Faculty Profiles - OGURA Atsushi

Lateral Nodal Features on Restaging Magnetic Resonance Imaging Associated With Lateral Local Recurrence in Low Rectal Cancer After Neoadjuvant Chemoradiotherapy or Radiotherapy. International journal

Atsushi Ogura, Tsuyoshi Konishi, Geerard L Beets, Chris Cunningham, Julio Garcia-Aguilar, Henrik Iversen, Shigeo Toda, In Kyu Lee, Hong Xiang Lee, Keisuke Uehara, Peter Lee, Hein Putter, Cornelis J H van de Velde, Harm J T Rutten, Jurriaan B Tuynman, Miranda Kusters

JAMA surgery Vol. 154 ( 9 ) page： e192172 2019.9

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

Importance: Previously, it was shown in patients with low rectal cancer that a short-axis (SA) lateral node size of 7 mm or greater on primary magnetic resonance imaging (MRI) resulted in a high lateral local recurrence (LLR) rate after chemoradiotherapy or radiotherapy ([C]RT) with total mesorectal excision (TME) and that this risk was lowered by a lateral lymph node dissection (LLND). The role of restaging MRI after (C)RT with regard to LLR risk and which specific patients might benefit from an LLND is not fully understood. Objective: To determine the factors on primary and restaging MRI that are associated with LLR in low rectal cancer after (C)RT and to formulate specific guidelines on which patients might benefit from an LLND. Design, Setting, and Participants: In this retrospective, multicenter, pooled cohort study, patients who underwent surgery for cT3 or cT4 low rectal cancer with a curative intent from 12 centers in 7 countries from January 2009 to December 2013 were included. All patients' MRIs were rereviewed according to a standardized protocol, with specific attention to lateral nodal features. The original cohort included 1216 patients. For this study, patients who underwent (C)RT and had a restaging MRI were selected, leaving 741 for analyses across 10 institutions, including 651 who underwent (C)RT with TME and 90 who underwent (C)RT with TME and LLND. Main Outcomes and Measures: The main purpose was to identify the factors on primary and restaging MRI associated with LLR after (C)RT with TME. Whether high-risk patients might benefit in terms of LLR reduction from an LLND was also studied. Results: Of the 741 included patients, 480 (64.8%) were male, and the mean (SD) age was 60.4 (12.0) years. An SA lateral node size of 7 mm or greater on primary MRI resulted in a 5-year LLR rate of 17.9% after (C)RT with TME. At 3 years, there were no LLRs in 28 patients (29.2%) with lateral nodes that were 4 mm or less on restaging MRI. Nodes that were 7 mm or greater on primary MRI and greater than 4 mm on restaging MRI in the internal iliac compartment resulted in a 5-year LLR rate of 52.3%, significantly higher compared with nodes in the obturator compartment of that size (9.5%; hazard ratio, 5.8; 95% CI, 1.6-21.3; P = .003). Compared with (C)RT with TME alone, treatment with (C)RT with TME and LLND in these unresponsive internal nodes resulted in a significantly lower LLR rate of 8.7% (hazard ratio, 6.2; 95% CI, 1.4-28.5; P = .007). Conclusions and Relevance: Restaging MRI is important in clinical decision making in lateral nodal disease. In patients with shrinkage of lateral nodes from an SA node size of 7 mm or greater on primary MRI to an SA node size of 4 mm or less on restaging MRI, which occurs in about 30% of cases, LLND can be avoided. However, persistently enlarged nodes in the internal iliac compartment indicate an extremely high risk of LLR, and an LLND lowered LLR in these cases.

DOI： 10.1001/jamasurg.2019.2172

Pattern of programmed cell death-ligand 1 expression and CD8-positive T-cell infiltration before and after chemoradiotherapy in rectal cancer. International journal

Atsushi Ogura, Takashi Akiyoshi, Noriko Yamamoto, Hiroshi Kawachi, Yuichi Ishikawa, Seiichi Mori, Koji Oba, Masato Nagino, Yosuke Fukunaga, Masashi Ueno

European journal of cancer (Oxford, England : 1990) Vol. 91 page： 11 - 20 2018.3

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

BACKGROUND: The synergistic effect of combining immune checkpoint inhibitors with radiotherapy was reported recently, but there are few studies on programmed cell death-ligand 1 (PD-L1) expression in rectal cancer treated by preoperative chemoradiotherapy (CRT). The aim of the present study was to investigate the PD-L1 expression status before and after CRT and its association with clinicopathological characteristics and recurrence in rectal cancer. METHODS: Immunostainings of PD-L1 and CD8 were performed in 287 patients with rectal cancer treated by CRT. PD-L1 expression on the tumour cells (tPD-L1) and on the stromal immune cells (iPD-L1) was evaluated before and after CRT. CD8+ cell density in tumour area (tCD8+) before CRT and in the stromal area (sCD8+) before and after CRT was also evaluated. RESULTS: High tPD-L1 expression was observed in only three patients (1.0%). High iPD-L1 expression significantly increased from 31.7% before CRT to 49.2% after CRT (P < 0.0001). The increase in high iPD-L1 expression after CRT was only observed in patients with tumour regression grades 1 and 2. High iPD-L1 expression was associated with high tCD8+ cell density before CRT (P < 0.0001) and sCD8+ cell density after CRT (P < 0.0001). High tCD8+ cell density before CRT was associated with better disease-free survival (DFS) (P = 0.0331), but its improved effect on DFS could be observed in patients with high iPD-L1 expression (P = 0.0081), not in patients with low iPD-L1 expression (P = 0.516). CONCLUSION: The present study demonstrated the significant correlations between iPD-L1 expression and CD8+ cell density both before and after CRT.

DOI： 10.1016/j.ejca.2017.12.005

Indications for neoadjuvant treatment based on risk factors for poor prognosis before and after neoadjuvant chemotherapy alone in patients with locally advanced rectal cancer. Reviewed International journal

Atsushi Ogura, Kay Uehara, Toshisada Aiba, Masanori Sando, Aya Tanaka, Noriaki Ohara, Yuki Murata, Yusuke Sato, Norifumi Hattori, Goro Nakayama, Tomoki Ebata, Yasuhiro Kodera, Masato Nagino

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Vol. 47 ( 5 ) page： 1005 - 1011 2021.5

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

INTRODUCTION: The oncological benefit of neoadjuvant chemotherapy (NAC) alone for locally advanced rectal cancer (LARC) remains controversial. The aim of this study was to clarify the clinical risk factors for poor prognosis before and after NAC for decision making regarding additional treatment in patients with LARC. MATERIALS AND METHODS: We examined a total of 96 patients with MRI-defined poor-risk locally advanced mid-low rectal cancer treated by NAC alone between 2006 and 2018. Survival outcomes and clinical risk factors for poor prognosis before and after NAC were analyzed. RESULTS: In the median follow-up duration after surgery of 60 months (3-120), the rates of 5-year overall survival (OS), relapse-free survival (RFS), and local recurrence (LR) were 83.6%, 78.4%, and 8.2%, respectively. In the multivariate analyses, patients with cT4 disease had a significantly higher risk of poor OS (HR; 6.10, 95% CI; 1.32-28.15, P = 0.021) than those with cT3 disease. After NAC, ycN+ was significantly associated with a higher risk of poor OS (HR; 5.92, 95% CI; 1.27-27.62, P = 0.024) and RFS (HR; 2.55, 95% CI; 1.01-6.48, P = 0.048) than ycN-. In addition, patients with CEA after NAC (post-CEA) ≥ 5 ng/ml had a significantly higher risk LR (HR; 5.63, 95% CI; 1.06-29.93, P = 0.043). CONCLUSION: NAC alone had an insufficient survival effect on patients with cT4 disease, ycN+, or an elevated post-CEA level. In contrast, NAC alone is a potential treatment for other patients with LARC.

DOI： 10.1016/j.ejso.2020.10.038

What is the impact of systemic chemotherapy for lateral lymph nodes in patients with locally advanced low rectal cancer? Reviewed International journal

Atsushi Ogura, Kay Uehara, Toshisada Aiba, Norifumi Hattori, Goro Nakayama, Osamu Maeda, Yuichi Ando, Yasuhiro Kodera, Tomoki Ebata, Masato Nagino

International journal of colorectal disease Vol. 35 ( 11 ) page： 2073 - 2080 2020.11

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

PURPOSE: Systemic chemotherapy (SC) before surgery is a potential treatment to improve survival in patients with advanced rectal cancer. However, the impact of SC on lateral lymph nodes (LLNs) remains unclear. METHODS: A total of 78 patients with stage II/III low rectal cancer, who received 3-month oxaliplatin-based SC followed by LLN dissection (LLND) in principle, were analysed retrospectively. "Total lateral lymph node metastases (tLLNMs)" was defined as having either pathological LLNMs (pLLNMs) or lateral local recurrences (LLRs). Patients with the maximum short-axis size of LLNs ≥ 7 mm were classified into the swollen group (n = 21). RESULTS: In the total cohort, tLLNMs included 6 pLLNMs (7.7%) and 2 LLRs (2.6%). In the non-swollen group, no patients had pLLNMs, but one had LLR (1.8%). In the swollen group, pLLNMs and LLRs were detected in 6 (28.6%) and 1 (4.8%), respectively. The swollen group was an independent risk factor for tLLNMs (P < 0.001), leading to the significantly worse 5-year relapse-free survival (RFS) of 52.4% than the others. CONCLUSION: For patients without swollen LLNs, SC could allow for omission both of lateral irradiation and LLND. For patients with swollen LLNs, the lateral local control was favourable after SC and LLND without chemoradiotherapy (CRT); however, oxaliplatin-based SC might be insufficient to improve survival, requiring more intensive chemotherapy. CRT should be indicated according to the other risk factors of central local recurrence, although the swollen LLNs should be removed.

