Faculty Profiles - OGURA Atsushi

Papers - OGURA Atsushi

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Malignant Features in Pretreatment Metastatic Lateral Lymph Nodes in Locally Advanced Low Rectal Cancer Predict Distant Metastases. International journal

Hidde M Kroon, Nagendra N Dudi-Venkata, Sergei Bedrikovetski, Jianliang Liu, Anouck Haanappel, Atsushi Ogura, Cornelis J H van de Velde, Harm J T Rutten, Geerard L Beets, Michelle L Thomas, Miranda Kusters, Tarik Sammour

Annals of surgical oncology Vol. 29 ( 2 ) page： 1194 - 1203 2022.2

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

INTRODUCTION: Pretreatment enlarged lateral lymph nodes (LLN) in patients with locally advanced low rectal cancer are predictive for local recurrences after neoadjuvant (chemo)radiotherapy (n(C)RT) followed by total mesorectal excision (TME). Not much is known of the impact on oncological outcomes when in addition malignant features are present in enlarged LLN. PATIENTS AND METHODS: A multicenter retrospective cohort study was conducted at five tertiary referral centers in the Netherlands and Australia. All patients were diagnosed with locally advanced low rectal cancer with LLN on pretreatment magnetic resonance imaging (MRI) and underwent n(C)RT followed by TME. LLN were considered enlarged with a short axis of ≥ 5 mm. Malignant features were defined as nodes with internal heterogeneity and/or border irregularity. Outcomes of interest were local recurrence-free survival (LRFS), distant metastatic-free survival (DMFS), and overall survival (OS). RESULTS: Out of 115 patients, the majority was male (75%) and the median age was 64 years (range 26-85 years). Median pretreatment LLN short axis was 7 mm (range 5-28 mm), and 60 patients (52%) had malignant features. After a median follow-up of 47 months, patients with larger LLN (7 + mm) had a worse LRFS (p = 0.01) but no difference in DMFS (p = 0.37) and OS (p = 0.54) compared with patients with smaller LLN (5-6 mm). LLN patients with malignant features had no difference in LRFS (p = 0.20) but worse DMFS (p = 0.004) and OS (p = 0.006) compared with patients without malignant features in the LLN. Cox regression analysis identified LLN short axis as an independent factor for LR. Malignant features in LLN were an independent factor for DMFS. CONCLUSION: The current study suggests that pretreatment enlarged LLN that also harbor malignant features are predictive of a worse DMFS. More studies will be required to further explore the role of malignant features in LLN.

DOI： 10.1245/s10434-021-10762-z

Web of Science

Scopus

PubMed

【胆道癌治療の最前線】肝外胆管癌に対する手術術式と適応

尾上俊介, 水野隆史, 渡辺伸元, 横山幸浩, 國料俊男, 伊神剛, 上原圭, 山口淳平, 宮田一志, 砂川真輝, 小倉淳司, 江畑智希

外科 Vol. 84 ( 2 ) page： 136 - 141 2022.2

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.

Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2022&ichushi_jid=J00393&link_issn=&doc_id=20220128060007&doc_link_id=10.15106%2Fj_geka84_136&url=https%3A%2F%2Fdoi.org%2F10.15106%2Fj_geka84_136&type=%88%E3%8F%91.jp_%83I%81%5B%83%8B%83A%83N%83Z%83X&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00024_2.gif

【ガイドラインには書いていない大腸癌外科治療のCQ-妥当な治療と適応を見直そう】高度進行大腸癌への術前治療を分子標的薬別に考える Total neoadjuvant therapy・triplet時代における術前治療の最新エビデンス

小倉淳司, 上原圭, 村田悠記, 水野隆史, 國料俊男, 伊神剛, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 横山幸浩, 江畑智希

臨床外科 Vol. 77 ( 2 ) page： 199 - 206 2022.2

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.

