigen, were also negative.

Conclusions: Although larger studies involving more patients are required to establish a therapeutic strategy, appropriate chemotherapy following an early diagnosis may be important to UC of the liver because the tumor behaves in an aggressive way.
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http://dx.doi.org/10.1186/s40792-017-0288-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5225379PMC
December 2017

Laparoscopic Resection of Gastric Cancer in a Patient with Chronic Lymphocytic Leukemia Accompanied by Neutropenia.

Anticancer Res 2016 Apr;36(4):1779-83

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Higashi-ku, Fukuoka, Japan

Aim: We report an unusual case of early gastric cancer and T-cell-type chronic lymphocytic leukemia accompanied by severe neutropenia that was successfully treated by laparoscopic gastrectomy.

Case Report: A 76-year-old female was referred to our Hospital for resection of a gastric adenoma that was suspicious for malignancy. Routine preoperative laboratory studies showed severe neutropenia and increased atypical lymphocytes in the peripheral blood. Bone marrow biopsy confirmed the diagnosis of T-cell chronic lymphocytic leukemia. One day before surgery, granulocyte colony-stimulating factor was administered. Laparoscopic-assisted distal gastrectomy was performed. The patient's postoperative course was uneventful and she was discharged after 10 days. The histopathological findings revealed well-differentiated adenocarcinoma (pT1a, pN0, and stage IA).

Conclusion: Laparoscopic gastrectomy may be considered a primary approach in patients with neutropenia because it is associated with lower risk of postoperative infection and a lower mortality rate compared to open resection.
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April 2016

One-step surgery for acute ischemia of the jejunal loop after pancreatoduodenectomy: report of a case.

Surg Case Rep 2016 Dec 14;2(1):24. Epub 2016 Mar 14.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan.

Background: Pancreatoduodenectomy (PD) is an extensive surgery, and its complications are grave. Acute ischemia of the jejunal loop due to thrombosis of the superior mesenteric vein (SMV) and its branches is one of the most dangerous complications that, although rare, if left untreated leads to abdominal sepsis and death of a patient.

Case Presentation: A 77-year-old man underwent PD for pancreatic cancer. On postoperative day 2, the patient developed a severe anemia with hypotension. The computed tomography showed acute ischemia of the jejunal loop due to thrombosis. The emergent surgery was performed. The removal of the ischemic intestine and re-anastomoses of the biliary and pancreatic ducts could be performed all at once because necrosis and inflammation were still very mild in early stage.

Conclusion: If suspicion for thrombosis of the SMV and its branches is raised, re-laparotomy should be considered. Early re-operation can lead to removal of the ischemic intestine and re-anastomoses in one-step surgery.
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http://dx.doi.org/10.1186/s40792-016-0153-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4791446PMC
December 2016

Risk factors for incisional hernia after hepatic resection for hepatocellular carcinoma in patients with liver cirrhosis.

Surgery 2015 Dec 23;158(6):1669-75. Epub 2015 Jun 23.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Background: The risk factors for incisional hernia (IH) and the association between liver fibrosis and IH after hepatic resection in patients with hepatocellular carcinoma (HCC) with liver cirrhosis (LC) are still unclear. We aimed to evaluate the rate of IH and to assess the effect of perioperative factors, including serum markers for liver fibrosis, on the risk of IH.

Methods: A total of 192 patients with HCC with LC who received hepatectomy were retrospectively analyzed. The primary end point was the incidence rate of IH and the secondary end points were associations between IH and 22 clinical factors.

Results: IH was diagnosed in 60 (31.3%) patients. The estimated incidence rates were 19.8% at 12 months, 32.5% at 36 months, and 38.8% at 60 months. In multivariable analysis, the presence of postoperative intractable ascites (odds ratio 24.83, P = .0003), abdominal wall closure by a single-layer mass closure with a continuous running suture (odds ratio 4.59, P = .0143), preoperative body mass index ≥ 25 kg/m(2) (odds ratio 3.36, P = .0025), and preoperative serum N-terminal pro-peptide of type IV collagen 7S domain (P4NP 7S) levels ≥ 5 ng/mL (odds ratio 3.13, P = .0234) were independent risk factors.