DOI： 10.1007/s00384-020-03690-z

Loss of Trefoil Factor 1 Accelerates the Immune Response to Colorectal Cancer

Jinno, T; Yamaguchi, J; Ogura, A; Kokuryo, T; Yokoyama, Y; Sunagawa, M; Baba, T; Murata, Y; Ebata, T

ANTICANCER RESEARCH Vol. 44 ( 9 ) page： 3757 - 3769 2024.9

Language：English Publisher：Anticancer Research

Background/Aim: Recent studies suggest that PD-L1 expression in immune cells, rather than tumor cells, plays a key role in tumor immunity. Trefoil factor family 1 (TFF1) is a secreted protein expressed mainly by the gastrointestinal epithelium and is related to the development of malignant disease. This study investigated the effects of TFF1 on tumor immunity in a xenograft mouse model of colorectal cancer (CRC). Materials and Methods: MC38 cells were implanted in wild-type (WT) and TFF1KO mice, and the tumor microenvironment was investigated using immunohistochemistry. The circulating immune cells were analyzed using flow cytometry. Results: Tumor growth was suppressed in TFF1KO mice. In the tumor microenvironment, CD8- and CD4-positive T cells and CD11c-positive dendritic cells (DCs) were frequently found in TFF1KO mice. When an immune checkpoint inhibitor was administered to these mice, almost half of the tumors in TFF1KO mice showed a complete response. The number of circulating PD-L1/DCs was markedly associated with tumor volume, with TFF1 deletion accelerating this effect and its injection decreasing it. These findings indicate that loss of TFF1 activates tumor immunity via frequent T-cell priming by DCs, and eventually suppresses tumor growth in CRC. In addition, the number of circulating PD-L1/DCs was identified as a predictive marker of checkpoint-inhibiting therapy efficacy. Conclusion: Loss of TFF1 resulted in accelerated immune response to colorectal cancer. Further studies are needed to investigate the precise mechanisms of TFF1 in immunotolerance and develop a novel TFF1-inhibiting immunotherapeutic strategy for CRC.

DOI： 10.21873/anticanres.17200

Two-team laparoscopic extended lateral lymph node dissection with transperineal resection of the distal main trunk of internal iliac vein using a linear stapler-A video vignette

Murata, Y; Ogura, A; Jinno, T; Yogo, K; Mizuno, T; Ebata, T

COLORECTAL DISEASE 2024.8

TLK1 Inhibition Enhances the Anticancer Effect of Deep UV Irradiation Through CHK1 Activation

Koike, Y; Kokuryo, T; Yamaguchi, J; Sunagawa, M; Ogura, A; Watanabe, N; Onoe, S; Miyata, K; Mizuno, T; Uehara, K; Igami, T; Yokoyama, Y; Ebata, T; Nagino, M

ANTICANCER RESEARCH Vol. 44 ( 7 ) page： 2827 - 2836 2024.7

Language：English Publisher：Anticancer Research

Background/Aim: A deep ultraviolet (DUV) light-emitting diode (LED) is a device that can irradiate electromagnetic waves from 250 nm to 350 nm. Tousled-like kinase 1 (TLK1) encodes a nuclear serine/threonine kinase, which is thought to influence the effects of DUV irradiation in cancer. The aim of this study was to clarify the interaction of TLK1 with DUV irradiation-induced DNA damage in cancer cells. Materials and Methods: Pancreatic cancer cell lines were treated with or without DUV. TLK1 expression and phosphorylation in the two groups were examined. Then, these cancer cell lines were treated with thioridazine (THD), DUV or both. Thereafter, cytomorphology and apoptosis were assessed. Several proteins related to DNA damage, were analyzed in cancer cells treated with DUV and THD. Tumors in a subcutaneous xenograft model were treated with THD, DUV, or both for six weeks. Results: DUV irradiation induced the phosphorylation of TLK1 in pancreatic cancer cell lines. Cytomorphology was significantly changed in pancreatic cancer cells treated with DUV and THD. TLK1 inhibition enhanced DUV irradiation-induced apoptosis in cancer cells. Interestingly, CHK1 and pCHK1 expression was suppressed after TLK1 inhibition. In addition, inhibition of MRE11 led to a decrease in the expression of CHK1 and pCHK1, accompanied by a notable increase in apoptosis. In the subcutaneous xenograft models, the tumor volume in the DUV and THD groups was lower than that in the other groups. Conclusion: TLK1 phosphorylation is an important event in DUV irradiation. DUV irradiation combined with TLK1 inhibition has therapeutic potential in pancreatic cancer cells.

DOI： 10.21873/anticanres.17095

Trefoil factor 1 suppresses stemness and enhances chemosensitivity of pancreatic cancer

Yamaguchi, J; Kokuryo, T; Yokoyama, Y; Oishi, S; Sunagawa, M; Mizuno, T; Onoe, S; Watanabe, N; Ogura, A; Ebata, T

CANCER MEDICINE Vol. 13 ( 11 ) page： e7395 2024.6

Language：English Publisher：Cancer Medicine

Background and Aims: Pancreatic cancer is one of the most lethal malignancies, partly due to resistance to conventional chemotherapy. The chemoresistance of malignant tumors is associated with epithelial-mesenchymal transition (EMT) and the stemness of cancer cells. The aim of this study is to investigate the availability and functional mechanisms of trefoil factor family 1 (TFF1), a tumor-suppressive protein in pancreatic carcinogenesis, to treat pancreatic cancer. Methods: To investigate the role of endogenous TFF1 in human and mice, specimens of human pancreatic cancer and genetically engineered mouse model of pancreatic cancer (KPC/TFF1KO; Pdx1-Cre/LSL-KRASG12D/LSL-p53R172H/TFF1−/−) were analyzed by immunohistochemistry (IHC). To explore the efficacy of extracellular administration of TFF1, recombinant and chemically synthesized TFF1 were administered to pancreatic cancer cell lines, a xenograft mouse model and a transgenic mouse model. Results: The deficiency of TFF1 was associated with increased EMT of cancer cells in mouse models of pancreatic cancer, KPC. The expression of TFF1 in cancer cells was associated with better survival rate of the patients who underwent chemotherapy, and loss of TFF1 deteriorated the benefit of gemcitabine in KPC mice. Extracellular administration of TFF1 inhibited gemcitabine-induced EMT, Wnt pathway activation and cancer stemness, eventually increased apoptosis of pancreatic cancer cells in vitro. In vivo, combined treatment of gemcitabine and subcutaneous administration of TFF1 arrested tumor growth in xenograft mouse model and resulted in the better survival of KPC mice by inhibiting EMT and cancer stemness. Conclusion: These results indicate that TFF1 can contribute to establishing a novel strategy to treat pancreatic cancer patients by enhancing chemosensitivity.

DOI： 10.1002/cam4.7395

Usefulness of fluorescent ureteral navigation in total pelvic exenteration using a two-team approach for locally recurrent pelvic malignancies-A video vignette

Ogura, A; Murata, Y; Jinno, T; Yoshikawa, N; Kajiyama, H; Ebata, T

COLORECTAL DISEASE Vol. 26 ( 4 ) page： 812 - 813 2024.4

Prediction model of the risk for lateral local recurrence in locally advanced rectal cancer without enlarged lateral lymph nodes: Lessons from a Japanese multicenter pooled analysis of 812 patients

Ogura, A; Shiomi, A; Yamamoto, S; Komori, K; Hamamoto, H; Manabe, S; Miyakita, H; Okuda, J; Yatsuya, H; Uehara, K

ANNALS OF GASTROENTEROLOGICAL SURGERY Vol. 8 ( 2 ) page： 284 - 292 2024.3

Language：English Publisher：Annals of Gastroenterological Surgery

Aim: Although the oncological impact of lateral lymph node dissection on enlarged lateral lymph nodes has been gradually accepted over the last decade, that on lateral lymph nodes without swelling remains doubtful. This study aimed to develop a prediction model for the future risk of lateral local recurrence and to clarify the value of adding lateral lymph node dissection in locally advanced rectal cancer without enlarged lateral lymph nodes. Methods: This retrospective, multi-institutional study recruited 812 patients with cStage II/III low rectal cancer without enlarged lateral lymph nodes <7 mm. Total lateral local recurrence was a hypothetical value of future risk of lateral local recurrence when lateral lymph node dissection was never performed. Results: Overall, total lateral local recurrences were observed in 67 patients (8.3%). In the multivariate analyses, the strongest risk factor for total local recurrences was no preoperative chemoradiotherapy (odds ratio [OR][95%Cl]: 33.2 [4.56–241.7], P < 0.001), followed by tumor distance ≤40 mm (OR [95%Cl]: 2.71 [1.51–4.86], P < 0.001) and lateral lymph node 5–7 mm (OR[95%Cl]: 2.38 [1.26–4.48], P = 0.007). In patients with lateral lymph nodes of 5–7 mm, the total lateral recurrence rate was 4.8% after preoperative chemoradiotherapy. Lateral lymph node dissection could reduce from a total lateral local recurrence of 21.6% to an actual lateral local recurrence of 8.0% in patients without preoperative treatment. Conclusion: We introduce a novel prediction model of future risk of lateral local recurrences, which has the potential to enable us to indicate lateral lymph node dissection selectively according to the patients' risks.

