Language：English   Publisher：Proceedings of the National Academy of Sciences of the United States of America  

In the final step of cytokinin biosynthesis, the main pathway is the elimination of a ribose-phosphate moiety from the cytokinin nucleotide precursor by phosphoribohydrolase, an enzyme encoded by a gene named LONELY GUY (LOG). This reaction accounts for most of the cytokinin supply needed for regulating plant growth and development. In contrast, the LOG-independent pathway, in which dephosphorylation and deribosylation sequentially occur, is also thought to play a role in cytokinin biosynthesis, but the gene entity and physiological contribution have been elusive. In this study, we profiled the phytohormone content of chromosome segment substitution lines of Oryza sativa and searched for genes affecting the endogenous levels of cytokinin ribosides by quantitative trait loci analysis. Our approach identified a gene encoding an enzyme that catalyzes the deribosylation of cytokinin nucleoside precursors and other purine nucleosides. The cytokinin/purine riboside nucleosidase 1 (CPN1) we identified is a cell wall-localized protein. Loss-of-function mutations (cpn1) were created by inserting a Tos17-retrotransposon that altered the cytokinin composition in seedling shoots and leaf apoplastic fluid. The cpn1 mutation also abolished cytokinin riboside nucleosidase activity in leaf extracts and attenuated the trans-zeatin riboside-responsive expression of cytokinin marker genes. Grain yield of the mutants declined due to altered panicle morphology under field-grown conditions. These results suggest that the cell wall-localized LOG-independent cytokinin activating pathway catalyzed by CPN1 plays a role in cytokinin control of rice growth. Our finding broadens our spatial perspective of the cytokinin metabolic system.

DOI： 10.1073/pnas.2217708120

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PubMed

Language：English   Publisher：Nature Communications  

Oncogene-induced DNA replication stress (RS) and consequent pathogenic R-loop formation are known to impede S phase progression. Nonetheless, cancer cells continuously proliferate under such high-stressed conditions through incompletely understood mechanisms. Here, we report taurine upregulated gene 1 (TUG1) long noncoding RNA (lncRNA), which is highly expressed in many types of cancers, as an important regulator of intrinsic R-loop in cancer cells. Under RS conditions, TUG1 is rapidly upregulated via activation of the ATR-CHK1 signaling pathway, interacts with RPA and DHX9, and engages in resolving R-loops at certain loci, particularly at the CA repeat microsatellite loci. Depletion of TUG1 leads to overabundant R-loops and enhanced RS, leading to substantial inhibition of tumor growth. Our data reveal a role of TUG1 as molecule important for resolving R-loop accumulation in cancer cells and suggest targeting TUG1 as a potent therapeutic approach for cancer treatment.

DOI： 10.1038/s41467-023-40243-8

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

AIMS: To explore the feasibility of modified docetaxel, cisplatin, and capecitabine (mDCX) chemotherapy with a lower dose of docetaxel than previously reported for stage III resectable gastric cancer patients with a high risk of recurrence or for stage IV gastric cancer patients aiming for conversion surgery. METHODS: Patients with stage III resectable HER2-negative gastric cancer with large type 3 or type 4 tumors or extensive lymph node metastasis (bulky N or cN3) and those who had stage IV HER2-negative gastric cancer with distant metastasis were enrolled to receive 30 mg/m2 docetaxel and 60 mg/m2 cisplatin on day 1, followed by 2000 mg/m2 capecitabine per day for 2 weeks every 3 weeks. RESULTS: Five patients with stage III gastric cancer with a high risk of recurrence received three courses of mDCX, and four patients with stage IV gastric cancer received three or four courses of mDCX. In terms of grade 3 or worse adverse events, leukopenia was observed in one (11%) patient, neutropenia in two (22%) patients, anemia in one (11%) patient, anorexia in two (22%) patients and nausea in two (22%) patients. All six patients with measurable lesions achieved a partial response. All nine patients underwent subsequent surgeries. The histological responses of the nine patients revealed grade 3 in one (11%) patient, grade 2 in five (56%) patients, and grade 1a in three (33%) patients. Three of the nine patients survived without recurrence, and two of them survived for more than four years. CONCLUSIONS: mDCX seems to be feasible and may be helpful as neoadjuvant chemotherapy for patients at high risk of recurrence or as chemotherapy for patients who are likely to undergo conversion surgery.

DOI： 10.1111/ajco.13995

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PubMed

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>Use of immune checkpoint inhibitors (ICIs) has recently been recommended for treatment of unresectable or recurrent colorectal cancer with a microsatellite instability-high (MSI-H) status. We report a case of recurrent sigmoid colon cancer that was treated with ICIs followed by radical resection. One year after primary resection, the patient was diagnosed with localized peritoneal metastasis invading the left lower abdominal wall. The tumor presented as RAS/BRAF wild-type and was treated with FOLFIRI+panitumumab as 1st line chemotherapy. After shrinkage was observed, the patient was referred to our department for possible resection. Treated with ipilimumab plus nivolumab was used for further disease control of the borderline resectable tumor. However, interim imaging showed a slight increase in tumor size, so radical surgery (abdominal wall tumor resection+lymph node dissection+fascia lata abdominal wall reconstruction) was performed after three courses of ICI treatment. The pathological results showed a complete response, and the patient is now under observation with neither adjuvant therapy nor recurrence.</p>

DOI： 10.5833/jjgs.2022.0056

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CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

The present study aimed to assess the feasibility of global standard chemoradiotherapy (CRT) followed by surgery in patients with esophageal cancer. A prospective study was conducted at Nagoya University Hospital (Nagoya, Japan) to evaluate global standard CRT followed by surgery in patients with esophageal cancer. The CRT regimen consisted of 75 mg/m2 cisplatin on day 1 and 1,000 mg/m2 fluorouracil daily on days 1-4 given twice 4 weeks apart together with concurrent esophageal irradiation starting on day 1 (group A). For comparison, 17 patients with esophageal cancer who had received the same chemotherapy regimen but with lower drug doses were retrospectively reviewed: 70 mg/m2 cisplatin on day 1 and 700 mg/m2 fluorouracil daily on days 1-4 given twice 4 weeks apart together with concurrent esophageal irradiation starting on day 1 (group B). Grade 3 or worse adverse events were observed in 9 of the 12 patients (75%) in group A and in 5 of the 17 patients (29%) in group B. The patients in group A were more likely to experience grade 3 or worse neutropenia (50%) than those in group B (6%). No febrile neutropenia or treatment-related deaths occurred in either group. A total of 11 patients (92%) in group A and 16 patients (94%) in group B subsequently underwent an esophagectomy, and 9 (82%) and 14 (88%) of these patients, respectively, achieved microscopically margin-negative resection (R0 resection). In conclusion, global standard CRT was more likely to cause severe but manageable adverse events. There was no apparent difference in the R0 resection rate or postoperative complications between the two treatments. This clinical trial was registered at the Japan Registry of Clinical Trials (trial registration number: jRCT1041180004) on September 11, 2018.

DOI： 10.3892/mco.2023.2630

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PubMed

Language：Japanese   Publisher：(一社)日本外科学会  

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: In patients with esophageal cancer, muscle loss induced by neoadjuvant therapy before esophagectomy is correlated with poor prognosis. However, little is known about the causes of muscle loss. Thus, the purpose of this retrospective study was to clarify the risk factors for muscle loss during neoadjuvant therapy. PATIENTS AND METHODS: Patients with esophageal cancer who underwent neoadjuvant therapy before esophagectomy between 2009 and 2020 were investigated (n=132). The patients received either cisplatin plus 5-fluorouracil (CF); docetaxel, cisplatin plus 5-fluorouracil (DCF); or CF with radiotherapy as neoadjuvant therapy. The cross-sectional areas of the bilateral psoas muscles were measured at the level of the third lumbar vertebra using CT, before and after neoadjuvant therapy, and psoas muscle loss was calculated. The patients were divided into the high muscle loss group with 5% or more muscle loss or the low muscle loss group with less than 5% loss. Correlations between muscle loss and clinical factors were evaluated. RESULTS: The median value of psoas muscle loss was 5.30%. Psoas muscle loss was significantly correlated with a poor 3-year overall survival rate (p=0.034). Multivariate analysis showed that the independent factors associated with muscle loss were age ≥70 years [odds ratio (OR)=2.43, p=0.022], treatment with DCF (OR=3.47, p=0.034), and a poor response to neoadjuvant therapy (OR=2.68, p=0.028). CONCLUSION: A regimen of DCF was a major trigger of muscle loss during neoadjuvant therapy.

