Faculty Profiles - MIYATA Kazushi

Papers - MIYATA Kazushi

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A Case of Esophageal Cancer with Lymph Node Recurrence Three Times and Secondary Cancer after Definitive Chemoradiotherapy

SAKATOKU Yayoi, FUKAYA Masahide, MIYATA Kazushi, TAKAHASHI Takamasa, NAGINO Masato

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 79 ( 1 ) page： 84 - 89 2018

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

尾上俊介, 江畑智希, 横山幸浩, 國料俊男, 角田伸行, 伊神剛, 菅原元, 深谷昌秀, 上原圭介, 水野隆史, 山口淳平, 宮田一志, 相場利貞, 梛野正人

臨床外科 Vol. 72 ( 13 ) page： 1419 - 1422 2017.12

Clinical value of a prophylactic minitracheostomy after esophagectomy: analysis in patients at high risk for postoperative pulmonary complications. International journal

Yayoi Sakatoku, Masahide Fukaya, Kazushi Miyata, Keita Itatsu, Masato Nagino

BMC surgery Vol. 17 ( 1 ) page： 120 - 120 2017.12

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

Successful bypass operation for esophageal obstruction after acute esophageal necrosis: a case report. International journal

Yayoi Sakatoku, Masahide Fukaya, Kazushi Miyata, Masato Nagino

Surgical case reports Vol. 3 ( 1 ) page： 4 - 4 2017.12

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

Retrosternal Reconstruction Can be a Risk Factor for Upper Extremity Deep Vein Thrombosis After Esophagectomy. International journal

Takamasa Takahashi, Masahide Fukaya, Kazushi Miyata, Yayoi Sakatoku, Masato Nagino

World journal of surgery Vol. 41 ( 12 ) page： 3154 - 3163 2017.12

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

Gradually shrinking intra-abdominal desmoid tumor derived from the stomach in a young boy: a case report. International journal

Kazushi Miyata, Masahide Fukaya, Masato Nagino

Surgical case reports Vol. 3 ( 1 ) page： 54 - 54 2017.12

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

外科におけるcontroversy-誌上ディベート肝門部領域癌の取り扱い　肝癌として扱うべきか胆管癌として扱うべきか　胆管癌として

江畑智希, 横山幸浩, 國料俊男, 菅原元, 伊神剛, 水野隆史, 山口淳平, 深谷昌秀, 上原圭介, 宮田一志, 相場利貞, 梛野正人

外科 Vol. 79 ( 5 ) page： 437 - 440 2017.5

腹腔内を占拠する婦人科系巨大腫瘍に対して切除手術を施行した3例

神谷忠宏, 上原圭介, 向井俊貴, 江畑智希, 横山幸浩, 國料俊男, 角田伸行, 伊神剛, 菅原元, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 梛野正人

日本臨床外科学会雑誌 Vol. 78 ( 2 ) page： 410 - 411 2017.2

Muscle sparing thoracotomy for esophageal cancer: a comparison with posterolateral thoracotomy Reviewed

Miyata K, Fukaya M, Itatsu K, Abe T, Nagino M

Surg Today 2015.8

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