DOI： 10.1002/ags3.12742

Standardization of laparoscopic pelvic exenteration; usefulness of lateral-first approach using the umbilical ligament as a reliable surgical landmark-A Video Vignette

Ogura, A; Murata, Y; Uehara, K; Kobayashi, R; Sando, M; Ebata, T

COLORECTAL DISEASE Vol. 26 ( 2 ) page： 399 - 400 2024.2

クローン病再手術症例に対する低侵襲手術の治療成績

服部憲史, 中山吾郎, 梅田晋一, 岸田貴喜, 小倉淳司, 村田悠記, 中西香企, 清水大, 神田光郎, 田中千恵, 藤原道隆, 小寺泰弘

日本内視鏡外科学会雑誌 Vol. 28 ( 7 ) page： 2164 - 2164 2023.12

特集見てわかる! 下部消化管手術における最適な剝離層悪性疾患の手術骨盤内臓全摘術の剝離層の選択-膀胱下腹筋膜を意識したumbilicalアプローチを中心に

村田悠記, 上原圭, 小倉淳司, 小林龍太朗, 深田浩志, 余語孝乃助, 江畑智希

臨床外科 Vol. 78 ( 9 ) page： 1093 - 1098 2023.9

Impact of combined resection of the internal iliac artery on loss of volume of the gluteus muscles after pelvic exenteration.

Yuki Murata, Kay Uehara, Atsushi Ogura, Satoko Ishigaki, Toshisada Aiba, Takashi Mizuno, Toshio Kokuryo, Yukihiro Yokoyama, Hiroshi Yatsuya, Tomoki Ebata

Surgery today Vol. 53 ( 7 ) page： 791 - 799 2023.7

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

PURPOSE: To clarify the influence of additional internal iliac artery (IIA) resection on the loss of the gluteus muscle volume after pelvic exenteration (PE). METHODS: The subjects of this retrospective analysis were 78 patients who underwent PE with or without IIA resection (n = 44 and n = 34, respectively) between 2006 and 2018. The areas of gluteal muscles (GMs) and psoas muscles (PSMs) were calculated using CT images before and 6 months after PE, and the difference was compared. RESULTS: The volumes of the GMs and PSMs were significantly reduced after PE (P < 0.001 and P = 0.005, respectively). In the IIA resection group, the GMs were significantly reduced after surgery, but the PSMs were not. The maximum GM (Gmax) was the most atrophied among the GMs. Multivariable analysis revealed that complete IIA resection was an independent promotor of the loss of volume of the Gmax (P = 0.044). In 18 patients with unilateral IIA resection, the downsizing rate of the Gmax was significantly greater on the resected side than on the non-resected side (P = 0.008). CONCLUSIONS: The GMs and PSMs were significantly smaller after PE. Complete IIA resection reduced the Gmax area remarkably. Preservation of the superior gluteus artery is likely to help maintain Gmax size, suggesting a potential preventative measure against secondary sarcopenia.

DOI： 10.1007/s00595-022-02635-z

特集消化管手術での"困難例"対処法-こんなとき,どうする? 総論開腹手術での癒着剝離のコツ

病理学的T3N0,T1N2,3を含むpStageII胃癌の治療成績の検討

杉田静紀, 宮田一志, 田中千恵, 中西香企, 清水大輔, 小倉淳司, 村田悠記, 水野隆史, 小寺泰弘, 江畑智希

日本消化器外科学会総会 Vol. 78回 page： P062 - 3 2023.7

山東雅紀, 上原圭, 小倉淳司, 村田悠記, 梅田晋一, 服部憲史, 中山吾郎

臨床外科 Vol. 78 ( 6 ) page： 650 - 653 2023.6

手術手技腸管粘膜反転が困難な場合の対処法─煙突状ストーマ造設術の有用性について

村田悠記, 小倉淳司, 小林龍太朗, 深田浩志, 上原圭, 江畑智希

手術 Vol. 77 ( 7 ) page： 1081 - 1085 2023.6

神経線維腫症I型に合併した巨大虫垂神経線維腫症の1例

野中有紀子, 上原圭, 小倉淳司, 村田悠記, 小林龍太朗, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 梅田晋一, 服部憲史, 中山吾郎, 横山幸浩, 江畑智希

日本外科系連合学会誌 Vol. 48 ( 3 ) page： 436 - 436 2023.5

特集外科手術と感染症 II. 各論 2. 下部消化管外科 3)直腸癌における術前化学療法は周術期感染性合併症を増加させるのか?-TNT時代に向けてわれわれが知っておくべきこと

小倉淳司, 村田悠記, 小林龍太朗, 上原圭, 中山吾郎, 江畑智希

外科 Vol. 85 ( 5 ) page： 536 - 539 2023.4

右側結腸癌における病理学的転移陰性腫大間膜リンパ節の意義の検討

村田悠記, 小倉淳司, 上原圭, 小林龍太朗, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 川勝章司, 中山吾郎, 服部憲史, 梅田晋一, 横山幸浩, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： SF - 2[Y] 2023.4

肛門管・直腸粘膜への進展を伴う肛門周囲Paget病に対する領域横断的手術治療戦略

深田浩志, 上原圭, 小倉淳司, 村田悠記, 小林龍太朗, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 川勝章司, 中山吾郎, 服部憲史, 梅田晋一, 横山幸浩, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： DP - 4 2023.4

局所進行結腸癌に対する術前化学療法の臨床経験

田根雄一郎, 上原圭, 小倉淳司, 村田悠記, 小林龍太朗, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 川勝章司, 中山吾郎, 服部憲史, 梅田晋一, 横山幸浩, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： DP - 7 2023.4

局所再発直腸癌の最難関側方再発への手術戦略

上原圭, 小倉淳司, 村田悠記, 小林龍太郎, 神原祐一, 田根雄一郎, 杉田静紀, 川勝章司, 渡辺伸元, 砂川真輝, 尾上俊介, 宮田一志, 山口淳平, 水野隆史, 梅田晋一, 服部憲史, 中山吾郎, 伊神剛, 横山幸浩, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： SF - 2 2023.4

術前血清C reactive proteinとprognostic nutritional indexの組み合わせは大腸癌術後長期予後を予測する

梅田晋一, 中山吾郎, 服部憲史, 岸田貴喜, 小倉淳司, 村田悠紀, 中西香企, 清水大, 神田光郎, 田中千恵, 藤原道隆, 小寺泰弘

日本外科学会定期学術集会抄録集 Vol. 123回 page： SF - 8 2023.4

領域横断的チームで臨む外科治療後腹膜軟部肉腫に対する"Onco-vascular surgery"の経験

砂川真輝, 横山幸浩, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小倉淳司, 杉田静紀, 村田悠記, 川勝勝司, 中西香企, 小寺泰弘, 坂野比呂志, 杉本昌之, 六鹿雅登, 徳田順之, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： WS - 6 2023.4

領域横断的チームで臨む外科治療後腹膜軟部肉腫に対する"Onco-vascular surgery"の経験

日本外科学会定期学術集会抄録集 Vol. 123回 page： WS - 6 2023.4

進行下部直腸癌に対する術前化学療法を基本とした治療戦略 Watch & Wait strategyを含めたresponse-guided strategyの導入経験

小倉淳司, 上原圭, 村田悠記, 小林龍太朗, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 川勝章司, 杉田静紀, 梅田晋一, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 123回 page： SF - 5 2023.4

Cyclodextrin Conjugated α-Bisabolol Suppresses FAK Phosphorylation and Induces Apoptosis in Pancreatic Cancer. International journal

Mikiko Takebayashi Kano, Toshio Kokuryo, Taisuke Baba, Kimitoshi Yamazaki, Junpei Yamaguchi, Masaki Sunagawa, Atsushi Ogura, Nobuyuki Watanabe, Shunsuke Onoe, Kazushi Miyata, Takashi Mizuno, Kay Uehara, Tsuyoshi Igami, Yukihiro Yokoyama, Tomoki Ebata, Masato Nagino

Anticancer research Vol. 43 ( 3 ) page： 1009 - 1016 2023.3

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

Antitumor Effects of Deep Ultraviolet Irradiation for Pancreatic Cancer. International journal

Kimitoshi Yamazaki, Toshio Kokuryo, Junpei Yamaguchi, Masaki Sunagawa, Atsushi Ogura, Nobuyuki Watanabe, Shunsuke Onoe, Kazushi Miyata, Takashi Mizuno, Kay Uehara, Tsuyoshi Igami, Yukihiro Yokoyama, Tomoki Ebata, Masato Nagino

Anticancer research Vol. 43 ( 2 ) page： 621 - 630 2023.2

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

下部進行直腸癌における術前化学療法後の側方リンパ節縮小の意義の検討

小倉淳司, 上原圭, 村田悠記, 神原祐一, 小池佳勇, 三品拓也, 小林龍太郎, 宮田一志, 水野隆史, 山口淳平, 國料俊男, 梅田晋一, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 76 ( 2 ) page： 184 - 184 2023.2

免疫チェックポイント阻害薬により病理学的完全奏功が得られたMSI-High大腸癌腹壁限局播種再発・小腸間膜リンパ節転移の1例

小林龍太朗, 上原圭, 小倉淳司, 村田悠記, 鳥居直矢, 深田浩志, 神原祐一, 梅田晋一, 服部憲史, 中山吾郎, 尾上俊介, 宮田一志, 山口淳平, 水野隆史, 伊神剛, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 76 ( 2 ) page： 248 - 248 2023.2

Current status of transanal total mesorectal excision for rectal cancer and the expanding indications of the transanal approach for extended pelvic surgeries. International journal

Kay Uehara, Atsushi Ogura, Yuki Murata, Masanori Sando, Toshiki Mukai, Toshisada Aiba, Takeshi Yamamura, Masanao Nakamura