DOI： 10.21873/anticanres.16278

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: α-Bisabolol is an essential oil component extracted from plants, such as chamomile. We have previously reported that α-bisabolol suppressed proliferation, invasion, and motility of pancreas cancer. Cyclodextrin improved the solubility of α-bisabolol, therefore it enabled to administer intravenously. The aim of this study was to clarify the effect of cyclodextrin conjugated α-bisabolol (CD-BSB) and the signals pathways associated with α-bisabolol for pancreatic cancer. MATERIALS AND METHODS: Human pancreatic cancer cell lines were treated with or without CD-BSB. Cytomorphology and apoptosis were assessed in these treated groups. In addition, several phosphorylated proteins were analyzed to clarify the signal pathway concerning CD-BSB. In subcutaneous xenograft model, tumor volume and Ki-67 expression were evaluated among Control (untreated), CD-BSB, or Gemcitabine (GEM). RESULTS: CD-BSB significantly changed cytomorphology and induced apoptosis in pancreatic cancer cells. CD-BSB suppressed phosphorylation of focal adhesion kinase (FAK). In addition, pFAK 397 was inhibited by CD-BSB in a concentration-dependent manner in cancer cells. In the subcutaneous xenograft models, the tumor volume in the CD-BSB groups was lower than Control groups. Ki67-positive cells in CD-BSB treated group were lower than the GEM-treated groups. CONCLUSION: We clarified the efficiency of CD-BSB in xenograft tumor using intravenous administration. α-Bisabolol suppresses phosphorylation of FAK 397 and impairs cytoskeletal polymerization in a pancreatic cancer cell line. Further investigations are required to reveal the precise mechanisms of the antitumor effects of solubilized α-bisabolol to facilitate its clinical application. Our data indicate that solubilized α-bisabolol has therapeutic potential and could improve the prognosis of cancer patients.

DOI： 10.21873/anticanres.16245

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Deep ultraviolet (DUV) light spans within the 250 nm to 350 nm invisible wavelength range. Although it strongly damages various cells, the efficacy of DUV irradiation on pancreatic cancer cells has never been clarified. The purpose of this study was to reveal the antitumor effects of DUV irradiation on pancreatic cancer cells. MATERIALS AND METHODS: Human pancreatic cancer cell lines were eradicated with DUV or ultraviolet A (UVA) for 5 s. Several angiogenesis-related proteins were studied in cancer cells after DUV irradiation using a protein antibody array. A subcutaneous xenograft model was established by inoculation of pancreatic cancer cells into mice. Tumors in this model were irradiated with DUV or UVA once or twice for two weeks. Tumor volumes in these groups (DUV×1: one irradiation, DUV×2: two irradiations, and untreated) were analyzed one week after the second irradiation. RESULTS: DUV irradiation significantly changed the cytomorphology of pancreatic cancer cells. In addition, DUV irradiation induced apoptosis on pancreatic cancer cells more strongly than UVA irradiation and no irradiation. Interestingly, lower expression of thrombospondin 1 (TSP1) and tissue inhibitor of metalloproteinase 1 (TIMP1) was identified after DUV treatment. The tumor volume in the DUV-treated groups (DUV×1 and DUV×2) was smaller than that in the untreated group. CONCLUSION: Further investigations are required to reveal the precise mechanisms of the antitumor effects of DUV irradiation and to facilitate its clinical application as a new therapy for pancreatic cancer. Overall, DUV irradiation can be potentially used as a therapeutic option of pancreatic malignancy.

DOI： 10.21873/anticanres.16198

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PubMed

Language：English  

Stereotactic radiosurgery (SRS) with >5 fraction (fr) has been increasingly adopted for brain metastases (BMs), given the current awareness of limited brain tolerance for ≤5 fr. The target volume/configuration change and/or deviation within the cranium during fractionated SRS can be unpredictable and critical uncertainties affecting treatment accuracy, plus the effect of these events on the long-term outcome remains uncertain. Herein, we describe a case of two challenging BMs treated by 10 fr SRS with a unique dose-gradient optimization strategy, in which the large cystic tumor revealed an intriguing correlation of such inter-fractional change with late radiographic sequela, suggesting a dose threshold for attaining long-term local tumor control and being immune to symptomatic brain necrosis. A 63-year-old man presented with two cystic lesions located in the left parietal lobe (19.9 cm3) and pons (1.1 cm3) one month after surgery for esophageal squamous cell carcinoma. The principles for 10 fr SRS were as follows: (1) very inhomogeneous gross tumor volume (GTV) dose covered by 53 Gy, biologically effective dose with an alpha/beta ratio of 10 (BED10) of ≥80 Gy; (2) moderate dose spillage margin outside the GTV boundary: 2-2.5 mm outside the GTV margin was covered by 37 Gy, BED10 of ≈50 Gy; (3) concentrically-laminated, steep dose increase inside the GTV boundary: 2 mm inside the GTV margin was covered by ≥62 Gy, BED10 of ≥100 Gy. At the completion of SRS, the parietal lesion showed significant shrinking and dorsomedial shifting with slight evisceration of the GTV, followed by marked regression of the parietal lesion within four months. At 13.5 months, a cystic change was noted at the dorsal part of the remnant. At 16.7 months, ventral enhancement gradually expanded without enlargement of the dorsal cystic component. On the T2-weighted images, the dorsal low-intensity remnant and ventral iso-intensity blurry-demarcated component were contrasting. Pathological examinations during and after lesionectomy at 17.4 months revealed necrosis only. At 30.5 months, the patient had a left visual field defect without recurrence. In contrast, the pons lesion showed no notable change during 10 fr SRS and nearly complete remission over six months with its sustainment without radiation injury at 30.5 months. Taken together, 10 fr SRS with a sufficient BED10 can provide superior tumor response and safety for BM that is not amenable to ≤5 fr SRS. Although a very inhomogeneous GTV dose can contribute to early and adequate tumor shrinkage and subsequent local tumor eradication, significant tumor shrinkage during fractionated SRS (fSRS) inevitably results in unnecessary higher dose exposure to the surrounding brain, which could lead to late radiation injury requiring intervention. The optimum dose should be determined through further investigation, in consideration of the dynamic and unpredictable nature of the actual absorbed doses to both the tumor and the surrounding brain.

DOI： 10.7759/cureus.33411

PubMed

Publisher：IEEJ Journal of Industry Applications  

This paper proposes the controller design for a shape memory alloy (SMA) positioning actuator system. The system utilizes spiral-formed SMA wire as the driving power source. SMA generates force via temperature-based crystalline phase transitions. The wire is deformed in the spiral form under low temperature and heated by applying direct current, it recovers to the original form and generates the recovering force, which rotates the attached load. This paper proposes using the electric resistance of the SMA, which is related to its crystalline phase status, for designing the controller of the actuator system. The feasibility of the proposed system and controller design are evaluated experimentally with a sample test device, manufactured using a 3D printer, and the device achieves the designed rotation.