Conclusion: There are several risk factors for IH after hepatic resection in HCC patients with LC. Preoperative serum P4NP 7S levels ≥ 5 ng/mL are a useful predictive marker, and abdominal wall closure with a continuous running suture by a single-layer mass closure should be avoided.
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http://dx.doi.org/10.1016/j.surg.2015.06.001DOI Listing
December 2015

Rectal cancer with disseminated carcinomatosis of the bone marrow: report of a case.

Int Surg 2014 Sep-Oct;99(5):518-22

1 Department of Surgery, Hiroshima Red Cross Hospital and Atomic-bomb Survivors Hospital, Hiroshima, Japan.

We report a rare case of disseminated carcinomatosis of the bone marrow from rectal cancer with disseminated intravascular coagulation (DIC). A 65-year-old man was admitted with melena and low back pain at rest. X-ray examination showed rectal cancer with multiple bone metastases. Laboratory examination showed severe anemia and DIC. Histologic examination showed disseminated carcinomatosis of the bone marrow. The DIC was considered to be caused by disseminated carcinomatosis of the bone marrow from rectal cancer, and we immediately started treatment with anti-DIC therapy and anticancer chemotherapy with the modified FOLFOX6 regimen (mFOLFOX6). After some response to therapy, the patient's general condition deteriorated, and he died 128 days after admission. This is the first English report showing disseminated carcinomatosis of the bone marrow from colorectal cancer treated with mFOLFOX6.
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http://dx.doi.org/10.9738/INTSURG-D-13-00130.1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4253917PMC
January 2016

CEA/CA72-4 levels in peritoneal lavage fluid are predictive factors in patients with gastric carcinoma.

J Cancer Res Clin Oncol 2014 Apr 9;140(4):607-12. Epub 2014 Feb 9.

Department of Surgery, Hiroshima Atomic Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima, 730-8619, Japan,

Purpose: Increased levels of tumor marker in intra-operative peritoneal lavage are associated with an earlier detection of recurrent peritoneal dissemination.

Method: Intra-operative peritoneal lavage samples from 193 patients with gastric cancer were obtained to determine the levels of the tumor markers, carcinoembryonic antigen (CEA) and cancer-related antigen 72-4 (CA72-4) using a chemiluminescent enzyme immunoassay.

Results: The peritoneal lavage CEA (CY-CEA), CA72-4 (CY-CA72-4) and serosal invasion were independent factors predicting the peritoneal dissemination including CY(+). The patients were divided into four groups on the basis of peritoneal lavage tumor marker status; group A: CY-CEA (-), CY-CA72-4 (-) group (CEA < 0.5 ng/ml, CA72-4 < 1.3 U/ml); group B: CY-CEA (-), CY-CA72-4 (+) group (CEA < 0.5 ng/ml, CA72-4 ≥ 1.3 U/ml); group C: CY-CEA (+), CY-CA72-4 (-) group (CEA ≥ 0.5 ng/ml, CA72-4 < 1.3 U/ml); and group D: CY-CEA (+), CY-CA72-4 (+) group (CEA ≥ 0.5 ng/ml, CA72-4 ≥ 1.3 U/ml). The 5-year survival among the patients in groups A, B, C and D was 87, 68, 38 and 20 %, respectively (p < 0.0001).

Conclusion: Combined analysis of these markers is therefore considered to be helpful for accurately determining sites of recurrence and the prognosis in advanced gastric cancer patients.
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http://dx.doi.org/10.1007/s00432-014-1601-yDOI Listing
April 2014

Case of early adenosquamous carcinoma of the stomach.

Fukuoka Igaku Zasshi 2013 Sep;104(9):315-20

Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.

Adenosquamous carcinoma of the stomach is very rare; at present, there are only seven published reports. We report here an eighth case involving a 77-year-old Japanese man who was diagnosed with gastric cancer by upper endoscopy and computed tomography (CT). He underwent laparoscopic-assisted distal gastrectomy for early gastric cancer and the resected specimen was diagnosed as adenosquamous carcinoma limited to the submucosal layer. Only one lymph node metastasis was noted. Seven months later, liver metastasis (3 tumors, 15 mm maximum in diameter) was detected by abdominal CT. He was started on chemotherapy with S-1 and cisplatin (CDDP) and is alive 14 months after surgery. Almost all cases of adenosquamous carcinoma of the stomach are diagnosed in advanced stages and carry a very poor prognosis. Most patients with early adenosquamous carcinoma of the stomach survive for 2 or more years without recurrence, however our patient experienced recurrence 7 months after surgery. Therefore, future treatment for recurrent adenosquamous carcinoma of the stomach should be considered.
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September 2013

Surgery after preoperative chemotherapy for patients with unresectable advanced gastric cancer.