Digestive endoscopy : official journal of the Japan Gastroenterological Endoscopy Society Vol. 35 ( 2 ) page： 243 - 254 2023.1

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

Transanal total mesorectal excision (taTME) has been rapidly accepted as a promising surgical approach to the distal rectum. The benefits include ease of access to the bottom of the deep pelvis linearly over a short distance in order to easily visualize the important anatomy. Furthermore, the distal resection margins can be secured under direct vision. Additionally, a two-team approach combining taTME with a transabdominal approach could decrease the operative time and conversion rate. Although taTME was expected to become more rapidly popularized worldwide, enthusiasm for it has stalled due to unfamiliar intraoperative complications, a lack of oncologic evidence from randomized trials, and the widespread use of robotic surgery. While international registries have reported favorable short- and medium-term outcomes from taTME, a Norwegian national study reported a high local recurrence rate of 9.5%. The characteristics of the recurrences included rapid, multifocal growth in the pelvis, which was quite different from recurrences following traditional transabdominal TME; thus, the Norwegian Colorectal Cancer Group reached a consensus for a temporary moratorium on the performance of taTME. To ensure acceptable baseline quality and patient safety, taTME should be performed by well-trained colorectal surgeons. Although the appropriate indications for taTME remain controversial, the transanal approach is extremely important as a means of goal setting in difficult TME cases and as an aid to the transabdominal approach in various types of extended pelvic surgeries. The benefits in transanal lateral lymph node dissection and pelvic exenteration are presented herein.

DOI： 10.1111/den.14464

A Case Report of Localized Peritoneal Disseminated Recurrence of Microsatellite Instability-High Colorectal Cancer with Pathologic Complete Response after Immune Checkpoint Inhibitor Therapy

Nishimura Motonobu, Uehara Kay, Ogura Atsushi, Murata Yuki, Kobayashi Ryutaro, Mizuno Takashi, Miyata Kazushi, Yokoyama Yukihiro, Ebata Tomoki

The Japanese Journal of Gastroenterological Surgery Vol. 56 ( 4 ) page： 221 - 228 2023

Language：Japanese Publisher：The Japanese Society of Gastroenterological Surgery

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.

DOI： 10.5833/jjgs.2022.0056

Renal Dysfunction after Rectal Cancer Surgery: A Long-term Observational Study

Sando Masanori, Uehara Kay, Li Yuanying, Ogura Atsushi, Murata Yuki, Mizuno Takashi, Yatsuya Hiroshi, Ebata Tomoki

Journal of the Anus, Rectum and Colon Vol. 7 ( 3 ) page： 176 - 185 2023

Language：English Publisher：The Japan Society of Coloproctology

Objectives: Despite the high incidence of urinary dysfunction (UD) after rectal surgery, it remains questionable whether UD causes future chronic kidney disease (CKD). This study aimed to clarify the long-term trends in renal function and risk factors for future CKD after rectal resection.Methods: For comparison, patients who underwent rectal resection (n = 129) and colectomy (n = 127) between 2006 and 2017 were identified. The estimated glomerular filtration rate (eGFR) ratio was calculated as the ratio to the baseline. "eGFR ratio < 0.75 at 3-year" was adopted as a surrogate indicator of future CKD.Results: eGFR ratio significantly decreased in the rectal cohort compared with the colon cohort at 1.5 years (0.9 vs. 0.95, p = 0.008) and at 3 years (0.85 vs. 0.94, p < 0.001). Although the preoperative prevalence of CKD was lower in the rectal than the colon cohort (13.9% vs. 23.6%, p = 0.055), it was similar at 3 years (29.5% vs. 30.7%). In multivariate analysis, females, and cT4 were independent risk factors for future CKD, but UD itself was not.Conclusions: Postoperative eGFR significantly decreased after rectal cancer surgery compared to colectomy. The prevalence of CKD more than doubled at 3 years after rectal resection. The female sex and cT4 tumor, instead of the UD, were independent risk factors for future CKD.

DOI： 10.23922/jarc.2022-059

A Case of Cecal Adenocarcinoma with Synchronous Liver Metastasis and BRCA1 Pathological Variant Detected in the Germline as a Secondary Finding ofa Cancer Gene Panel Test

Nonaka Yukiko, Uehara Kay, Ogura Atsushi, Murata Yuki, Kobayashi Ryutaro, Morikawa Maki, Hatakeyama Miki, Morita Mami, Yokoyama Yukihiro, Ebata Tomoki

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 76 ( 6 ) page： 443 - 446 2023

Language：Japanese Publisher：The Japan Society of Coloproctology

A 75-year-old woman was referred to our hospital with a chief complaint of tiredness. She was diagnosed with cecum cancer, unresectable multiple liver metastases, and peritoneal dissemination. The companion gene test result showed that she was RAS mutant (KRAS G12V), BRAF V600E wild type, and microsatellite stable, and she was treated with FOLFOX + bevacizumab. Her cancer gene panel test revealed a BRCA1 pathological variant in the germline, and she was diagnosed with hereditary breast and ovarian cancer syndrome. With the increasing use of cancer gene panel testing, it is expected that the number of cases in which secondary findings in the germ line are unexpectedly detected, leading to the diagnosis of inherited diseases, will increase. Although this information is always included in the consent document, not only patients but also health care providers are often unaware of the importance of genetic counseling.

DOI： 10.3862/jcoloproctology.76.443

Minimum radial margin in pelvic exenteration for locally advanced or recurrent rectal cancer. International journal

Toshisada Aiba, Kay Uehara, Yuta Tsuyuki, Atsushi Ogura, Yuki Murata, Takashi Mizuno, Junpei Yamaguchi, Toshio Kokuryo, Yukihiro Yokoyama, Tomoki Ebata

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Vol. 48 ( 12 ) page： 2502 - 2508 2022.12

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

PURPOSE: The aim of this study was to clarify the suitable radial margin (RM) for favourable outcomes after pelvic exenteration (PE), focusing on the discrepancy between the concepts of circumferential resection margin (CRM) and traditional R status. METHODS: Seventy-three patients with locally advanced (LARC, n = 24) or locally recurrent rectal cancer (LRRC, n = 49) who underwent PE between 2006 and 2018 were retrospectively analysed. Patients were histologically classified into the following 3 groups; wide RM (≥1 mm, n = 45), narrow RM (0-1 mm, n = 10), and exposed RM (n = 18). The analysis was performed not only in the entire cohort but also in each disease group separately. RESULTS: The rates of traditional R0 (RM > 0 mm) and wide RM were 75.3% and 61.6%, respectively, resulting in the discrepancy rate of 13.7% between the two concepts. Preoperative radiotherapy was given in 12.3%. In the entire cohort, the local recurrence and overall survival (OS) rates for narrow RMs were significantly worse than those for wide RMs (p < 0.001 and p = 0.002), but were similar to those for exposed RMs. In both LARC and LRRC, RM < 1 mm resulted in significantly worse local recurrence and OS rates compared to the wide RMs. Multivariate analysis showed that RM < 1 mm was an independent risk factor for local recurrence in both LARC (HR 15.850, p = 0.015) and LRRC (HR 4.874, p = 0.005). CONCLUSIONS: Narrow and exposed RMs had an almost equal impact on local recurrence and poor OS after PE. Preoperative radiotherapy might have a key role to ensure a wide RM.

DOI： 10.1016/j.ejso.2022.06.015

T4b大腸癌に対する腹腔鏡手術:手技の工夫と成績 cT4b大腸癌に対する腹腔鏡手術の適応と攻略法

上原圭, 小倉淳司, 村田悠記, 小林龍太郎, 神原祐一, 深田浩志, 野中有紀子, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 杉田静紀, 服部憲史, 中山吾郎, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 79 - 79 2022.12

胆道解剖の変異を伴う症例に対する単孔式腹腔鏡下胆嚢摘出術における蛍光胆道鏡の有効性と限界

伊神剛, 上原圭, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 小倉淳司, 杉田静紀, 川勝章司, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 1365 - 1365 2022.12

広範囲胆管癌術後に縦隔膿瘍をきたした1例

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

日本臨床外科学会雑誌 Vol. 83 ( 12 ) page： 2149 - 2149 2022.12

困難症例に対する大腸癌手術:手技の工夫と成績他臓器浸潤結腸癌に対する腹腔鏡手術の実際と工夫

小倉淳司, 上原圭, 村田悠記, 鳥居直矢, 小林龍太朗, 深田浩志, 野中有紀子, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 中山吾郎, 服部憲史, 梅田晋一, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 1875 - 1875 2022.12

切除不能肺転移を有する直腸癌同時性切除可能肝転移に対する腹腔鏡下rescue liver resection

水野隆史, 小倉淳司, 尾上俊介, 村田悠記, 川勝章司, 伊神剛, 宮田一志, 杉田静紀, 上原圭, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 2508 - 2508 2022.12

イマチニブ投与後に経肛門アプローチを併用して前方臓器温存し得た直腸巨大GISTの1例

神原祐一, 上原圭, 小倉淳司, 村田悠記, 小林龍太朗, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 砂川真輝, 杉田静紀, 梅田晋一, 服部憲史, 中山吾郎, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 659 - 659 2022.12

進行再発直腸癌に対する腹腔鏡拡大手術:手技の工夫と成績当科における局所再発直腸癌に対する腹腔鏡下拡大手術の治療成績

深田浩志, 上原圭, 小倉淳司, 村田悠記, 鳥居直矢, 小林龍太朗, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 砂川真輝, 杉田静紀, 服部憲史, 中山吾郎, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 933 - 933 2022.12

