Faculty Profiles - OGURA Atsushi

Malignant Features in Pre-Treatment Metastatic Lateral Lymph Nodes in Low Rectal Cancers Predict Distant Metastases and Survival, But Not Local Recurrences

Kroon, H; Dudi-Venkata, N; Bedrikovetski, S; Liu, J; Haanappel, A; Ogura, A; van de Velde, C; Rutten, H; Beets, G; Thomas, M; Kusters, M; Sammour, T

ANNALS OF SURGICAL ONCOLOGY Vol. 28 ( SUPPL 1 ) page： S13 - S13 2021.2

The survival benefit of neoadjuvant chemotherapy for resectable colorectal liver metastases with high tumor burden score.

Yoshihiko Yonekawa, Kay Uehara, Takashi Mizuno, Toshisada Aiba, Atsushi Ogura, Toshiki Mukai, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Masato Nagino

International journal of clinical oncology Vol. 26 ( 1 ) page： 126 - 134 2021.1

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

BACKGROUND: The indications for neoadjuvant chemotherapy (NAC) in resectable colorectal liver metastases (CRLMs) remain unclear. Tumor burden score (TBS) is a prognostic tool based on tumor size and number of tumors. However, its utility in the NAC setting for initially resectable CRLM has never been investigated. METHODS: TBS is a distance from the origin on a Cartesian plane to the coordinates (x, y) = (tumor size in centimeter, number of tumors). TBS < 3 was defined as "TBS-low", whereas TBS ≥ 3 as "TBS-high". Between 2008 and 2018, 102 patients who underwent hepatectomy for resectable CRLM were retrospectively analyzed using the Kaplan-Meier method and Cox proportional hazards regression models. RESULTS: Among the TBS-low (n = 46) and TBS-high (n = 56) groups, baseline patient characteristics were mostly similar except for TBS-related parameters. NAC was more frequently administered in the TBS-high group (p = 0.038). The overall survival (OS) rates were similar between the two groups. Subgroup analysis showed that NAC was associated with non-significantly improved 5-year OS in the TBS-high group [76.1% with NAC and 54.9% without NAC (p = 0.093)]. In multivariate analysis, NAC was an independent prognostic factor for favorable OS only in the TBS-high group, while adjuvant chemotherapy (AC) was associated with improved OS only in the TBS-low group. CONCLUSION: In patients with resectable CRLM, the TBS-high population had a survival benefit from NAC, while the TBS-low population benefited from AC. TBS may serve as an indicator for patients who will benefit from NAC.

DOI： 10.1007/s10147-020-01793-9

Pathological Complete Response to Second Line Chemotherapy in a Patient with Cervical Lymph Node Metastasis from Transverse Colon Cancer with RAS and BRAF V600E Mutations: A Case Report

Yuki Murata, Kay Uehara, Toshisada Aiba, Atsushi Ogura, Masahide Fukaya, Kazushi Miyata, Aya Tanaka, Noriaki Ohara, Takanori Jinno, Tomoki Ebata

Japanese Journal of Gastroenterological Surgery Vol. 54 ( 4 ) page： 278 - 284 2021

Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Society of Gastroenterological Surgery

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 &lt
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.

DOI： 10.5833/jjgs.2020.0057

CiNii Research

Pelvic exenteration associated with future renal dysfunction. Reviewed

Masanori Sando, Kay Uehara, Yuanying Li, Toshisada Aiba, Atsushi Ogura, Tomoki Ebata, Yasuhiro Kodera, Hiroshi Yatsuya, Masato Nagino

Surgery today Vol. 50 ( 12 ) page： 1601 - 1609 2020.12

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

PURPOSE: This study aimed to clarify the long-term change in the renal function after pelvic exenteration (PE) and to evaluate the risk factors for any future dysfunction. METHODS: This study comprised 40 patients. A greater than 25% decline in the estimated glomerular filtration rate (eGFR) at 3 years was defined as early renal function disorder (ERFD), possibly predicting future chronic kidney disease (CKD). RESULTS: In the entire cohort, the median eGFR decreased by 23% at 3 years, and CKD developed in 50%. The patients were divided into the ERFD (n = 16) and non-ERFD (n = 24) groups. In the ERFD group, the eGFR significantly decreased by 28% during the first 1.5 years and continued to decline after that, resulting in 81.3% of patients reaching CKD, whereas it was 4% and 37.5%, respectively, in the non-ERFD group. In a growth model analysis, late urinary tract complications (UTC) and small bowel obstruction were shown to be risk factors for ERFD. CONCLUSION: Although PE was associated with a high incidence of future CKD, ERFD could predict it. Close observation of the eGFR decline over 1.5 years might be beneficial to identify ERFD patients. High-risk patients with late UTC and small bowel obstruction should, therefore, be observed carefully.