Oncology 2013 4;85(4):241-7. Epub 2013 Oct 4.

Department of Surgery, Hiroshima Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Objective: The study aimed to evaluate the efficacy of surgery after preoperative chemotherapy for unresectable advanced gastric cancer.

Method: Twenty patients with disappeared peritoneal dissemination or decreased lymph node metastasis by systemic chemotherapy underwent surgery (group S), while 14 with peritoneal dissemination or lymph nodes >N2 (group C) received continuous systemic chemotherapy. Among group S patients, 15 underwent a curative resection (group R0), while the other 5 did not microscopically undergo a curative resection (group R1).

Results: The median survival time for all patients was 535 days. Survival time was significantly dependent on the chemotherapy response (p < 0.002). The survival period in group S was significantly longer than that in group C (median survival time 747 vs. 476 days; p < 0.02). The relapse-free survival was 299 days in group S. In particular, the survival period of patients who underwent R0 surgery by preoperative chemotherapy was significantly longer than that of group R1 patients (median survival time 794 vs. 485 days; p < 0.02). Multivariate analysis revealed that R0 surgery was a significant and independent prognostic factor.

Conclusion: Surgery was effective for advanced gastric cancer patients when performed as R0 resection following the disappearance of non-curative factors by preoperative chemotherapy.
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http://dx.doi.org/10.1159/000354420DOI Listing
January 2014

Outcome and status of microsatellite stability in Japanese atomic bomb survivors with early gastric carcinoma.

Ann Surg Oncol 2013 Mar 13;20(3):798-803. Epub 2012 Nov 13.

Department of Surgery, Hiroshima Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Background: In the decade after the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. However, the incidence of other cancers gradually increased, while that of leukemia decreased after this period. We evaluated the clinical outcome of early gastric cancer and microsatellite stability over a long-term period in atomic bomb survivors.

Methods: The results of surgical treatment for early gastric cancer were reviewed for 117 atomic bomb survivors and 394 control patients between 1995 and 2006. In addition, immunohistochemical staining for hMSH2 and hMLH1 expression was performed to evaluate the status of microsatellite stability in 57 atomic bomb survivors and 82 control patients.

Results: The long-term survival rate for early gastric cancer in atomic bomb survivors was significantly lower than that in control patients (p < 0.01). Multivariable analysis revealed that age and sex were significant and independent prognostic factors for early gastric cancer. Defective hMSH2 and/or hMLH1 expression was also significantly higher in survivors than in control patients (p < 0.001). Logistic regression analysis revealed that atomic bomb survivorship was related to defective hMSH2 and/or hMLH1 expression.

Conclusions: The prognosis of early gastric cancer in atomic bomb survivors was poor and was related to age and sex, rather than to being an atomic bomb survivor. Furthermore, a higher rate of defective hMSH2 and/or hMLH1 expression was observed in the survivors.
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http://dx.doi.org/10.1245/s10434-012-2567-0DOI Listing
March 2013

Ectopic thymoma presenting as a giant intrathoracic mass: a case report.

J Cardiothorac Surg 2012 Jul 16;7:68. Epub 2012 Jul 16.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-Machi, Naka-ku, Hiroshima, Japan.

Thymoma is an epithelial neoplasm of the thymus, which commonly lies in the anterior mediastinum and, therefore, an intrathoracic origin is considered to be rare. This report presents a case of giant thymoma arising in the thoracic cavity. A 61-year-old male presented with a chronic cough and breathlessness. Chest CT revealed a well enhanced giant mass approximately 18 cm in diameter in the right thoracic cavity. FDG-PET showed that the SUVmax of the tumor was 5.0 in the center and almost 2.5 in the surrounding area. A trans- bronchial needle biopsy was performed to find atypical cells. Surgery was scheduled based on the radiological and histological findings. A well-defined giant mass in the thoracic cavity, measuring 18 × 14.5 × 11 cm had undergone expansive growth without apparent invasion. The tumor was completely resected without combined resection of the other organs. The weight of the tumor was 1350 g. The tumor was histologically diagnosed to be type AB thymoma according to the World Health Organization classification and Masaoka stage IIB.
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http://dx.doi.org/10.1186/1749-8090-7-68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3412705PMC
July 2012

Preliminary trial of surgery after chemotherapy for advanced gastric cancer with peritoneal dissemination.