Local Recurrence after Abdominoperineal Resection with Vertical Rectus Abdominis Musculocutaneous Flap:A Case Report of Pelvic Exenteration with Preservation of the Flap

Murata Yuki, Uehara Kay, Ogura Atsushi, Aiba Toshisada, Mishina Takuya, Kambara Yuichi, Suzuki Yumi, Ebata Tomoki

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 75 ( 1 ) page： 15 - 20 2022

Language：Japanese Publisher：The Japan Society of Coloproctology

A 75-year-old man underwent abdominoperineal resection （APR） and reconstruction using a right vertical rectus abdominis musculocutaneous （VRAM） flap for fistula-associated anal cancer 1 year ago. Pathological findings revealed mucinous adenocarcinoma （T4N0M0） with R1 resection. Six months after surgery, local recurrence developed and he was referred to our hospital. CT findings showed that the recurrent tumor, 30 mm in diameter, was adjacent to the right side of the prostate and the ventral side of the VRAM flap, however, there was no finding of invasion of the feeding vessels.Total pelvic exenteration （TPE） with preservation of the VRAM flap was successfully performed. He was discharged on the 27th day after surgery and remains alive without recurrence 1 year after surgery.The VRAM flap has been widely used in perineal reconstruction after extended pelvic surgery. In the case of local recurrence thereafter, redo surgery may be complicated, especially when the flap should be preserved. In this case, fortunately we could achieve R0 resection, however, preservation sometimes threatens curability, therefore, the indication should be carefully considered.

DOI： 10.3862/jcoloproctology.75.15

CiNii Research

Solitary Recurrent Tumor from Cecal Cancer Adjacent to the Femoral Head: A Surgical Case Report

Mishina Takuya, Uehara Kay, Aiba Toshisada, Ogura Atsushi, Murata Yuki, Kambara Yuichi, Suzuki Yumi, Sato Yusuke, Hattori Norifumi, Nakayama Goro, Kodera Yasuhiro, Ebata Tomoki

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 75 ( 1 ) page： 44 - 50 2022

Language：Japanese Publisher：The Japan Society of Coloproctology

A 69-year-old woman visited a previous hospital with chief complaints of abdominal pain and a femoral mass. CT revealed locally advanced cecal cancer which had retroperitoneal penetration and formed a widespread abscess extending to the right femur. Systemic chemotherapy brought remarkable tumor shrinkage, therefore, conversion ileocecal resection could be performed. She received capecitabine monotherapy as an adjuvant chemotherapy for a half year.Two and a half years after surgery, a femoral tumor was found and she was referred to our hospital. Incisional biopsy revealed that the tumor was recurrent cecal cancer. The tumor was successfully removed with combined resection of the joint capsule and femoral nerve in cooperation with orthopedic surgeons. Intraoperative radiotherapy was given around the acetabulum to improve local control. Pathological examination demonstrated that it was R1 resection at that site.Postoperative lymphatic leakage was prolonged, therefore, a rectus abdominis musculocutaneous flap was given by plastic surgeons.One and a half years after surgery, although meningeal dissemination without neurological symptoms developed, she remains healthy without local relapse and is receiving systemic chemotherapy.

DOI： 10.3862/jcoloproctology.75.44

CiNii Research

Optimal Surgical Indications for Resectable Metastatic Colorectal Cancer with BRAF V600E Mutation

Jinno Takanori, Uehara Kay, Ogura Atsushi, Murata Yuki, Yokoyama Yukihiro, Kokuryo Toshio, Igami Tsuyoshi, Mizuno Takashi, Yamaguchi Junpei, Ebata Tomoki

The Japanese Journal of Gastroenterological Surgery Vol. 55 ( 8 ) page： 473 - 482 2022