DOI： 10.1007/s00595-020-02036-0

The role of surgery for locally recurrent and second recurrent rectal cancer with metastatic disease. Reviewed International journal

Aya Tanaka, Kay Uehara, Toshisada Aiba, Atsushi Ogura, Toshiki Mukai, Yukihiro Yokoyama, Tomoki Ebata, Yasuhiro Kodera, Masato Nagino

Surgical oncology Vol. 35 page： 328 - 335 2020.12

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

BACKGROUND: The role of surgery for locally recurrent rectal cancer (LRRC) with resectable distant metastases or second LRRC remains unclear. This study aimed to clarify the influence of synchronous distant metastases (SDMs), a history of distant metastasis resection (HDMR), and a second LRRC on the outcome. METHODS: The long-term outcomes of 70 surgically treated patients with LRRC between 2006 and 2018 were compared by SDM (n = 10), HDMR (n = 17), and second LRRC (n = 7). RESULTS: Among the 10 patients with SDM, 4 patients underwent simultaneous resection, whereas the other 6 underwent staged resection with distant first approach. Recurrence developed in 9 patients, of which 2 patients with liver re-resection achieved long-term survival without cancer. The patients with and without SDM had equivalent 5-year overall survival rate (40.5% vs. 53.3%, p = 0.519); however, patients with SDM had a worse 3-year recurrence-free survival rate than those without SDM (10.0% vs. 37.5%, p = 0.031). Multivariate analysis showed that primary non-sphincter-preserving surgery, second LRRC, and R1 resection were independent risk factors for overall survival. Similarly, primary non-sphincter-preserving surgery, second LRRC, SDM, and R1 resection were risk factors for recurrence-free survival. CONCLUSIONS: Patients with SDM might still be suitable to undergo salvage surgery and achieve favourable overall survival. Distant metastasectomy should be performed first, followed by a sufficient interval to avoid unnecessary LRRC resection in uncurable patients. An HDMR should not be taken into consideration when making surgical plans. Surgical indication of second LRRC should be strict, especially in referred patients.

DOI： 10.1016/j.suronc.2020.09.001

各科(外科、婦人科、泌尿器科)における側方リンパ節(骨盤リンパ節)郭清意義と実際下部進行直腸癌に対する側方リンパ節郭清の意義、予防的郭清から新たなステージへ

小倉淳司, 上原圭介, 相場利貞, 山東雅紀, 田中綾, 小池佳勇, 大原規彰, 村田悠記, 神野孝徳, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 小寺泰弘, 梛野正人

日本外科系連合学会誌 Vol. 45 ( 5 ) page： 565 - 565 2020.12

大動脈周囲リンパ節にS状結腸癌と前立腺癌の転移を認めた同時性重複癌の1例

神野孝徳, 上原圭介, 相場利貞, 小倉淳司, 山東雅紀, 田中綾, 大原規彰, 村田悠記, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 小寺泰弘, 梛野正人

日本外科系連合学会誌 Vol. 45 ( 5 ) page： 655 - 655 2020.12

局所再発直腸癌および肝転移切除後の長期生存例に発症した下行結腸ストマ部癌の一例

村田悠記, 上原圭介, 相場利貞, 小倉淳司, 山東雅紀, 田中綾, 大原規彰, 神野孝徳, 佐藤雄三, 服部憲史, 中山吾郎, 江畑智希, 小寺泰弘, 梛野正人

日本ストーマ・排泄リハビリテーション学会誌 Vol. 36 ( 3 ) page： 128 - 128 2020.12

Neoadjuvant (chemo)radiotherapy and Lateral Node Dissection: Is It Mutually Exclusive? Reviewed International journal

Atsushi Ogura, Stefan van Oostendorp, Miranda Kusters

Clinics in colon and rectal surgery Vol. 33 ( 06 ) page： 355 - 360 2020.11

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

The importance of total mesorectal excision (TME) has been the global standard of care in patients with rectal cancer. However, there is no universal strategy for lateral lymph nodes (LLN). The treatment of the lateral compartment remains controversial and has gone to the opposite directions between Eastern and Western countries in the past decades. In the East, mainly Japan, surgeons consider LLN metastases as regional disease and have performed TME with lateral lymph node dissection (LLND) without neoadjuvant (chemo)radiotherapy ([C]RT) in patients with clinical Stage II/III rectal cancer below the peritoneal reflection. In the West, neoadjuvant radiotherapy or has been the standard, and surgeons do not perform LLND assuming the (C)RT can sterilize most lateral lymph node metastasis (LLNM). Recent evidences show that lateral nodes are the major cause of local recurrence after (C)RT plus TME, and LLND reduces local recurrence particularly from the lateral compartment. Probably a combination of the two strategies, that is, neoadjuvant (C)RT plus LLND, would be needed to improve outcomes in patients with lateral nodal disease.

DOI： 10.1055/s-0040-1714239