Oncol Lett 2012 Mar 14;3(3):662-666. Epub 2011 Dec 14.

Department of Surgery, Hiroshima Red Cross Hospital, Naka-ku, Hiroshima 730-8619.

Systemic chemotherapy is the key treatment for patients presenting with advanced gastric cancer with peritoneal dissemination. In certain cases, adjuvant surgery following systemic chemotherapy may result in improved long-term survival. This study aimed to evaluate the efficacy of adjuvant surgery following response to chemotherapy for advanced gastric cancer with peritoneal dissemination. The study included 13 patients with a diagnosis of advanced gastric cancer with peritoneal dissemination. Of the 13 patients, 5 patients underwent surgery after the peritoneal dissemination was eradicated following systemic chemotherapy (group S), while the remaining 8 patients continued to receive systemic chemotherapy due to persistent peritoneal dissemination (group C). All 13 patients underwent treatment between October 2008 and February 2011. The chemotherapy regimen included cis-diamminedichloride platinum plus S-1 (an oral fluoropyrimidine) or docetaxel plus S-1 for all patients. The median overall survival time of the 13 patients was 660 days. The survival time did not differ with patient response to chemotherapy. The median survival time of the patients in group S was 794 days, which was significantly higher than that of the patients in group C (505 days; p<0.05). One- and 2-year survival was observed in 100 and 60% of patients, respectively, in group S, and 66.7 and 0% of patients in group C. In conclusion, adjuvant surgery led to longer survival in patients having advanced gastric cancer with peritoneal dissemination, which was eradicated following systemic chemotherapy.
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http://dx.doi.org/10.3892/ol.2011.525DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3362621PMC
March 2012

Plasma D-dimer level as a mortality predictor in patients with advanced or recurrent colorectal cancer.

Oncology 2012 21;83(1):10-5. Epub 2012 Jun 21.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Objective: Plasma D-dimer levels are elevated in patients with a variety of solid tumors. Recently, it has been reported that the level before curative surgery is a prognostic factor for colorectal cancer (CRC). We investigated whether the plasma D-dimer level before systemic chemotherapies is a predictor for advanced or recurrent unresectable CRC.

Methods: This study included 42 patients treated with systemic chemotherapies for advanced or recurrent unresectable CRC. Variables including clinicopathological factors, plasma D-dimer levels and the modified Glasgow Prognostic Factor Score (mGPS) were evaluated.

Results: The plasma D-dimer level was closely related to the mGPS. Survival was shorter for patients with plasma D-dimer levels >5 µg/ml than for those with lower levels. Compared with an mGPS of 0 or 1, an mGPS of 2 was predictive of poor prognosis (p < 0.0001). Old age, advanced stage, plasma D-dimer level and mGPS were significantly associated with mortality, but plasma D-dimer level was the only independent risk factor in multivariate analysis, and was significant related to the clinical response to chemotherapy (p < 0.05).

Conclusions: Survival was significantly shorter in patients with elevated plasma D-dimer levels having advanced or recurrent CRC. The plasma D-dimer level before systemic chemotherapies was an independent mortality predictor.
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http://dx.doi.org/10.1159/000338329DOI Listing
October 2012

Laparoscopy-assisted resection for Mesenteric Castleman's disease: Report of a case.

Surg Today 2011 Oct 16;41(10):1405-9. Epub 2011 Sep 16.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6 Senda-Machi, Naka-ku, Hiroshima, 730-8619, Japan.

A 65-year-old female patient was diagnosed with breast cancer in 1995. An abdominal mass was detected by computed tomography and the patient was preoperatively diagnosed with a gastrointestinal stromal tumor. Laparoscopy-assisted surgical resection revealed a mesenteric Castleman's tumor of the hyaline vascular type. Mesenteric Castleman's disease is rare, and there have been only 42 cases reported in the English literature. We herein discuss the clinical findings of these cases.
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http://dx.doi.org/10.1007/s00595-010-4456-0DOI Listing
October 2011

Gastric carcinoma with protein-losing gastroenteropathy: report of a case.

Surg Today 2011 Jan 30;41(1):125-9. Epub 2010 Dec 30.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic-Bomb Survivors Hospital, 1-9-6 Senda-machi, Naka-ku, Hiroshima 730-8619, Japan.