Language：Japanese Publisher：The Japanese Society of Gastroenterological Surgery

Purpose: Patients with metastatic colorectal cancer (mCRC) with BRAF V600E mutation have a poor response to standard cytotoxic agents and extremely poor outcomes. Thus, the optimal indication for metastasectomy remains debatable, even when the metastatic region is resectable. The aims of this retrospective study were to examine the outcomes of BRAF V600E mCRC, identify risk factors for poor survival, and establish the optimal surgical indication for resection. Materials and Methods: The subjects were 14 patients with BRAF V600E mCRC who started treatment in our department between December 2016 and April 2020. No patients underwent surgery prior to introduction of systemic chemotherapy. Patients were divided into two groups based on the initial response to first-line chemotherapy: controlled disease (CD, n=8) for tumors that shrunk or stabilized from baseline, and uncontrolled disease (UD, n=6) for tumors that increased in size. Results: The median follow-up period was 39.7 months. The 2-year overall survival rate was 35.7% in all patients, and was higher in the CD group than in the UD group (50.0% vs. 16.7%, P=0.051). Six patients (42.9%) underwent curative metastasectomy, of whom 4 developed recurrence and one underwent re-resection. In the CD group, 2 of 3 patients who underwent metastasectomy were alive without cancer, while all 3 patients in the UD group developed recurrence after metastasectomy and 2 had early recurrence within 3 months. Conclusion: This study suggests that evaluation of the initial response to first-line chemotherapy may be a useful prognostic factor in BRAF V600E mCRC. Even if a tumor is resectable, the indication for metastasectomy should be carefully considered in cases with poor disease control in the initial response.

DOI： 10.5833/jjgs.2021.0129

Scopus

CiNii Research

The significance of the time to arterial perfusion in intraoperative ICG angiography during colorectal surgery. Reviewed International journal

Toshisada Aiba, Kay Uehara, Atsushi Ogura, Aya Tanaka, Yoshihiko Yonekawa, Norifumi Hattori, Goro Nakayama, Yasuhiro Kodera, Tomoki Ebata, Masato Nagino

Surgical endoscopy Vol. 35 ( 12 ) page： 7227 - 7235 2021.12

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

BACKGROUND: Intraoperative indocyanine green angiography (ICG-A) is a promising tool to confirm blood supply; however, the assessment is difficult without clear demarcation. In this study, the clinical impact of the time to arterial perfusion (TAP) on anastomotic leakage (AL) was evaluated, especially in patients without ICG demarcation. METHODS: The TAP was assessed using ICG-A during colorectal surgery in 110 patients. ICG demarcation required changing the transection line, and the TAP was measured at the new stump. The patients were divided into marginal flow (MF) and direct flow (DF) groups according to the arterial route. Delayed TAP was defined as the third quartile or slower TAP in each group. RESULTS: Sixty-six patients (60%) were classified into the MF group, including 64 patients who underwent rectal or sigmoid resection with high ligation of the inferior mesenteric artery. The cut-off value of the delayed TAP in the MF group was significantly slower than that in the DF group (30 and 22 s, respectively, p < 0.001). In the entire cohort, the transection line was changed in 2 patients, resulting in no AL. Nevertheless, AL still developed in 6 patients (5.4%), 5 of whom were in the MF group, and delayed TAP was found in 5 of 6 patients. Delayed TAP was significantly associated with AL in the MF group (p = 0.046). CONCLUSIONS: In patients without ICG demarcation, delayed TAP might be helpful for predicting the high-risk patients with AL in the MF group; however, performing diverting stoma or strictly careful observation might be a realistic reaction.

DOI： 10.1007/s00464-020-08185-0

Web of Science

Scopus

PubMed

鏡視下での骨盤拡大手術の適応と限界腹腔鏡下骨盤内臓全摘術の適応と限界

上原圭, 小倉淳司, 村田悠記, 三品拓也, 小池佳勇, 神原祐一, 西村元伸, 小林龍太郎, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 砂川真輝, 杉田静紀, 江畑智希

日本内視鏡外科学会雑誌 Vol. 26 ( 7 ) page： CSY17 - 2 2021.12

切除不能同時性肝肺転移を有する直腸癌に対してFOLFOXIRI+bevacizumab療法で奏功が得られ二期的にR0切除し得た1例

村田悠記, 水野隆史, 上原圭, 小倉淳司, 三品拓也, 小池佳勇, 神原祐一, 西村元伸, 小林龍太郎, 神野孝徳, 國料俊男, 伊神剛, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 横山幸浩, 江畑智希