DOI： 10.1541/ieejjia.L22000583

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: The docetaxel and cisplatin plus 5-fluorouracil (5-FU) (DCF) regimen is expected to be superior to cisplatin plus 5-FU for the preoperative treatment of esophageal cancer. However, a high risk of adverse effects, including febrile neutropenia (FN), has been reported. To evaluate the effectiveness and safety of DCF with prophylactic pegfilgrastim, we conducted a phase II study. METHODS: The regimen consisted of intravenous administration of docetaxel (70 mg/m2 per day) and cisplatin (70 mg/m2 per day) on day 1 and a continuous infusion of 5-FU (750 mg/m2 per day) on days 1-5. A single 3.6-mg dose of pegfilgrastim was given as a subcutaneous injection on day 7 of each cycle. This regimen was repeated every 3 weeks for a maximum of three cycles. The primary endpoint was the grade-2/3 histopathological response rate. RESULTS: Thirty-seven eligible patients were enrolled and received DCF. Thirty-four patients underwent esophagectomy. Two patients received chemoradiotherapy or radiotherapy without surgery. One patient withdrew consent and ended his hospital visit. One patient received additional radiotherapy before surgery. Histopathological responses of grade 3, grade 2, grade 1b, and grade 1a were observed in two (5.4%), 14 (37.8%), 10 (27.0%), and seven (18.9%) patients, respectively, and the primary endpoint was met. Of the 37 eligible patients, 11 (29.7%) developed FN in the first cycle. CONCLUSIONS: Since the histopathological responses were as expected, DCF with prophylactic pegfilgrastim is considered to be effective as preoperative chemotherapy. However, the prophylactic use of pegfilgrastim on day 7 was insufficient to prevent FN.

DOI： 10.1111/ajco.13755

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Late-onset postoperative pneumonia (LOPP) after esophagectomy is poorly understood. This study was designed to clarify the features and risk factors for this event. Patients who underwent esophagectomy for esophageal cancer between 2006 and 2016 were included. LOPP was defined as radiologically proven pneumonia that occurred over 3 months after surgery, and clinically relevant late-onset postoperative pneumonia (CR-LOPP) was defined as LOPP that required administration of oxygen and antibiotics in the hospital and/or more intensive treatment. The total psoas muscle area (TPA) was measured using preoperative and postoperative (at 3 months after surgery) computed tomography scan images. Potential risk factors for CR-LOPP were investigated. Among 175 study patients, 46 (26.3%) had LOPP, 29 (16.6%) of whom exhibited CR-LOPP with a cumulative incidence of 15.6% at 3 years and 22.4% at 5 years. Four (13.8%) of these patients died of LOPP. Univariable analysis showed that clinical stage ≥III (P = 0.005), preoperative prognostic nutritional index (PNI) <45 (P = 0.035), arrhythmia (P = 0.014), postoperative hospital stay ≥40 days (P = 0.003), and percent decrease of TPA more than 5% (P < 0.001) were associated with CR-LOPP but not early onset postoperative pneumonia. Multivariable analysis revealed that clinical stage ≥III (hazard ratio [HR] 3.01, P = 0.004), postoperative hospital stay ≥40 days (HR 2.51, P = 0.015), and percent decrease of TPA >5% (HR 9.93, P < 0.001) were independent risk factors for CR-LOPP. CR-LOPP occurred in over 20% of patients at 5 years, and early postoperative loss of TPA was a potential trigger for this delayed complication.

DOI： 10.1093/dote/doac019

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

Trefoil factor family 1 (TFF1) is one of three members of the trefoil factor family that are abundantly expressed in the gastrointestinal mucosal epithelium. Recent studies have shown that TFF1 acts as a tumor suppressor in gastric, pancreatic and hepatocellular carcinogenesis; however, little is known about its function in esophageal carcinogenesis, especially in esophageal adenocarcinoma (EAC). Barrett's epithelium is the metaplastic columnar epithelium of the esophagus and a known premalignant lesion of EAC. To investigate the role of TFF1 in EAC development, a mouse model of Barrett's epithelium was employed, and human specimens of EAC were assessed by immunohistochemistry (IHC) and methylation-specific PCR. Wild-type (WT) mice underwent gastrojejunostomy on the forestomach, resulting in the development of Barrett's epithelium-like (BE-like) epithelium adjacent to the anastomotic site. BE-like epithelium in these mice expressed TFF1, indicating the association of TFF1 with esophageal adenocarcinoma. TFF1-knockout (TFF1KO) mice underwent the same procedure as well, revealing that a deficiency in TFF1 resulted in the development of adenocarcinoma in the anastomotic site, presumably from BE-like epithelium. IHC of human samples revealed strong TFF1 expression in Barrett's epithelium, which was lost in some EACs, confirming the association between TFF1 and EAC development. Aberrant DNA hypermethylation in TFF1 promoter lesions was detected in TFF1-negative human EAC samples, further confirming not only the role of TFF1 in EAC but also the underlying mechanisms of TFF1 regulation. In addition, IHC revealed the nuclear translocation of β-catenin in human and mouse EAC, suggesting that activation of the Wnt/β-catenin pathway was induced by the loss of TFF1. In conclusion, these results indicate that TFF1 functions as a tumor suppressor to inhibit the development of esophageal carcinogenesis from Barrett's epithelium.

DOI： 10.1038/s41374-022-00771-1

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PubMed

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407213704

CiNii Research

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

局所再発直腸癌に対する治療戦略はその病態の不均一性から治療は個々の症例に応じて選択すべきである.そのためには,手術技術を磨くことは当然のことであるが,近年発達著しい集学的治療の知識を身に着け,経験を積むことが必要不可欠である.性質上,無作為化比較試験からの情報を得ることが難しく,多くがセンター施設での経験に基づく指針ではあるが,本稿では,本邦および海外での局所再発直腸癌治療の現状と展望を述べる.(著者抄録)

Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>We report two cases of cholangiocarcinoma with a small cell carcinoma (SCC) component that exhibited contrasting courses after resection, with early death versus long-term survival. Case 1 was a 70-year-old man who underwent left hepatectomy with caudate lobectomy for perihilar cholangiocarcinoma. Histopathological examination showed adeno-neuroendocrine carcinoma composed of papillary adenocarcinoma and SCC. The tumor was classified as pT2N0M0, Stage II, but with extensive venous invasion from SCC. Gemcitabine alone was administered postoperatively based on normal treatment of biliary tract cancer, but the patient died only five months after surgery due to early relapse with multiple liver metastases. Case 2 was a 65-year-old man who underwent subtotal stomach preserving pancreatoduodenectomy for distal cholangiocarcinoma. Histopathological examination showed neuroendocrine SCC with lymph node metastasis. The tumor was classified as pT2N1M0, Stage III. As standard chemotherapy for pulmonary SCC, cisplatin plus etoposide was given for 4 cycles postoperatively. The patient has been alive without recurrence for 8 years after surgery. An SCC component in cholangiocarcinoma often leads to early relapse with subsequent cancer-related death after resection. Therefore, multidisciplinary approach including chemotherapy similar to that for pulmonary SCC should be considered in this setting.</p>

DOI： 10.5833/jjgs.2021.0083

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CiNii Research

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Publisher：南江堂  

DOI： 10.15106/j_geka84_136

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND & AIMS: To elucidate the impact of synbiotics on bacterial translocation and subsequent bacteremia during neoadjuvant chemotherapy for esophageal cancer. METHODS: Patients requiring neoadjuvant chemotherapy for esophageal cancer were randomized to receive synbiotics (synbiotics group) or no synbiotics (control group) during chemotherapy. Blood and fecal samples were taken before and after every chemotherapy cycle, and 1 day before surgery. Mesenteric lymph nodes (MLNs) were harvested at laparotomy (MLN-1) and after resection of the tumor (MLN-2). Bacteria in each sample were detected. Fecal microbiota and organic acid concentrations were also determined. The primary endpoint was the detection of bacteria in the blood samples, as well as the incidence of side effects during chemotherapy. The secondary endpoint was the detection rate of bacteria in the MLN samples collected during surgery. RESULTS: The study recruited a total of 42 patients (22 in the control group, 20 in the synbiotics group). Bacteria were detected in 16 of 101 blood samples in the control group, whereas those were detected only 2 of 100 blood samples in the synbiotics group (p < 0.001) during neoadjuvant chemotherapy. Additionally, bacteria were detected in 12 of 34 MLN samples in the control group, whereas no bacteria were detected in 38 MLN samples in the synbiotics group (p < 0.001). Suppression of bacterial translocation was at least partly associated with an increased fecal acetic acid concentration as well as a lowered fecal pH by synbiotics. The incidence rate of grade 3 gastrointestinal toxicity during chemotherapy was lower in the synbiotics group compared to the control group (8/22 vs. 1/20, p = 0.022). CONCLUSIONS: Neoadjuvant chemotherapy for esophageal cancer may induce bacterial translocation and subsequent bacteremia, which can be prevented by synbiotics administration. TRIAL REGISTRATION: The University Hospital Medical Information Network (http://www.umin.ac.jp; registration number ID 000007651).