This report describes the successful treatment of a case of true gastric cancer presenting as protein-losing gastroenteropathy. A 58-year-old Japanese male presented gastric carcinoma. His serum albumin and total protein levels were 1.8 and 4.2 g/dl, respectively. He was diagnosed with gastric cancer with protein-losing gastroenteropathy based on (99m)Tc-human serum albumin scintigraphy. The patient underwent a total gastrectomy following neoadjuvant chemotherapy. There are 23 detailed case reports of gastric carcinoma with protein-losing gastroenteropathy. Most of these cases had large villous or cauliflower-like gastric tumors that were defined as papillary or well differentiated adenocarcinoma. Gastric cancer with protein-losing gastroenteropathy is extremely rare, but it can easily be diagnosed if the villous or cauliflower-like features are well defined.
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http://dx.doi.org/10.1007/s00595-009-4209-0DOI Listing
January 2011

The Akt expression correlates with the VEGF-A and -C expression as well as the microvessel and lymphatic vessel density in breast cancer.

Oncol Rep 2010 Mar;23(3):621-30

Department of Breast Surgery, Hiroshima Red Cross and Atomic-bomb Survivors Hospital, Hiroshima 730-8619, Japan.

Akt activation has been found in various human cancers, while experimental studies have suggested that Akt plays an important role in the development of tumor angiogenesis and lymphangiogenesis. Immunohistochemical analyses for VEGF-C and Akt and the lymphatic endothelial specific marker D2-40 were performed on a series of 242 invasive ductal carcinomas of the breast, in which VEGF-A expression and microvessel density (MVD) had been determined previously. Lymphatic vessel density (LVD) was estimated in three hot spots. A significant correlation was observed between the VEGF-C expression and LVD (p=0.0026) and between LVD and the lymph node status (p<0.0001). The VEGF-C expression, however, did not correlate significantly with the lymph nodes status, while a high VEGF-C expression was associated with a smaller tumor size (p=0.0188). There was a significant correlation between VEGF-C and VEGF-A expression (p=0.0079) and between LVD and MVD (p=0.0008). The VEGF-C expression correlated with MVD (p<0.0001), while the VEGF-A expression correlated with LVD (p=0.0155). The Akt expression correlated with VEGF-A (p=0.0173) and -C expression (p=0.0056) as well as MVD (p=0.0482) and LVD (p=0.0012), while the correlation of Akt expression to VEGF-C expression and LVD was stronger than that to VEGF-A expression and MVD. Although the patients with a high LVD have a poorer disease-free survival than those with a low LVD (p=0.0005), a multivariate analysis determined the lymph node status and MVD to be independently significant factors for the disease-free survival. In conclusion, the correlation of both VEGF-C and VEGF-A to LVD and MVD suggested the two growth factors to be involved in both angiogenesis and lymphangiogenesis in breast cancer. The correlation of the Akt expression to the VEGF-A and -C expression as well as MVD and LVD, thus, suggested Akt activation to contribute to both angiogenesis and lymphangiogenesis via VEGF-A and -C expression in breast cancer.
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http://dx.doi.org/10.3892/or_00000677DOI Listing
March 2010

Hepatocellular carcinoma infiltrated with non-Hodgkin's lymphoma: report of a case.

Surg Today 2009 1;39(11):1010-2. Epub 2009 Nov 1.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

A 70-year-old woman diagnosed to have a hepatitis C virus (HCV) infection was referred to our hospital because of a solitary liver tumor. because of a solitary liver tumor. She underwent a partial hepatectomy, and the tumor was histologically diagnosed as a hepatocellular carcinoma (HCC). diagnosed as a hepatocellular carcinoma (HCC). In addition, a focal follicle consisting of atypical lymphoid cells was seen within the HCC. cells was seen within the HCC. Two months later, she was readmitted because of weakness and rapidly developing abdominal fullness. developing abdominal fullness. An abdominal computed tomography scan showed widespread tumors with ascites. with ascites. A cytological examination of the ascites showed large-sized atypical lymphoid cells. showed large-sized atypical lymphoid cells. An immunohistochemical stain confirmed that the atypical lymphoid cells within the HCC were positive for the CD 20 antigen. antigen. Taking these findings into account, the hepatic tumor was determined to be a HCC infiltrated with diffuse large B-cell lymphoma. diffuse large B-cell lymphoma. The coexistence of HCC and non-Hodgkin's lymphoma (NHL) is extremely rare. and non-Hodgkin's lymphoma (NHL) is extremely rare. We herein report a case of HCC infiltrated with NHL. We herein report a case of HCC infiltrated with NHL.
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http://dx.doi.org/10.1007/s00595-009-3966-0DOI Listing
October 2010

High dorsal resection for recurrent hepatocellular carcinoma originating in the caudate lobe.