骨盤外科手術に必要な外科解剖-拡大手術、他臓器合併切除を安全に行うために- 局所進行・再発直腸癌に対する腹腔鏡下骨盤内臓全摘術の安全な導入に向けた取り組み umbilical 1stアプローチの有用性

村田悠記, 上原圭, 小倉淳司, 小林龍太朗, 鳥居直矢, 深田浩志, 野中有紀子, 伊神剛, 水野隆史, 宮田一志, 尾上俊介, 中山吾郎, 服部憲史, 梅田晋一, 江畑智希

日本内視鏡外科学会雑誌 Vol. 27 ( 7 ) page： 908 - 908 2022.12

Early volume loss of skeletal muscle after esophagectomy: a risk for late-onset postoperative pneumonia. International journal

Koudai Nishimura, Kazushi Miyata, Masahide Fukaya, Yukihiro Yokoyama, Kay Uehara, Junpei Yamaguchi, Takashi Mizuno, Shunsuke Onoe, Atsushi Ogura, Tomoki Ebata

Diseases of the esophagus : official journal of the International Society for Diseases of the Esophagus Vol. 35 ( 11 ) 2022.11

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

BRAF V600E変異陽性進行再発大腸癌の治療成績から考える転移巣切除の至適適応

神野孝徳, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 神原祐一, 小林龍太朗, 尾上俊介, 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

日本癌治療学会学術集会抄録集 Vol. 60回 page： OF - 3 2022.10

肝門部領域胆管癌術後のComprehensive Complication Indexの至適な算出期間は?

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

日本消化器外科学会雑誌 Vol. 55 ( Suppl.2 ) page： 241 - 241 2022.10

膵癌における栄養評価およびCA19-9に基づく術前予後層別化非解剖学的バイオマーカーによるアプローチ

尾上俊介, 横山幸浩, 伊神剛, 上原圭, 水野隆史, 山口淳平, 宮田一志, 砂川真輝, 渡辺伸元, 小倉淳司, 杉田静紀, 村田悠記, 川勝章司

日本消化器外科学会雑誌 Vol. 55 ( Suppl.2 ) page： 163 - 163 2022.10

高齢者に対する大腸がん治療の個別化を考える術前CRP/Alb比高値と術後内臓脂肪面積減少は高齢者大腸癌患者の予後不良因子である

神原祐一, 上原圭, 小倉淳司, 村田悠記, 小林龍太朗, 伊神剛, 水野隆史, 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

日本癌治療学会学術集会抄録集 Vol. 60回 page： OWS9 - 2 2022.10

困難な状況下でも良いストーマを造設する手技腸管粘膜反転が困難な場合の対処法煙突状ストーマ造設術の有用性について

村田悠記, 上原圭, 小倉淳司, 神原祐一, 小林龍太朗, 鳥居直矢, 深田浩志, 國料俊男, 伊神剛, 水野隆史, 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

日本大腸肛門病学会雑誌 Vol. 75 ( 9 ) page： A69 - A69 2022.9

直腸癌術後異時性肝・肺転移に対して化学療法開始後1年7ヵ月でconversion切除し得た1例

深田浩志, 上原圭, 小倉淳司, 村田悠記, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 75 ( 9 ) page： A221 - A221 2022.9

直腸癌術前集学的治療の成績:Watch & Waitを含めて局所進行直腸癌に対する術前化学療法を基本とした治療戦略Tripletレジメンの臨床経験とWatch and Wait strategyの安全な導入

小倉淳司, 上原圭, 村田悠記, 鳥居直矢, 小林龍太朗, 深田浩志, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 杉田静紀, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 75 ( 9 ) page： A54 - A54 2022.9

当院におけるMSI-High大腸癌に対する免疫チェックポイント阻害薬の臨床経験

小林龍太朗, 上原圭, 小倉淳司, 村田悠記, 神原祐一, 伊神剛, 水野隆史, 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

日本大腸肛門病学会雑誌 Vol. 75 ( 9 ) page： A149 - A149 2022.9

Role of resection for extrahepatopulmonary metastases of colon cancer. International journal

Takuya Mishina, Kay Uehara, Atsushi Ogura, Yuki Murata, Toshisada Aiba, Takashi Mizuno, Yukihiro Yokoyama, Tomoki Ebata

Japanese journal of clinical oncology Vol. 52 ( 7 ) page： 727 - 733 2022.7

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

BACKGROUND: Although surgical resection for liver or lung metastases of colorectal cancer has been widely accepted, the use of this approach for extrahepatopulmonary metastases remains debatable due to the systemic nature of the disease. The aim of this study was to clarify the utility of resection along with perioperative chemotherapy for patients with extrahepatopulmonary metastases of colon cancer. METHODS: This is a retrospective single-arm study at a single institution. Forty-two patients with resectable extrahepatopulmonary metastases who underwent metastasectomy with curative intent between 2009 and 2018 at Nagoya University Hospital were retrospectively analyzed. The primary outcomes measured were overall and relapse-free survival. RESULTS: The most common metastatic site was the peritoneum (n = 31), followed by the distant lymph nodes (n = 10), ovary (n = 1) and spleen (n = 1), with overlaps. Preoperative and postoperative chemotherapies were administered to 22 and 8 patients, respectively; the remaining 14 patients received surgery alone. R0 resection was achieved in 36 patients (85.7%). The 5-year overall survival and 3-year relapse-free survival rates were 58.6% and 33.8%, respectively. In the univariate analysis, R1 resection was associated with a poor relapse-free survival rate (P = 0.02). In the multivariate analysis, the absence of perioperative chemotherapy was an independent risk factor for poor overall survival rates (P = 0.02). CONCLUSIONS: Surgical resection benefited selected patients with extrahepatopulmonary metastases with favorable long-term survival outcomes. Surgery alone without systemic chemotherapy is likely to bring poor outcome; therefore, preoperative induction might be promising to keep up with chemotherapy.

DOI： 10.1093/jjco/hyac045

Stoma creation is associated with a low incidence of midline incisional hernia after colorectal surgery: the "fighting over the fascia" theory concerning the incision and stoma hole.

切除可能同時性大腸癌肝転移症例に対する肝実質温存肝切除が生存率に与える影響

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

日本消化器外科学会総会 Vol. 77回 page： P093 - 4 2022.7

術前CAR(CRP/albumin ratio)は高齢者大腸癌術後症例の予後予測因子である

神原祐一, 上原圭, 小倉淳司, 村田悠記, 宮田一志, 山口淳平, 水野隆史, 伊神剛, 横山幸浩, 江畑智希

日本消化器外科学会総会 Vol. 77回 page： P119 - 6 2022.7

Noriaki Ohara, Kay Uehara, Atsushi Ogura, Masanori Sando, Toshisada Aiba, Yuki Murata, Takashi Mizuno, Kokuryo Toshio, Yukihiro Yokoyama, Satoko Ishigaki, Yuanying Li, Hiroshi Yatsuya, Tomoki Ebata

Surgery today Vol. 52 ( 6 ) page： 953 - 963 2022.6

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

PURPOSE: Parastomal hernia (PH) develops more frequently than incisional hernia (IH) after colorectal surgery with stoma. This study evaluated our hypothesis that inward traction of the fascia when closing a midline incision widens the stoma hole and increases the incidence of PH. METHODS: A total of 795 patients who underwent colorectal resection between 2006 and 2016 were retrospectively analyzed. The risk classification was constructed from IH risk factors extracted from the non-stoma group. Then, the classification was extrapolated to the stoma group for predicting midline IH and PH. RESULTS: The incidence of IH was 5.3% in the stoma group and 12.5% in the non-stoma group (p = 0.005). PH developed in 19.6% of 97 patients with permanent stoma. The risk classification was able to predict PH without a significant difference but was well balanced in patients with permanent stoma; however, it failed to predict IH in the stoma group. CONCLUSION: The risk classification constructed from the non-stoma group was useful for predicting not midline IH but PH, suggesting that the stoma site was the most vulnerable for herniation. The "fighting over the fascia" theory between the midline incision and stoma hole may explain the causal relationship between the midline IH and PH.

DOI： 10.1007/s00595-021-02434-y

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

村田悠記, 上原圭, 小倉淳司, 杉田静紀, 渡辺伸元, 砂川真輝, 尾上俊介, 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

臨床外科 Vol. 77 ( 5 ) page： 514 - 519 2022.5

特集内視鏡手術からみえる新しい解剖学 II. 下部消化管 6.左側結腸癌に対する腹腔鏡下大動脈周囲リンパ節郭清

相場利貞, 上原圭, 小倉淳司, 村田悠記, 水野隆史, 横山幸浩, 江畑智希

外科 Vol. 84 ( 5 ) page： 484 - 488 2022.5

【本邦の大腸癌治療の現状と展望-海外における標準治療と比較して】局所再発に対する治療選択と実践

上原圭, 小倉淳司, 村田悠記, 渡辺伸元, 砂川真輝, 尾上俊介, 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

日本外科学会雑誌 Vol. 123 ( 3 ) page： 255 - 261 2022.5

【本邦の大腸癌治療の現状と展望-海外における標準治療と比較して】局所再発に対する治療選択と実践

上原圭, 小倉淳司, 村田悠記, 渡辺伸元, 砂川真輝, 尾上俊介, 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

日本外科学会雑誌 Vol. 123 ( 3 ) page： 255 - 261 2022.5

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)

扁平上皮癌に悪性転化した仙尾部奇形腫の1例

日本外科系連合学会誌 Vol. 47 ( 3 ) page： 470 - 470 2022.5

他科と連携した骨盤内臓全摘術骨盤部感染の低減/QOL向上を目指して

村田悠記, 上原圭, 小倉淳司, 神原祐一, 小林龍太朗, 伊神剛, 水野隆史, 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

日本外科系連合学会誌 Vol. 47 ( 3 ) page： 421 - 421 2022.5

村田悠記, 上原圭, 小倉淳司, 杉田静紀, 渡辺伸元, 砂川真輝, 尾上俊介, 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

臨床外科 Vol. 77 ( 5 ) page： 514 - 519 2022.5

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.