日本消化器病学会東海支部例会プログラム抄録集 Vol. 135回 page： 81 - 81 2021.12

横行結腸・脾彎曲・下行結腸癌に対する郭清手技と治療成績下行結腸癌下行結腸癌に対するリンパ節郭清

日本内視鏡外科学会雑誌 Vol. 26 ( 7 ) page： PD16 - 1 2021.12

【conversion surgeryのすべて切除不能を切除可能に!】局所進行直腸癌に対するconversion surgeryの現状と展望術前化学療法を施行してきた立場から日本独自の治療戦略を考える

小倉淳司, 上原圭, 村田悠記, 宮田一志, 山口淳平, 水野隆史, 伊神剛, 國料俊男, 横山幸浩, 江畑智希

消化器外科 Vol. 44 ( 13 ) page： 1873 - 1885 2021.12

肝門部胆管癌術後,三度の右側大腸癌を切除した一例

神原祐一, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 鈴木優美, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 佐藤雄介, 服部憲史, 中山吾郎, 相場利貞, 横山幸浩, 小寺泰弘, 江畑智希

日本消化器外科学会雑誌 Vol. 54 ( Suppl.2 ) page： 186 - 186 2021.11

増刊号 Stepごとに要点解説標準術式アトラス最新版-特別付録Web動画 4.大腸直腸癌-骨盤内臓全摘術

小倉淳司, 上原圭, 村田悠記, 三品拓也, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 横山幸浩, 江畑智希

臨床外科 Vol. 76 ( 11 ) page： 128 - 137 2021.10

II. Treatment for Recurrent Cholangiocarcinoma

Watanabe N., Yokoyama Y., Igami T., Uehara K., Mizuno T., Yamaguchi J., Miyata K., Onoe S., Ogura A., Ebata T.

Japanese Journal of Cancer and Chemotherapy Vol. 48 ( 10 ) page： 1223 - 1226 2021.10

[Ⅱ.Treatment for Recurrent Cholangiocarcinoma].

Nobuyuki Watanabe, Yukihiro Yokoyama, Tsuyoshi Igami, Kay Uehara, Takashi Mizuno, Junpei Yamaguchi, Kazushi Miyata, Shunsuke Onoe, Atsushi Ogura, Tomoki Ebata

Gan to kagaku ryoho. Cancer & chemotherapy Vol. 48 ( 10 ) page： 1223 - 1226 2021.10

Bismuth I型胆管癌に対する肝門部胆管高位切離肝切除を避けるために

尾上俊介, 水野隆史, 渡辺伸元, 横山幸浩, 國料俊男, 伊神剛, 上原圭, 山口淳平, 宮田一志, 砂川真輝, 小倉淳司, 江畑智希

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S502 - S502 2021.10

胆道癌肝切除における門脈切除・再建

江畑智希, 水野隆史, 尾上俊介, 渡辺伸元, 伊神剛, 山口淳平, 上原圭, 宮田一志, 砂川真輝, 小倉淳司, 國料俊男, 横山幸浩

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S503 - S503 2021.10

肝門部領域胆管癌における膵内胆管の切除法 PDを避ける工夫

渡辺伸元, 水野隆史, 尾上俊介, 横山幸浩, 國料俊男, 伊神剛, 上原圭, 山口淳平, 宮田一志, 砂川真輝, 小倉淳司, 江畑智希

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S503 - S503 2021.10

肝十二指腸間膜の定型的リンパ節郭清

水野隆史, 尾上俊介, 渡辺伸元, 横山幸浩, 伊神剛, 山口淳平, 砂川正輝, 國料敏男, 上原圭, 宮田一志, 小倉淳司, 江畑智希

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S502 - S502 2021.10

右側肝切除におけるArantius管を指標にした肝門部血管処理

尾上俊介, 水野隆史, 渡辺伸元, 横山幸浩, 國料俊男, 伊神剛, 上原圭, 山口淳平, 宮田一志, 砂川真輝, 小倉淳司

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S504 - S504 2021.10

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Papers - OGURA Atsushi