DOI： 10.1016/j.clnu.2021.10.004

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PubMed

Language：English   Publishing type：Research paper (scientific journal)  

In Japan, esophagectomy after two courses of 5-fluorouracil plus cisplatin is regarded a standard strategy for treating resectable stage II or III esophageal squamous cell carcinoma (ESCC). However, 5-fluorouracil plus cisplatin does not benefit cohorts with clinical stage III ESCC, suggesting the requirement for a more effective regimen. We are conducting a single-arm phase II study to assess the safety and efficacy of neoadjuvant docetaxel, oxaliplatin plus S-1 (DOS) for treating patients with clinical stage III ESCC. The primary endpoint is the pathological response rate, and the target number is 45 patients. Safety, response rate, R0 resection rate, and survival are secondary endpoints. This trial is registered in the Japan Registry of Clinical Trials as jRCTs041210023. We are conducting a prospective phase II trial to evaluate the safety and efficacy of three courses of neoadjuvant DOS treatment followed by radical esophagectomy for clinical stage III ESCC.

DOI： 10.1016/j.conctc.2021.100853

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PubMed

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407213500

CiNii Research

Language：Japanese   Publisher：Japanese Journal of Cancer and Chemotherapy  

Scopus

Language：Japanese   Publishing type：Research paper (scientific journal)  

PubMed

Language：Japanese   Publisher：(株)癌と化学療法社  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00296&link_issn=&doc_id=20211021370007&doc_link_id=%2Fab8gtkrc%2F2021%2F004810%2F008%2F1223-1226%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2021%2F004810%2F008%2F1223-1226%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407213349

CiNii Research

Publisher：金原出版  

DOI： 10.18888/op.0000002217

CiNii Research

Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>Patients with colorectal cancer with the BRAF V600E mutation, which rarely coexists with a RAS mutation, have an extremely poor prognosis. In contrast, the outcomes of patients with a BRAF mutation and high microsatellite instability (MSI-high) have been found to be favorable. Thus, the significance of having multiple mutations remains unclear. We experienced a rare case with cervical lymph node metastasis from right-sided transverse colon cancer with RAS mutation, BRAF mutation and MSI-high, which developed 9 months after primary resection, just after completion of oxaliplatin-based 6-month adjuvant chemotherapy. As second-line chemotherapy, the patient received FOLFIRI plus aflibercept for 12 months. The tumor shrank markedly from 37 mm to 12 mm in maximum diameter and no new lesion was found; therefore, she underwent conversion surgery. Pathological findings confirmed no residual cancer cells (pathological complete response). Although the postoperative follow-up period is still <9 months, the patient has had no additional treatment after conversion surgery and is alive without recurrence. This case suggests that even in patients with metastatic colorectal cancer with the BRAF V600E mutation, aggressive surgical treatment might be an option in a situation of well-controlled systemic disease similar to that without a BRAF mutation. Further investigation of the significance of coexisting MSI-high with a BRAF mutation is required.</p>

DOI： 10.5833/jjgs.2020.0057

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CiNii Research

Language：Japanese   Publisher：金原出版(株)  

症例は60歳代男性で、下咽頭癌術後7年の上部消化管内視鏡検査で中咽頭癌と胸部上部表在食道癌が指摘された。中咽頭癌に対するELPS(endoscopic laryngopharyngeal surgery)を先行し、その後、食道癌に対するESD(endoscopic submucosal dissection)を予定した。下咽頭癌に対する手術時、術後に永久気管孔壊死と皮弁壊死を繰り返し、右DP(deltopectoral)皮弁再建、さらに左DP皮弁再建が追加された。気管血流を温存することに配慮して術式を立案した。気管支動脈、奇静脈弓のほか、伴走する右気管支動脈の上行枝と下行枝を温存し、大動脈弓から直接分岐する左気管枝動脈も温存し、気管分岐部の郭清を省略した。さらに、腹腔鏡用手補助下胃管を作製、後縦隔経路で胃管を挙上した。頸部は皮弁からの気管孔血流を温存するため、左DP皮弁外縁で切開、遊離空腸-食道吻合部で離断し、残食道を全摘した。その後、吻合部狭窄に対しバルーン拡張を、嚥下機能低下に対し嚥下訓練を行い、術後101日から食事を開始し術後138日に退院した。

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J00620&link_issn=&doc_id=20210428180019&doc_link_id=10.18888%2Fop.0000002217&url=https%3A%2F%2Fdoi.org%2F10.18888%2Fop.0000002217&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Gastro-tracheobronchial fistula after esophagectomy is a rare but life-threatening complication associated with high mortality. Several authors reported postoperative management of tracheobronchial fistula. However, treatment is demanding and challenging, and the strategy is still controversial. CASE PRESENTATION: A 64-year-old man underwent thoracoscopic esophagectomy with two-field lymph node dissection and gastric conduit reconstruction by an intrathoracic anastomosis for esophageal cancer at a local hospital in June 2013. After surgery, a gastro-tracheal fistula and a gastro-bronchial fistula of the left main bronchus were diagnosed, and the patient was referred to our hospital for the management of the gastro-tracheobronchial fistula. CT and bronchoscopy and esophagogastroduodenoscopy performed at our hospital revealed that the gastro-bronchial fistula of the left main bronchus was cured by packing with the omentum from the gastric conduit and the gastro-tracheal fistula located 3 cm above the carina remained open. We concluded that the fistula would not resolve without further surgical procedure. However, such an operation was expected to be difficult and to need much time due to severe adhesion among the gastric conduit and/or trachea, bronchus, lung, and chest wall. Therefore, a two-stage operation was planned for safety and outcome certainty. The first operation was performed to close the fistula in October 2013. The gastric conduit was separated from the trachea and resected; then, the fistula was sutured and covered by intercostal muscle and latissimus dorsi muscle flaps. A month after the first operation, reconstruction with pedunculated jejunum was performed via the percutaneous route. The patient's postoperative course was uneventful. CONCLUSION: If the omentum is not observed between the gastric conduit and the tracheobronchus when a gastro-tracheobronchial fistula occurs after esophagectomy, surgeons should perform surgical treatment because conservative treatment is unlikely to cure. During surgery, the use of two types of muscle flaps, such as the intercostal muscle and the latissimus dorsi muscle flaps, is helpful for the closure of gastro-tracheobronchial fistulas.