腹腔鏡下直腸癌手術におけるエネルギーデバイスの選択腹腔鏡下直腸癌手術におけるエネルギーデバイスの選択電気メスを中心とした立場から

上原圭, 小倉淳司, 村田悠記, 小林龍太郎, 神原祐一, 深田浩志, 服部憲史, 中山吾郎, 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

日本外科系連合学会誌 Vol. 47 ( 3 ) page： 413 - 413 2022.5

高度肥満者に対する手術の工夫高度肥満症例に対し"小さいが安全な術野"を連続させる腹腔鏡下大腸切除術

日本外科系連合学会誌 Vol. 47 ( 3 ) page： 394 - 394 2022.5

骨盤内臓全摘術後の骨盤死腔炎のリスク因子から考える対策法

小林龍太朗, 上原圭, 小倉淳司, 村田悠記, 小池佳勇, 三品拓也, 神原祐一, 西村元伸, 服部憲史, 中山吾郎, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡邊伸元, 横山幸浩, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 122回 page： DP - 4 2022.4

切除可能同時性肝転移症例の治療戦略肝実質温存術式の有用性

三品拓也, 水野隆史, 上原圭, 小倉淳司, 村田悠記, 小池佳勇, 神原祐一, 西村元伸, 小林龍太朗, 服部憲史, 中山吾郎, 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, 横山幸浩, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 122回 page： SF - 7 2022.4

悪性転化した仙尾部奇形腫の2例

西村元伸, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 小池佳勇, 神原祐一, 小林龍太朗, 神野孝徳, 國料俊男, 伊神剛, 水野隆史, 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

日本外科学会定期学術集会抄録集 Vol. 122回 page： DP - 8 2022.4

進行直腸癌に対する治療戦略【International】所進行直腸癌に対する術前化学療法におけるbevacizumabの意義の検討

小倉淳司, 上原圭, 村田悠記, 小池佳男, 三品拓也, 神原祐一, 西村元伸, 小林龍太郎, 服部憲史, 中山吾郎, 横山幸浩, 國料俊男, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 砂川真輝, 渡辺伸元, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 122回 page： PD - 1 2022.4

ウィズコロナ時代のオンライン補完型外科臨床実習

高見秀樹, 宮田一志, 渡辺伸元, 柴田雅央, 小倉淳司, 清水大, 服部憲史, 菊森豊根, 江畑智希, 小寺泰弘

日本外科学会定期学術集会抄録集 Vol. 122回 page： DP - 6 2022.4

肝門部胆管癌の手術限界を考える肝門部領域胆管癌肝切除における術中出血量の安全限界

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

日本外科学会定期学術集会抄録集 Vol. 122回 page： SY - 1 2022.4

悪性転化した仙尾部奇形腫の2例

日本外科学会定期学術集会抄録集 Vol. 122回 page： DP - 8 2022.4

切除可能同時性肝転移症例の治療戦略肝実質温存術式の有用性

日本外科学会定期学術集会抄録集 Vol. 122回 page： SF - 7 2022.4

進行直腸癌に対する治療戦略【International】所進行直腸癌に対する術前化学療法におけるbevacizumabの意義の検討

日本外科学会定期学術集会抄録集 Vol. 122回 page： PD - 1 2022.4

骨盤内臓全摘術後の骨盤死腔炎のリスク因子から考える対策法

日本外科学会定期学術集会抄録集 Vol. 122回 page： DP - 4 2022.4

Increased Risk of Thyroid Dysfunction by PD-1 and CTLA-4 Blockade in Patients Without Thyroid Autoantibodies at Baseline. International journal

Shintaro Iwama, Tomoko Kobayashi, Yoshinori Yasuda, Takayuki Okuji, Masaaki Ito, Masahiko Ando, Xin Zhou, Ayana Yamagami, Takeshi Onoue, Yohei Kawaguchi, Takashi Miyata, Mariko Sugiyama, Hiroshi Takagi, Daisuke Hagiwara, Hidetaka Suga, Ryoichi Banno, Tetsunari Hase, Masahiro Morise, Keiko Wakahara, Kenji Yokota, Masashi Kato, Naoki Nishio, Chie Tanaka, Kazushi Miyata, Atsushi Ogura, Takanori Ito, Tsunaki Sawada, Tomoya Shimokata, Kaoru Niimi, Fumiharu Ohka, Masatoshi Ishigami, Momokazu Gotoh, Naozumi Hashimoto, Ryuta Saito, Hitoshi Kiyoi, Hiroaki Kajiyama, Yuichi Ando, Hideharu Hibi, Michihiko Sone, Masashi Akiyama, Yasuhiro Kodera, Hiroshi Arima

The Journal of clinical endocrinology and metabolism Vol. 107 ( 4 ) page： E1620 - E1630 2022.3

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

BACKGROUND: Previous studies showed that although the risk of thyroid dysfunction [thyroid immune-related adverse events (irAEs)] induced by anti-programmed cell death-1 antibodies (PD-1-Ab) was as low as 2% to 7% in patients negative for anti-thyroid antibodies (ATAs) at baseline, it was much higher (30%-50%) in patients positive for ATAs. However, whether a similar increase occurs with combination therapy using PD-1-Ab plus anti-cytotoxic T-lymphocyte antigen-4 antibody (CTLA-4-Ab) is unknown. METHODS: A total of 451 patients with malignancies treated with PD-1-Ab, CTLA-4-Ab, or a combination of PD-1-Ab and CTLA-4-Ab (PD-1/CTLA-4-Abs) were evaluated for ATAs at baseline and for thyroid function every 6 weeks for 24 weeks after treatment initiation and then observed until the last clinical visit. RESULTS: Of the 451 patients, 51 developed thyroid irAEs after immunotherapy [41 of 416 (9.9%) treated with PD-1-Ab, 0 of 8 (0%) treated with CTLA-4-Ab, and 10 of 27 (37.0%) treated with PD-1/CTLA-4-Abs]. The cumulative incidence of thyroid irAEs was significantly higher in patients who were positive vs negative for ATAs at baseline after both PD-1-Ab [28/87 (32.2%) vs 13/329 (4.0%), P < 0.001] and PD-1/CTLA-4-Abs [6/10 (60.0%) vs 4/17 (23.5%), P < 0.05] treatments. The risk of thyroid irAEs induced by PD-1/CTLA-4Abs, which was significantly higher than that induced by PD-1-Ab, in patients negative for ATAs at baseline was not statistically different from that induced by PD-1-Ab in patients positive for ATAs at baseline. CONCLUSIONS: This study showed that the incidence of thyroid irAEs was high and not negligible after PD-1/CTLA-4-Abs treatment even in patients negative for ATAs at baseline.

DOI： 10.1210/clinem/dgab829

ASO Visual Abstract: Malignant Features in Pretreatment Metastatic Lateral Lymph Nodes in Locally Advanced Low Rectal Cancer Predict Distant Metastases

特集胆道癌治療の最前線 II. 各論 4.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

Kroon, HM; Dudi-Venkata, NN; Bedrikovetski, S; Liu, JL; Haanappel, A; Ogura, A; van de Velde, CJH; Rutten, HJT; Beets, GL; Thomas, ML; Kusters, M; Sammour, T

ANNALS OF SURGICAL ONCOLOGY Vol. 29 ( 2 ) page： 1206 - 1207 2022.2

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

【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

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

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

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

II. Treatment for Recurrent Cholangiocarcinoma

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

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

他科連携で高難度手術を克服する他科と連携した骨盤内臓全摘術骨盤部感染の低減/QOL向上を目指して

村田悠記, 上原圭, 小倉淳司, 三品拓也, 小池佳勇, 神原祐一, 西村元伸, 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

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S120 - S120 2021.10

【Stepごとに要点解説標準術式アトラス最新版】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

Liver、Pancreas、Biliary Tract Cancer 肝・胆・膵癌再発肝胆膵がんへの新たな挑戦 II.胆管癌切除後再発への治療方針

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

癌と化学療法 Vol. 48 ( 10 ) page： 1223 - 1226 2021.10

腹腔鏡下仙骨合併腫瘍切除を施行した骨盤内巨大神経鞘腫の一例

西村元伸, 上原圭, 小倉淳司, 服部憲史, 中山吾郎, 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, 横山幸浩, 小寺泰弘, 江畑智希

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S932 - S932 2021.10

骨盤内巨大Solitary fibrous tumorの2例

神原祐一, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 小池佳勇, 西村元伸, 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

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S673 - S673 2021.10

進行直腸癌に対する集学的治療 Total Neoadjuvant Therapyを見据えた、進行直腸癌に対する術前化学療法の治療奏効予測因子の検討

三品拓也, 上原圭, 小倉淳司, 村田悠記, 小池佳勇, 神原祐一, 西村元伸, 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

日本臨床外科学会雑誌 Vol. 82 ( 増刊 ) page： S343 - S343 2021.10

Local recurrences in western low rectal cancer patients treated with or without lateral lymph node dissection after neoadjuvant (chemo)radiotherapy: An international multi-centre comparative study. International journal