Surg Today 2009 24;39(9):829-32. Epub 2009 Sep 24.

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Standards that enable surgeons to balance radical operative procedures with functional preservation for recurrent hepatocellular carcinoma (HCC) in the caudate lobe have not yet been established. A 54-year-old man with recurrent HCC originating in the caudate lobe was readmitted to our hospital. The combined resection of the adjacent hepatic parenchyma may have carried a risk of postoperative liver failure. The anterior transhepatic approach may have caused massive bleeding due to the presence of scarring from the previous hepatectomy. Therefore, we performed an isolated total caudate lobectomy, i.e., a "high dorsal resection" as a second hepatectomy. The postoperative course of the patient was uneventful, and there has been no local recurrence 1 year after the repeat hepatectomy. Indeed a "high dorsal resection" is rarely required, but it is still ingenious, and this surgical modality can balance the curability with the hepatic functional reserve even for recurrent caudate HCC in patients with liver cirrhosis.
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http://dx.doi.org/10.1007/s00595-009-3969-xDOI Listing
December 2009

The long-term outcome of atomic bomb survivors with gastric carcinoma.

J Surg Oncol 2009 Dec;100(7):594-7

Department of Surgery, Hiroshima Atomic Bomb Survivors Hospital, Hiroshima, Japan.

Objective: During the decade following the 1945 atomic bombing of Hiroshima, a high incidence of leukemia was observed among atomic bomb survivors. Subsequently, the incidence of other cancers gradually increased while that of leukemia decreased. We examined the long-term clinical outcome of gastric cancer and second primary cancer in atomic bomb survivors.

Methods: Results of surgical treatment of gastric cancer were reviewed in 231 atomic bomb survivors and 759 control patients between 1995 and 2006.

Results: Long-term prognosis of gastric cancer in atomic bomb survivors was significantly poorer than that in control patients (P < 0.05). In a multivariate analysis, age, depth of tumor invasion, lymph node metastases, and curability were found to be significant and independent prognostic factors for gastric cancer. The incidence of second primary cancer after gastric cancer was significantly higher in survivors than in control patients (P < 0.01), because the number of elderly patients in the survivors was higher.

Conclusions: Gastric cancer in survivors had a significantly poorer prognosis. Although the frequency of second primary cancer after gastric cancer in survivors was higher than that in control patients, it did not influence the prognosis.
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http://dx.doi.org/10.1002/jso.21399DOI Listing
December 2009

Prognostic re-evaluation of peritoneal lavage cytology in Japanese patients with gastric carcinoma.

Hepatogastroenterology 2009 Jan-Feb;56(89):261-5

Department of Surgery, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, 1-9-6, Senda-machi, Naka-ku, Hiroshima 730-8619, Japan.

Background/aims: The aim of the present study was to re-evaluate CY(+) with gastric carcinoma in Japanese patients to identify the characteristics that might distinguish patients with a poor prognosis from those with an intermediate prognosis among CY(+) patients.

Methodology: CY(+) was found in 56 of 566 patients (9.9%) who had undergone surgery for gastric carcinoma between January 2000 and December 2006. The 56 patients with CY(+) were classified into four groups: group A, P(-)CY(+) (n = 10); group B, P1CY (+) (n = 10); group C, P2,3CY(+) (n = 18); group D, other (n = 18).

Results: The 5-year survival of all patients with CY(+) was 12%. A multivariate analysis demonstrated serosal invasion, lymph node metastasis, and CY(+) to be independent prognostic factors. However, the 5-year survival in group A was 30%. The prognosis of group A patients was significantly better than that of patients in any other group (Groups B, C, D; p < 0.02). Sites of the recurrence in group A were located only in the peritoneum but the lymph nodes, etc.

Conclusions: Gastric carcinoma with CY(+) has a poor prognosis because it is associated with non-curative factors, peritoneal dissemination, and liver or lymph nodes metastases. However, a small subpopulation of patients with P(-)CY(+) showed an intermediate prognosis.
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June 2009
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