DOI： 10.1186/s40792-020-00936-4

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Locally advanced hepatocellular carcinoma (HCC), which is unsuitable for standard locoregional therapies, remains a challenge to manage. Among the recently developed treatments, proton beam therapy (PBT) has been reported to achieve good local control. However, in patients with large HCC adjacent to the esophagus, high-dose PBT may rarely lead to radiation-induced esophageal necrosis or perforation. Furthermore, the optimal strategy to safely treat these fatal complications remains unclear. CASE PRESENTATION: A 49-year-old man who was diagnosed with a large (16 cm) HCC in the right lobe with tumor thrombosis in the main trunk of the portal vein (PVTT) received high-dose hypofractionated PBT in another hospital. A total dose of 66 GyE in 10 fractions was administered to the primary tumor and the PVTT. After 5 months, a 1-cm solitary nodule was noted in the upper lobe of the right lung. Therefore, sorafenib was started. About 6 months after the PBT, lower esophageal mucosal inflammation that progressed to an ulcer was noted. About 7 months after the PBT, the lower esophagus developed full-thickness necrosis. Therefore, emergency thoracoscopic esophagectomy was performed, followed by two-stage reconstruction 2 months later. The operation and postoperative clinical course were mostly uneventful, except for a minor anastomotic leakage. The outcome of the primary HCC, including the PVTT, was graded as a complete response, which has been maintained for 51 months after the PBT. CONCLUSION: PBT is a promising option for patients with locally advanced HCC; however, for large tumors adjacent to the esophagus, ischemic esophageal necrosis due to antiangiogenic effects may occur, particularly with the combined use of PBT and sorafenib. In such a life-threatening condition, the thoracoscopic esophagectomy and the two-stage reconstruction are a safe option that can prevent critical postoperative complications due to the poor general condition, effects of PBT on the remnant gastric conduit, and use of sorafenib.

DOI： 10.1186/s40792-020-00902-0

Web of Science

PubMed

Publisher：南江堂  

DOI： 10.15106/j_geka82_742

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

Anastomotic leakage after esophagectomy is associated with prolonged hospitalization and increased medical cost. Additionally, it sometimes leads to a fatal condition and impaired postoperative quality of life. During the process of wound healing, β-hydroxy-β-methylbutyrate (HMB) is important for collagen biosynthesis. An open-label prospective intervention trial has been designed to evaluate the treatment effect of an enteral nutrient containing HMB with arginine and glutamine (Abound, Abbott Japan Co., Ltd.) for leakage at the anastomotic site after esophagectomy. Patients in whom leakage at the anastomotic site developed within 14 days after esophagectomy are eligible and Abound (24 g) is administered for 14 days through an enteral feeding tube. The target sample size is 10. The primary endpoint is duration between diagnosis and cure of leakage. Surgical procedure, safety, length of fasting, drainage placement and hospital stay, and nutritional status are determined as secondary endpoints. A historical control consisting of 20 patients who had leakage at the anastomotic site after esophagectomy between 2005 and 2018 at Nagoya University Hospital is compared with enrolled patients.

DOI： 10.18999/nagjms.82.1.33

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: The aim of this study was to evaluate the impact of cervical lymph node dissection on acid reflux and duodenogastroesophageal reflux (DGER) in patients undergoing transthoracic esophagectomy with gastric tube reconstruction and intrathoracic esophagogastrostomy. METHODS: Thirty-one patients receiving transthoracic esophagectomy with gastric tube reconstruction by intrathoracic esophagogastrostomy were divided into the following two groups: a two-field lymph node dissection group (2F group) and a three-field lymph node dissection group (3F group). All patients underwent 24-h pH and bilirubin monitoring and gastrointestinal endoscopy at 1 year after surgery. The 24-h pH and bilirubin monitoring results, endoscopic findings, and reflux symptoms were compared between the 2 groups. RESULTS: No acid reflux was observed in the 2F group, whereas it was observed in 6 (40%) patients in the 3F group (p = 0.007). DGER was found in 2 patients (13%) in the 2F group and in 8 (53%) in the 3F group (p = 0.023). Four patients (25%) in the 2F group and 9 (60%) in the 3F group (p = 0.048) had reflux esophagitis. CONCLUSION: Cervical lymph node dissection increases acid reflux and DGER and can lead to an increase in the incidence of reflux esophagitis in patients undergoing intrathoracic esophagogastrostomy.

DOI： 10.1007/s00595-019-01835-4

Web of Science

Scopus

PubMed

DOI： 10.18999/nagjms.81.4.679

Web of Science

DOI： 10.18999/nagjms.81.4.693

Web of Science

Publisher：学研メディカル秀潤社  

DOI： 10.15105/gz.0000001162

CiNii Research

Language：Japanese   Publisher：Japan Surgical Association  

<p>A 41-year-old man with chest pain visited a nearby hospital in February 2017. Chest CT scan detected a mediastinal cystic tumor, and he was referred to our hospital for further examination and treatment. In the blood test, the serum CA19-9 level was as high as 5,960 U/ml, and upper gastrointestinal endoscopy showed a submucosal bulging with bluish purple mucosa encircling the half of the lumen in the middle to lower esophagus.</p><p>Ultrasound endoscopy visualized the lesion as a tumor with mosaic pattern contents, indicating the presence of hematoma. CT scan showed an 83 × 41 × 115 mm bilocular cystic lesion in the anterior surface of the esophagus which compressed and narrowed the esophagus. Although it was diagnosed as esophageal cyst, he had chest pain and dysphagia, and so cystectomy using thoracoscopy was performed in March. The postoperative course was uneventful and he was discharged on the 10th postoperative day. Histologically, pseudostratified epithelium was found on the inner surface of the cyst and the cystic wall had two muscular layers. Duplication cyst was thus diagnosed.</p>

DOI： 10.3919/jjsa.80.700

CiNii Research

Web of Science

Publisher：南江堂  

DOI： 10.15106/j_geka80_851

CiNii Research

Language：Japanese   Publisher：Japan Society for Surgical Infection  

<p>【Aim】To report the course and management for Clavien-Dindo gradeⅢ・Ⅳ complications after hepatectomy with extrahepatic bile duct resection.【Patient】428 consecutive patients who underwent hepatobiliary resection with cholangiojejunostomy between January 2009 and December 2015 were analyzed retrospectively.【Results】There were 278 men and 150 women, with a median age of 68 years (range 29-89 years) . The cases of Grade Ⅲ complications were 229, and those of Ⅳ were 28. Compared with Grade Ⅲ, the rate of male patients, the incidence of preoperative bacteremia of patients with Grade Ⅳ was significantly higher. Compared with Grade Ⅲ, the incidence of combined vascular resection of patients with Grade Ⅳ was significantly higher, operative time was longer, and blood loss was much more. Compared with Grade Ⅲ, the incidence of incisional SSI, pneumoniae, and postoperative bacteremia of patients with Grade Ⅳ was significantly higher. The amount of blood loss more than 1,500mL, presence of pneumoniae, and bacteremia were recognized as a risk factor of postoperative hepatic failure. 【Conclusion】 The management and control for Clavien-Dindo grade Ⅲ complications leads to prevention of occurrence of Grade Ⅳ complications. </p>

DOI： 10.24679/gekakansen.15.3_201

CiNii Research

Language：Japanese   Publisher：(一社)日本外科感染症学会  

【目的】胆道再建を伴う肝切除術後のClavien-Dindo Grade III・IV症例の経過について検討すること。【対象と方法】2009年から2015年の7年間における胆道再建を伴う肝切除施行例428例を対象として、Grade III・IV症例の患者背景・術式・術後合併症および治療経過について比較検討した。肝不全発症の危険因子についても検討した。【結果】Grade IV症例はIII症例に比較して、右肝切除施行および血管合併切除併施症例が多く、出血量が多かった。術後合併症では肺炎・敗血症の発症が多く、平均在院期間は長かった。肝不全発症の危険因子は出血量1,500mL以上、肺炎・敗血症の発症であった。Grade III・IV症例ともに治療法は、腹腔内のドレナージ状況を良好に保つこと、全身性の感染症が疑われる際は抗菌薬を追加投与することが基本となる。【結論】Clavien-Dindo Grade III症例に対する感染管理を徹底することが、Clavien-Dindo Grade IV症例の発症予防につながる。(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J04188&link_issn=&doc_id=20180925370001&doc_link_id=%2Fdg9srgif%2F2018%2F001503%2F001%2F0201-0208%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdg9srgif%2F2018%2F001503%2F001%2F0201-0208%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Publisher：Neurology and Clinical Neuroscience  

A 58-year-old man with Parkinson's disease experienced peritonitis after percutaneous endoscopic gastrojejunostomy (PEG-J) for levodopa–carbidopa intestinal gel treatment despite concomitant use of gastropexy. Although gastropexy reduces complications including peritonitis, clinicians should consider structural characteristics of PEG-J devices and patients’ anatomical differences. We recommend that suture threads are removed 2–4 weeks after PEG-J and that the PEG-J tube length outside the body is routinely recorded to assess tube dislocation.