Hidde M Kroon, Songphol Malakorn, Nagendra N Dudi-Venkata, Sergei Bedrikovetski, Jianliang Liu, Tim Kenyon-Smith, Brian K Bednarski, Atsushi Ogura, Cornelis J H van de Velde, Harm J T Rutten, Geerard L Beets, Michelle L Thomas, Miranda Kusters, George J Chang, Tarik Sammour

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Vol. 47 ( 9 ) page： 2441 - 2449 2021.9

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

BACKGROUND: In the West, low rectal cancer patients with abnormal lateral lymph nodes (LLNs) are commonly treated with neoadjuvant (chemo)radiotherapy (nCRT) followed by total mesorectal excision (TME). Additionally, some perform a lateral lymph node dissection (LLND). To date, no comparative data (nCRT vs. nCRT + LLND) are available in Western patients. METHODS: An international multi-centre cohort study was conducted at six centres from the Netherlands, US and Australia. Patients with low rectal cancers from the Netherlands and Australia with abnormal LLNs (≥5 mm short-axis in the obturator, internal iliac, external iliac and/or common iliac basin) who underwent nCRT and TME (LLND-group) were compared to similarly staged patients from the US who underwent a LLND in addition to nCRT and TME (LLND + group). RESULTS: LLND + patients (n = 44) were younger with higher ASA-classifications and ypN-stages compared to LLND-patients (n = 115). LLND + patients had larger median LLNs short-axes and received more adjuvant chemotherapy (100 vs. 30%; p < 0.0001). Between groups, the local recurrence rate (LRR) was 3% for LLND + vs. 11% for LLND- (p = 0.13). Disease-free survival (DFS, p = 0.94) and overall survival (OS, p = 0.42) were similar. On multivariable analysis, LLND was an independent significant factor for local recurrences (p = 0.01). Sub-analysis of patients who underwent long-course nCRT and had adjuvant chemotherapy (LLND-n = 30, LLND + n = 44) demonstrated a lower LRR for LLND + patients (3% vs. 16% for LLND-; p = 0.04). DFS (p = 0.10) and OS (p = 0.11) were similar between groups. CONCLUSION: A LLND in addition to nCRT may improve loco-regional control in Western patients with low rectal cancer and abnormal LLNs. Larger studies in Western patients are required to evaluate its contribution.

DOI： 10.1016/j.ejso.2021.06.004

The carcinoembryonic antigen ratio is a potential predictor of survival in recurrent colorectal cancer.

会陰部に広範に自壊した局所再発直腸粘液癌に対し、仙骨合併骨盤内臓全摘術+複数の筋皮弁再建を施行し、R0切除を達成し得た一例

神原祐一, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 小池佳勇, 鈴木優美, 西村元伸, 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, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 74 ( 9 ) page： A204 - A204 2021.9

結腸癌腹膜播種に対する外科切除の意義

三品拓也, 上原圭, 小倉淳司, 村田悠記, 小池佳勇, 鈴木優美, 神原祐一, 西村元伸, 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, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 74 ( 9 ) page： A209 - A209 2021.9

当科における局所進行結腸癌に対する術前化学療法の臨床経験

小倉淳司, 上原圭, 小池佳勇, 村田悠記, 神野孝徳, 鈴木優美, 三品拓也, 神原祐一, 西村元伸, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 74 ( 9 ) page： A200 - A200 2021.9

当科におけるBRAF V600E変異陽性大腸癌に対するBRAF阻害剤併用療法の使用経験

神野孝徳, 上原圭, 小倉淳司, 村田悠記, 三品拓也, 小池佳勇, 神原祐一, 鈴木優美, 西村元伸, 伊神剛, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 74 ( 9 ) page： A208 - A208 2021.9

Yumi Suzuki, Atsushi Ogura, Kay Uehara, Toshisada Aiba, Noriaki Ohara, Yuki Murata, Takanori Jinno, Takuya Mishina, Yusuke Sato, Norifumi Hattori, Goro Nakayama, Yasuhiro Kodera, Tomoki Ebata

International journal of clinical oncology Vol. 26 ( 7 ) page： 1264 - 1271 2021.7

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

BACKGROUND: The carcinoembryonic antigen (CEA) "value" itself is often useless in patients with a normal CEA level at initial presentation and those with tumor-irrelevant elevated CEA. Although the unified marker using CEA has been desirable for recurrent tumor staging as well as for primary tumor staging, little is known concerning its relationship with the survival of patients with recurrent colorectal cancer in particular. METHODS: This retrospective historical study included patients who experienced disease relapse after curative surgery for stage I-III colorectal cancer between 2006 and 2018. A total of 129 patients with recurrent disease after curative surgery for colorectal cancer were included. We focused on the CEA "ratio" (CEA-R: the ratio of the CEA level at the time of recurrence to that measured 3 months before recurrence) and aimed to evaluate the correlation between CEA-R and survival in recurrent colorectal cancer. RESULTS: Patients with a high CEA-R (≥ 2) exhibited significantly worse 2 year survival than those with a low CEA-R (< 2) (88.1% vs. 44.9%, P < 0.001), irrespective of the CEA value before primary resection. Multivariate analyses demonstrated that the CEA-R (HR; 3.270, 95% CI 1.646-6.497, P = 0.001) was a significant prognostic factor. CONCLUSION: The CEA-R is a potential marker stratifying the survival of patients with disease relapse who exhibit aggressive biology at recurrent disease foci. As a novel marker, the CEA-R would serve as a clinical guide for tailoring treatment strategies at the time of disease relapse in patients with colorectal cancer.

DOI： 10.1007/s10147-021-01919-7

Transanal lateral pelvic lymph node dissection

Vol. 76 ( 5 ) page： 596 - 602 2021.5

特集専門医必携新外科手術書-新しい手術手技のエッセンス IV. 大腸 5.剝離層を意識した腹腔鏡下低位前方切除術の手術手技

小倉淳司, 上原圭, 相場利貞, 村田悠記, 江畑智希

外科 Vol. 83 ( 5 ) page： 506 - 512 2021.4

Laparoscopic surgery for sigmoid colon cancer with complicated communication between the superior and inferior mesenteric arteries. Reviewed

Ryutaro Kobayashi, Atsushi Ogura, Satoru Kawai, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Masanori Sando, Konosuke Yogo, Natsuki Nagano, Satoaki Kamiya

Asian journal of endoscopic surgery Vol. 14 ( 2 ) page： 267 - 270 2021.4

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

To perform complete mesocolic excision with central vessel ligation, it is important to recognize the vessel anomaly and the location of the tumor. For left-sided colon cancer, the variations in the course of the left colic artery and accessary middle colic artery must be recognized preoperatively. Here, we describe our experience with a 57-year-old man who was diagnosed with sigmoid colon cancer with complicated inter-mesenteric connections between the inferior mesenteric artery (IMA) and superior mesenteric artery (SMA), possibly due to median arcuate ligament syndrome. We performed laparoscopic sigmoidectomy with low ligation of the IMA to preserve the extremely enlarged left colic artery. The total operative time was 155 minutes, and the estimated total blood loss was 10 mL. The patient was discharged on postoperative day 9 without any postoperative complications. For patients with vascular anomalies in the left-sided mesocolon, preoperatively ruling out SMA stenosis by using angiography and 3-D CT might be important.

DOI： 10.1111/ases.12844

頸部リンパ節転移再発に対し二次治療が著効し病理学的完全奏効を得たRAS/BRAF V600E変異型横行結腸癌の1例

下部直腸癌術後患者の長期腎機能へ影響を与える因子の検討

山東雅紀, 上原圭, 相場利貞, 小倉淳司, 大原規彰, 村田悠記, 三品拓也, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 川井覚, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： SF - 5 2021.4

直腸癌同時性肝転移に対する手術治療戦略

米川佳彦, 上原圭, 相場利貞, 小倉淳司, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 三品拓也, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： PS - 8 2021.4

局所進行直腸癌における術前化学療法後の病理学的リンパ節転移奏功度の意義

相場利貞, 上原圭, 小倉淳司, 大原規彰, 神野孝徳, 鈴木優美, 三品拓也, 村田悠記, 渡辺伸元, 尾上俊介, 宮田一志, 山口淳平, 水野隆史, 深谷昌秀, 伊神剛, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： SF - 5 2021.4

大腸癌術後ストマ造設症例における腹壁瘢痕および傍ストマヘルニアの因果関係

大原規彰, 上原圭, 相場利貞, 小倉淳司, 村田悠記, 神野孝徳, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： SF - 8 2021.4

再発大腸癌における予後予測マーカーとしてのCEA比の有用性

鈴木優美, 小倉淳司, 上原圭, 相場利貞, 大原規彰, 村田悠記, 神野孝徳, 三品拓也, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： PS - 1 2021.4

進行再発大腸癌における3次治療以降の予後予測因子の検討

神野孝徳, 上原圭, 相場利貞, 小倉淳司, 大原規彰, 村田悠記, 鈴木優美, 三品拓也, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： SF - 7 2021.4

骨盤内臓全摘術後のサルコペニア内腸骨動脈血管処理に着目して

村田悠記, 上原圭, 相場利貞, 小倉淳司, 大原規彰, 神野孝徳, 三品拓也, 鈴木優美, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： SF - 4 2021.4