DOI： 10.1111/ncn3.12183

Web of Science

Scopus

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of this study was to evaluate the impact of the location of esophagogastrostomy on acid and duodenogastroesophageal reflux (DGER) in patients undergoing gastric tube reconstruction and intrathoracic esophagogastrostomy. METHODS: Thirty patients receiving transthoracic esophagectomy without cervical lymph node dissection and gastric tube reconstruction by intrathoracic anastomosis were enrolled. All patients underwent 24-h pH and bilirubin monitoring and gastrointestinal endoscopy one year after surgery. Patients were divided into three groups according to esophagogastrostomy location: group A (n = 9), above the top of the aortic arch; group B (n = 15), between the top and bottom of the aortic arch; and group C (n = 6), below the bottom of the aortic arch. The relations among the esophagogastrostomy location, 24-h pH and bilirubin monitoring results, endoscopic findings, and reflux symptoms were investigated. RESULTS: No acid reflux into the remnant esophagus was observed in group A, whereas it was observed in three of 15 patients (20%) in group B and in two of six patients (33%) in group C (P = 0.139). No DGER was found in group A, whereas DGER was observed in eight (53%) patients in group B and all patients in group C (P < 0.001). Reflux esophagitis was observed in one patient (11%) in group A, five patients (33%) in group B, and all patients in group C (P = 0.002). CONCLUSION: In gastric tube reconstruction via intrathoracic anastomosis, esophagogastrostomy should be performed above the top of the aortic arch to prevent postoperative DGER and reduce the incidence of reflux esophagitis.

DOI： 10.1007/s00268-017-4186-1

Web of Science

Scopus

PubMed

Language：Japanese   Publisher：Japan Surgical Association  

A 50-year-old woman was diagnosed with unresectable advanced middle thoracic esophageal cancer with lymph node metastases involving the trachea in July 2008. After definitive chemoradiotherapy (dCRT) with cisplatin (CDDP) / 5-fluorouracil (5-FU) and 60 Gy irradiation and additional 2 courses of CDDP / 5-FU were performed, complete response (CR) was obtained. Around half year after the treatment, positron emission tomography-computed tomography showed para-aortic lymph node (PAN) and supraclavicular lymph node (SCN) metastases. Five courses of CDDP / 5-FU and 3 courses of 5-FU / nedaplatin (CDGP) were performed. CR was achieved for PAN but not for SCN, which was judged as stable disease (SD). Since no other lesions were identified, she underwent salvage lymphadenectomy in July 2010. Seven months after the operation, paraesophageal and peri-gastric lymph nodes metastases were detected. After 5 courses of 5-FU / CDGP, the metastatic lymph nodes disappeared. However, relapse of paraesophageal lymph node metastasis and secondary primary esophageal cancer at 23 cm from the incisor teeth developed in February 2012. As R0 resection could be expected, salvage esophagectomy by laparotomy-right thoracotomy approach was performed in March 2012. The patient is now alive without recurrence for 3 years and 7 months after the salvage esophagectomy (or 7 years and 3 months after dCRT).

DOI： 10.3919/jjsa.79.84

CiNii Research

Publisher：株式会社医学書院  

DOI： 10.11477/mf.1407211870

CiNii Research

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of this study is to evaluate the clinical value of a prophylactic minitracheostomy (PMT) in patients undergoing an esophagectomy for esophageal cancer and to clarify the indications for a PMT. METHODS: Ninety-four patients who underwent right transthoracic esophagectomy for esophageal cancer between January 2009 and December 2013 were studied. Short surgical outcomes were retrospectively compared between 30 patients at high risk for postoperative pulmonary complications who underwent a PMT (PMT group) and 64 patients at standard risk without a PMT (non-PMT group). Furthermore, 12 patients who required a delayed minitracheostomy (DMT) due to postoperative sputum retention were reviewed in detail, and risk factors related to a DMT were also analyzed to assess the indications for a PMT. RESULTS: Preoperative pulmonary function was lower in the PMT group than in the non-PMT group: FEV1.0 (2.41 vs. 2.68 L, p = 0.035), and the proportion of patients with FEV1.0% <60 (13.3% vs. 0%, p = 0.009). No between-group differences were observed in the proportion of patients who suffered from postoperative pneumonia, atelectasis, or re-intubation due to respiratory failure. Of the 12 patients with a DMT, 11 developed postoperative pneumonia, and three required re-intubation due to severe pneumonia. Multivariate analysis revealed FEV1.0% <70% and vocal cord palsy were independent risk factors related to a DMT. CONCLUSION: A PMT for high-risk patients may prevent an increase in the incidence of postoperative pneumonia and re-intubation. The PMT indications should be expanded for patients with vocal cord palsy or mild obstructive respiratory disturbances.

DOI： 10.1186/s12893-017-0321-z

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Intra-abdominal desmoid tumors, particularly those derived from the stomach, are rare. Such tumors are associated with a history of familial adenomatous polyposis (FAP), trauma, or surgical procedures in general. In addition, spontaneous shrinking of an intra-abdominal desmoid tumor is rarer. And desmoid tumors most commonly arise during the fourth decade of life. CASE PRESENTATION: A 17-year-old boy with lower abdominal pain was diagnosed with a gastrointestinal stromal tumor (GIST) or a hematoma at a local hospital. He had no history of FAP, trauma, or previous surgery. Abdominal computed tomography (CT) was performed for observational purposes three times over a 9-month period. The tumor gradually decreased in size over time; however, the tumor did not shrink sufficiently to be diagnosed as a hematoma. Because there was a high possibility of a GIST from the stomach, he underwent laparotomy. Operative findings revealed that the tumor was a hard mass firmly attached to both the greater curvature of the stomach and the inferior pole of the spleen. Pathologically, the tumor was diagnosed as a desmoid tumor derived from the stomach. CONCLUSION: For a young boy without a history of FAP, trauma, or surgical procedures, it is difficult to define an intra-abdominal tumor near the stomach as a desmoid tumor. In such cases, surgical resection is recommended for a definitive diagnosis.

DOI： 10.1186/s40792-017-0330-2

Web of Science

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Upper extremity deep vein thrombosis (UEDVT) is a rare but important complication because it can cause pulmonary embolism. The aim of this study was to investigate the incidence of UEDVT after esophagectomy and the risk factors related to UEDVT. METHODS: This study included 88 patients who underwent esophagectomy with retrosternal or posterior mediastinal reconstruction using gastric tube. The incidence of UEDVT and the diameter of left brachiocephalic vein were measured using postoperative contrast-enhanced computed tomography (CT). (a) The distance from sternum to brachiocephalic artery and (b) the distance from sternum to vertebra were measured by preoperative CT, and the ratio of (a) to (b) was defined as the width of the retrosternal space. RESULTS: Among the patients, 14 (15.9%) suffered from UEDVT. All UEDVTs were found in left-side upper extremity deep veins. Twelve of the 14 patients (85.7%) underwent retrosternal reconstruction. In a multivariate analysis, retrosternal reconstruction was an independent risk factor for UEDVT (odds ratio 5.48). The diameter of the left brachiocephalic vein in patients with retrosternal reconstruction was significantly smaller than that in patients with posterior mediastinal reconstruction (4.3 vs 6.9 mm; P < 0.001) due to compression of left brachiocephalic vein by the gastric tube. Among patients with retrosternal reconstruction, the width of the retrosternal space in patients with UEDVT was significantly smaller than that in patients without UEDVT (0.21 vs 0.27; P = 0.001). CONCLUSION: Retrosternal reconstruction can be a risk factor for UEDVT. In patients with small width of the retrosternal space, retrosternal reconstruction might be inappropriate.

DOI： 10.1007/s00268-017-4120-6

Web of Science

Scopus

PubMed

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Acute esophageal necrosis (AEN) is a rare clinical disorder. Esophageal stenosis or obstruction is one of severe complications, but there are a few reports about surgical treatments. In such a situation, it still remains controversial which to choose, esophagectomy or bypass operation. CASE PRESENTATION: A 61-year-old woman was admitted to the local hospital for septic shock with diabetic ketoacidosis due to necrotizing fasciitis of the right thigh. Three days later, she had hematemesis, and gastrointestinal endoscopy revealed black mucosal coloration throughout the entire esophagus. She was diagnosed as having AEN. Her general condition improved after intensive care, debridement, and treatment with antibiotics and a proton pump inhibitor; the esophageal mucosal color recovered. However, an esophageal stricture developed after 1 month, and the patient underwent gastrostomy to remove an esophageal obstruction after 3 months. She was referred to our hospital for surgical treatment 1 year and 4 months after the occurrence of AEN because of her strong desire for oral intake. Her medical condition was poor, and she could not walk due to generalized muscle weakness. After rehabilitation for 8 months, we performed an esophageal bypass using a gastric conduit via the percutaneous route rather than esophagectomy because of her multiple severe comorbidities including walking difficulty, chronic hepatitis C, cerebrovascular disease, and chronic renal failure. Minor leakage of the esophagogastrostomy occurred and was resolved with conservative treatment. The patient began oral intake on postoperative day 34 and was discharged on day 52. CONCLUSION: Esophageal obstruction after AEN was successfully treated by esophageal bypass using a gastric conduit in a high-risk patient. Because the majority of patients with AEN have multiple severe comorbidities, assessing the medical condition of the patient adequately is important prior to choosing either an esophagectomy or bypass surgery.

DOI： 10.1186/s40792-016-0277-8

Web of Science

PubMed

Publisher：南江堂  

DOI： 10.15106/j00393.2017258593

CiNii Research

Language：Japanese   Publisher：日本臨床外科学会  

Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00595-015-1240-1

PubMed

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本胃癌学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：English   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：(一社)日本胸部外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：English   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント ◆局所再発直腸癌の治療ではR0切除がきわめて重要であり,R0達成のためには拡大切除を躊躇すべきでない.◆尿路機能温存のためには,少なくとも片側の骨盤神経を温存する.また膀胱後屈を避けるため,腸管再建や骨盤充填術の施行が望ましい.◆切除可能同時性遠隔転移を伴う症例も手術適応としている.ただし,切除の順序やタイミングは慎重に考慮すべきである.

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J01539&link_issn=&doc_id=20220506510007&doc_link_id=10.11477%2Fmf.1407213704&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407213704&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(株)メディカ出版  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07192&link_issn=&doc_id=20220221060007&doc_link_id=%2Fao7tnuri%2F2022%2F002703%2F011%2F0285-0287%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7tnuri%2F2022%2F002703%2F011%2F0285-0287%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント ◆局所進行直腸癌に対し,術前CRTへの分子標的薬併用による局所制御・生存率への上乗せ効果は証明されていない.一方,NACやinduction chemotherapyへの分子標的薬併用による局所制御への上乗せ効果の報告は散見される.◆Stage IV・再発大腸癌では,分子標的薬を併用することで奏効率・腫瘍縮小率が上昇し,原発巣・遠隔転移巣ともR0切除やconversion手術のチャンスが増加する.◆"Cure"をめざした術前治療との併用こそが,分子標的薬の真の使いどころかもしれない.

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Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞肝外胆管癌は,非治癒因子が存在しない限り根治切除をめざす.肝外胆管癌は肝門部領域胆管癌と遠位胆管癌に分類され,それぞれ尾状葉を伴う肝葉切除・肝外胆管切除術,膵頭十二指腸切除術(pancreaticoduodenectomy:PD)が標準術式となる.肝門部領域胆管癌に対する肝切除術式を決定する際はBismuth分類が有用である.遠位胆管癌のPDの術式は,胃切除範囲や再建法にバリエーションがあり,上腸間膜動脈周囲リンパ節郭清はリンパ節の適正評価に有用である.これら肝外胆管癌の手術適応は癌遺残度の可能性,血管浸潤,リンパ節転移などの腫瘍因子を考慮したうえで決定する.

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞ポイント ◆経肛門的アプローチでの側方リンパ節郭清(taLPLD)は,転移頻度の高い骨盤深部領域の郭清を目の前で,かつ解剖学的構造物に対して良好な鉗子の刺入角度で施行できる.◆しかし,本法で展開される経肛門視点の術野は独特であり,十分慣れ親しんでおく必要がある.◆また,taLPLDは,プラットフォームに対して極端に側方に位置する領域に対して単孔式腹腔鏡下手術の技術を使って行う手技であるため,技術的には決して容易ではない.

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：医学図書出版(株)  

胆道癌の切除後の生存率は不良であり、とくに進行例に対する手術単独の効果には限界がある。このため集学的治療が必要で、そのなかでも切除後の補助化学療法に関する臨床試験の結果が重要である。最近、重要な第III相試験の結果が公開された。第一は、本邦のBCAT試験である。Gemcitabineと切除単独を比較したが、その有効性は認めなかった。第二はフランスで行われたPRODIGE-12試験で、GEMOXの切除単独群に対する有効性は認めなかった。第三は、Capecitabineの有効性を検証する英国BILCAP試験である。ITT解析では有意差を認めなかったものの、per protocol解析で有意差を認めた。これらの結果から、欧米諸国ではCapecitabineが胆道癌の術後補助化学療法として推奨されるに至った。一方、本邦では胆道癌に対して保険収載されていないため、本方針を日常診療で用いることはできない。(著者抄録)

Language：Japanese   Publisher：(一社)日本消化管学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本外科感染症学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一財)日本消化器病学会  

Language：Japanese   Publisher：(一財)日本消化器病学会  

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＜文献概要＞局所再発直腸癌に対する治療戦略は施設間差が大きく,外科医のdecisionが患者の人生を大きく左右する可能性がある.そのため,われわれは限られた症例の中で外科治療の限界と可能性を判断し,治療戦略を決定していく必要がある.一般的に局所再発直腸癌の長期予後は不良で,特に側方再発パターンは手術の難易度も高くかつ予後がわるい.当科のデータからも,いかにして側方再発をR0切除するかが大きな課題である.そのためには坐骨神経周りの詳細な解剖の理解とピットフォールを熟知しておくことが必須である.さらに必要に応じて術中放射線療法などの追加治療を行うことによって,さらなる治療成績の向上をめざしている.

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その解剖学的特性のため、肝門部領域胆管癌は容易に肝動脈や門脈に浸潤し、非切除の要因となっていた。手術手技や周術期管理の向上に伴い、門脈切除は多くの施設で行われるようになったが、肝動脈切除については十分なエビデンスが得られていないため今でも挑戦的な手術である。当教室では、2010年に動脈・門脈同時切除を行った肝門部領域胆管癌50例の治療成績を検討した。高度な技術が必要であるが、手術関連死亡は許容範囲内で長期予後が期待できることを報告した。近年、動脈切除を伴う肝門部領域胆管癌の治療成績の報告は増加しているが、その周術期死亡率や長期予後については、いまだ良好とはいえない。教室における動脈・門脈切除を伴う肝門部領域胆管癌の手術とその選択根拠について症例を通じて解説する。(著者抄録)

Authorship：Lead author   Language：Japanese   Publishing type：Article, review, commentary, editorial, etc. (trade magazine, newspaper, online media)  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：English  

A 71-year-old woman with dysphagia was diagnosed with thoracic esophageal squamous cell carcinoma by endoscopic biopsy at another hospital. She had previously undergone partial breast excision with axillary lymph node dissection for right breast cancer eleven years earlier and subtotal stomach-preserving pancreatoduodenectomy with Child's reconstruction for ampullary cancer ten years earlier. Gastrointestinal endoscopy showed a stricture due to a bulging submucosal tumor in the mid-thoracic esophagus. The tumor was diagnosed as an esophageal metastasis from breast cancer by endoscopic ultrasound-guided fine-needle aspiration biopsy. After six courses of fulvestrant, the tumor progressed, completely impeding her ability to swallow. An esophagectomy was planned in a one-stage operation because of the expectation of a prolonged survival and her strong hope of regaining oral intake. Unfortunately, she underwent emergent omental patch repair for perforation of the gastrojejunostomy site due to an anastomotic ulcer one day before the scheduled operation. Due to postoperative impairment of her performance status, she subsequently underwent a two-stage esophageal operation. In the first surgical stage, prone position thoracoscopic esophagectomy and cervical esophagostomy were performed and she was discharged with enteral nutrition on postoperative day 15. Sixty-one days after the first surgical stage, esophageal reconstruction was performed using a pedicled jejunum with microvascular anastomosis via the subcutaneous route. She was discharged without any complications 20 days after the second operation.

DOI： 10.18999/nagjms.81.4.679

Scopus

PubMed

Language：English  

A 52-year-old man with a cough, high fever, and inappetence was diagnosed with thoracic empyema on computed tomography at a local hospital. He had undergone continuous thoracic drainage for a spontaneous esophageal rupture that occurred 17 years earlier. He developed left thoracic empyema 2, 14 and 17 years following the initial esophageal rupture that improved with conservative therapy each time. The most recent episode of thoracic empyema also resolved with conservative therapy. However, he was referred to our hospital for further examination and more complete surgical treatment for recurrent thoracic empyema. Gastrointestinal endoscopy showed a scar from the previous esophageal rupture in the lower esophagus. We considered that recurrent esophageal rupture may have caused repeated episodes of thoracic empyema based on endoscopic findings and his past history and elected to perform subtotal esophagectomy to provide a complete cure. A left transthoracic esophagectomy with a left lower lung lobectomy and gastric tube reconstruction via a retrosternal route were performed. A latissimus dorsi muscle flap was used to eliminate the dead space after lower lung lobectomy to prevent recurrent thoracic empyema. The bronchial stump was covered with a pedicled intercostal muscle flap to prevent leakage from the stump. Minor leakage from the esophagogastrostomy site developed during the postoperative course but resolved with conservative therapy. The patient was transferred to the previous hospital on the 36th postoperative day. Four years after surgery, he had good oral intake and nutritional status without any evidence of recurrent thoracic empyema.

DOI： 10.18999/nagjms.81.4.693

Scopus

PubMed

Language：Japanese   Publisher：日本消化器病学会-東海支部  

Language：Japanese   Publisher：日本消化器病学会-東海支部  

Language：Japanese   Publisher：日本臨床外科学会  

Language：English   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本臨床栄養代謝学会  

Language：Japanese   Publisher：(株)篠原出版新社  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(株)メディカ出版  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J07192&link_issn=&doc_id=20190423050003&doc_link_id=%2Fao7tnuri%2F2019%2F002405%2F005%2F0419-0429%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7tnuri%2F2019%2F002405%2F005%2F0419-0429%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(株)南江堂  

＜文献概要＞胆道癌の切除後の生存率は不良であり,切除後の補助化学療法の有効性が現在検証されている.残念ながら,近年の3本のランダム化第III相試験は術後補助化学療法の有効性を明確に示すことはできなかった.現時点では,"切除後は無治療で経過観察する"ことが基本方針である.一方,切除不能胆道癌の中には,化学療法が奏効し外科切除が再考されることがある.このような症例をどのように扱うかは今後の検討課題である.

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Language：Japanese   Publisher：(株)へるす出版  

Language：Japanese   Publisher：(株)Gakken  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2019&ichushi_jid=J00235&link_issn=&doc_id=20190607110004&doc_link_id=10.15105%2FGZ.0000001162&url=https%3A%2F%2Fdoi.org%2F10.15105%2FGZ.0000001162&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(株)メディカ出版  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J03018&link_issn=&doc_id=20181019040002&doc_link_id=%2Fao7skani%2F2018%2F002311%2F005%2F0972-0977%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fao7skani%2F2018%2F002311%2F005%2F0972-0977%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)メディカ出版  

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Language：Japanese   Publisher：(株)医学書院  

＜文献概要＞point ・MDCTから作成した三次元画像を用い,術前に右肝動脈後枝の分岐と走行を把握しておく.術中の経験的判断に依存すると誤認切離の可能性が高まる.・同時に,門脈・胆管の右後枝の解剖も把握しておく.3つの脈管は同じ右後区系であるが,その走行と分岐には個人差がある.・右門脈との位置関係から右肝動脈後枝はinfraportal typeとsupraportal typeに大別される.前者は左肝・尾状葉切除の難易度を上げる変異である.

Language：Japanese   Publisher：日本臨床外科学会  

Language：English   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：English   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：(株)メディカ出版  

Language：Japanese   Publisher：医学図書出版(株)  

古くから乳頭型胆管癌(PCC)は予後が良好なことが知られている。近年、WHO分類においてIPNBが提唱され、膵IPMNのカウンターパートとされた。しかし、IPNBはPCCと重複し、その定義があいまいであるため、日常臨床において混乱をもたらしている。われわれの解析では、PCCは浸潤癌成分の増加に伴って、連続的に進行する疾患群であることが確認できた。また、胆管腫瘍には前癌病変は認められなかった。したがって、IPNBを"あえて"定義するのであればPCCの発育スペクトルの早期病変に相当すると考えられ、独立した疾患として扱うべきではない。(著者抄録)

Language：Japanese   Publisher：肝胆膵治療研究会  

Language：Japanese   Publisher：(株)メディカルレビュー社  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：English   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(株)医学書院  

＜ポイント＞肝門部領域胆管癌の切除適応や切除術式を決定する際に考慮すべき予後因子として,癌遺残度,胆管側方進展,血管浸潤,リンパ節転移,遠隔転移,腫瘍形態,術前減黄法が挙げられる.肝門部領域胆管癌は積極的な手術により長期生存する症例が少なくないため,手術の安全が担保される限り切除を考慮すべきである.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J01539&link_issn=&doc_id=20171130440008&doc_link_id=10.11477%2Fmf.1407211870&url=https%3A%2F%2Fdoi.org%2F10.11477%2Fmf.1407211870&type=%E5%8C%BB%E6%9B%B8.jp_%E3%82%AA%E3%83%BC%E3%83%AB%E3%82%A2%E3%82%AF%E3%82%BB%E3%82%B9&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本癌治療学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本外科系連合学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本消化器外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(NPO)日本食道学会  

Language：Japanese   Publisher：(株)南江堂  

肝門部胆管癌は「肝門レベルでの胆管閉塞」という臨床徴候で特徴づけられ,肝内・肝外の胆管癌を含む疾患カテゴリーである.胆道癌取扱い規約第6版において,肝門部「領域」胆管癌の新名称のもとに,従来の肝門部胆管癌のみならず腫瘤形成型肝内胆管癌(の一部)を含めると定義された.組織・病理発生論が考慮されていないという批判は存在するが,臨床的実用性を重視する観点からは妥当な定義である.(著者抄録)

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：(一社)日本外科学会  

Language：Japanese   Publisher：日本臨床外科学会  

Language：Japanese   Publisher：(株)メディカ出版  

Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J03018&link_issn=&doc_id=20170106120002&doc_link_id=issn%3D2434-4575%26volume%3D22%26issue%3D1%26spage%3D9&url=http%3A%2F%2Fwww.pieronline.jp%2Fopenurl%3Fissn%3D2434-4575%26volume%3D22%26issue%3D1%26spage%3D9&type=PierOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00005_2.gif

Language：Japanese   Publisher：(株)メディカ出版  

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