村田悠記, 上原圭, 相場利貞, 小倉淳司, 深谷昌秀, 宮田一志, 田中綾, 大原規彰, 神野孝徳, 江畑智希

日本消化器外科学会雑誌 Vol. 54 ( 4 ) page： 278 - 284 2021.4

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

今日,進行再発大腸癌治療において遺伝子検査は必要不可欠なものとなっている.中でもBRAF V600E変異症例の予後は極めて不良と報告され,その治療選択に悩むことは少なくない.今回,オキサリプラチンベースの術後補助化学療法が終了した直後の術後9ヵ月の早期に,頸部リンパ節再発を来し,BRAF V600E変異型で予後不良が予測された症例に対し,二次治療としてのFOLFIRI+aflibercept療法が著効し,切除により病理学的完全奏効を確認した1例を経験した.術後経過観察期間は9ヵ月とまだ短いが,外来で無再発,無治療で経過観察中である.予後不良とされるBRAF V600E変異型であっても野生型と同様に一定の全身コントロールが可能であれば,転移巣切除を考慮する意義はあると考えられた.(著者抄録)

Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J01117&link_issn=&doc_id=20210519510007&doc_link_id=10.5833%2Fjjgs.2020.0057&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2020.0057&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

進行再発大腸癌に対する集学的アプローチの最先端結腸癌非肝肺転移に対する外科切除の意義

三品拓也, 上原圭, 相場利貞, 小倉淳司, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 服部憲史, 中山吾郎, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 江畑智希

日本外科学会定期学術集会抄録集 Vol. 121回 page： WS - 2 2021.4

直腸がんの治療戦略-内視鏡外科をどう活かすか? 骨盤拡大手術における内視鏡外科手術での後腹膜アプローチ

上原圭, 相場利貞, 小倉淳司, 村田悠記, 松村卓樹, 三品拓也, 大原規彰, 鈴木優美, 伊神剛, 水野隆史, 宮田一志, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本内視鏡外科学会雑誌 Vol. 25 ( 7 ) page： SSY5 - 3 2021.3

Rectal cancer lateral lymph nodes: multicentre study of the impact of obturator and internal iliac nodes on oncological outcomes

Schaap, DP; Boogerd, LSF; Konishi, T; Cunningham, C; Ogura, A; Garcia-Aguilar, J; Beets, GL; Suzuki, C; Toda, S; Lee, IK; Sammour, T; Uehara, K; Lee, P; Tuynman, JB; van de Velde, CJH; Rutten, HJT; Kusters, M

BRITISH JOURNAL OF SURGERY Vol. 108 ( 2 ) page： 205 - 213 2021.2

Language：English Publisher：British Journal of Surgery

Background: In patients with rectal cancer, enlarged lateral lymph nodes (LLNs) result in increased lateral local recurrence (LLR) and lower cancer-specific survival (CSS) rates, which can be improved with (chemo)radiotherapy ((C)RT) and LLN dissection (LLND). This study investigated whether different LLN locations affect oncological outcomes. Methods: Patients with low cT3-4 rectal cancer without synchronous distant metastases were included in this multicentre retrospective cohort study. All MRI was re-evaluated, with special attention to LLN involvement and response. Results: More advanced cT and cN category were associated with the occurrence of enlarged obturator nodes. Multivariable analyses showed that a node in the internal iliac compartment with a short-axis (SA) size of at least 7 mm on baseline MRI and over 4 mm after (C)RT was predictive of LLR, compared with a post-(C)RT SA of 4 mm or less (hazard ratio (HR) 5.74, 95 per cent c.i. 2.98 to 11.05 vs HR 1.40, 0.19 to 10.20; P < 0.001). Obturator LLNs with a SA larger than 6 mm after (C)RT were associated with a higher 5-year distant metastasis rate and lowered CSS in patients who did not undergo LLND. The survival difference was not present after LLND. Multivariable analyses found that only cT category (HR 2.22, 1.07 to 4.64; P = 0.033) and margin involvement (HR 2.95, 1.18 to 7.37; P = 0.021) independently predicted the development of metastatic disease. Conclusion: Internal iliac LLN enlargement is associated with an increased LLR rate, whereas obturator nodes are associated with more advanced disease with increased distant metastasis and reduced CSS rates. LLND improves local control in persistent internal iliac nodes, and might have a role in controlling systemic spread in persistent obturator nodes. Members of the Lateral Node Study Consortium are co-authors of this study and are listed under the heading Collaborators.

DOI： 10.1093/bjs/znaa009

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

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

【大腸癌術前治療up-to-date】大腸癌術前化学療法のup-to-date

ICGを用いた大腸癌手術の現状と展望と創造大腸切除術中ICG-angiographyの「時間」による評価とその課題

相場利貞, 上原圭, 小倉淳司, 田中綾, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本臨床外科学会雑誌 Vol. 81 ( 増刊 ) page： 250 - 250 2020.10

高齢大腸癌患者に対する外科治療の成績

相場利貞, 上原圭, 小倉淳司, 山東雅紀, 田中綾, 大原規彰, 神野孝徳, 村田悠記, 佐藤雄介, 服部憲史, 中山吾郎, 横山幸浩, 國料俊男, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 江畑智希, 小寺泰弘, 梛野正人

日本消化器病学会雑誌 Vol. 117 ( 臨増大会 ) page： A717 - A717 2020.10

局所進行・再発直腸癌に対する安全な手術手技局所再発直腸癌の最難関"Sacroiliac recurrence"に対する挑戦と安全な手術手技

小倉淳司, 上原圭, 相場利貞, 田中綾, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本臨床外科学会雑誌 Vol. 81 ( 増刊 ) page： 262 - 262 2020.10

大腸癌肺転移に対する術前化学療法の意義

三品拓也, 上原圭, 相場利貞, 小倉淳司, 田中綾, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 佐藤雄介, 服部憲史, 中山吾郎, 横山幸浩, 小寺泰弘, 江畑智希

日本臨床外科学会雑誌 Vol. 81 ( 増刊 ) page： 325 - 325 2020.10

上原圭, 相場利貞, 小倉淳司, 村田悠記, 佐藤雄介, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 73 ( 10 ) page： 417 - 423 2020.10

Chemotherapy-free intervalを得るため積極的に手術適応としたBRAF V600E変異型盲腸癌腹膜播種再発の1例

神野孝徳, 上原圭, 相場利貞, 小倉淳司, 田中綾, 大原規彰, 村田悠記, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 73 ( 9 ) page： A185 - A185 2020.9

骨盤内臓全摘術の手術手技と成績骨盤内臓全摘術の基本と応用

上原圭, 相場利貞, 小倉淳司, 田中綾, 大原規彰, 村田悠記, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 73 ( 9 ) page： A68 - A68 2020.9

直腸癌に対する術前治療の現状と展望下部進行直腸癌に対するpatient-adopted strategyを目指した当科の術前治療と成績

小倉淳司, 上原圭, 相場利貞, 田中綾, 大原規彰, 村田悠記, 神野孝徳, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 73 ( 9 ) page： A52 - A52 2020.9

大腸癌手術の精度とCMEとTMEの意義直腸癌他臓器合併切除標本の環状切開処理によるCRMの意義

相場利貞, 上原圭, 小倉淳司, 田中綾, 大原規彰, 村田悠記, 鈴木優美, 三品拓也, 佐藤雄介, 服部憲史, 中山吾郎, 小寺泰弘, 江畑智希

日本大腸肛門病学会雑誌 Vol. 73 ( 9 ) page： A41 - A41 2020.9

Importance of the neoadjuvant rectal (NAR) score to the outcome of neoadjuvant chemotherapy alone for locally advanced rectal cancer. Reviewed

Toshiki Mukai, Keisuke Uehara, Toshisada Aiba, Atsushi Ogura, Toyonori Tsuzuki, Aya Tanaka, Masanori Sando, Noriyuki Ohara, Yusuke Sato, Norifumi Hattori, Goro Nakayama, Yasuhiro Kodera, Masato Nagino

Surgery today Vol. 50 ( 8 ) page： 912 - 919 2020.8

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

PURPOSE: The neoadjuvant rectal (NAR) score is a promising indicator of survival after preoperative chemoradiotherapy for rectal cancer. However, its effectiveness after neoadjuvant chemotherapy (NAC) alone has not been fully investigated. METHODS: We analyzed data retrospectively on 61 patients with rectal cancer, who received NAC followed by surgical resection between 2010 and 2015, and evaluated the impact of the NAR score on survival. RESULTS: The median NAR score was 14.9. Of the 61 patients, 13, 35, and 13 were classified as having NAR-low (< 8), NAR-intermediate (8-16), and NAR-high (> 16) scores, respectively. The median observation period was 49.0 months. According to the NAR score, the 3-year DFS in the NAR-low group was 100%, which was significantly better than that in the NAR-intermediate (64.8%, p = 0.041), and NAR-high (61.5%, p = 0.018) groups. When the NAR-intermediate and NAR-high groups were investigated as a single high-risk group, the 3-year DFS of the patients who received adjuvant chemotherapy was 88.7%, which was significantly better than that of the patients who did not receive adjuvant chemotherapy (53.3%, p = 0.042). CONCLUSIONS: The NAR score may predict the DFS and could serve as a favorable indicator of adjuvant chemotherapy after NAC alone.

DOI： 10.1007/s00595-020-01964-1

局所進行直腸癌に対する放射線照射を伴わない術前化学療法の経験を踏まえた当科の術前化学放射線療法

2臓器以上への同時性遠隔転移を伴うStageIV大腸癌における長期生存例の検討

田中綾, 上原圭介, 相場利貞, 小倉淳司, 山東雅紀, 大原規彰, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 梛野正人

日本外科学会定期学術集会抄録集 Vol. 120回 page： DP - 6 2020.8

難治性直腸肛門病変を有するクローン病に対する直腸切断術の検討

服部憲史, 中山吾郎, 上原圭介, 相場利貞, 佐藤雄介, 小倉淳司, 山田豪, 小池聖彦, 藤原道隆, 梛野正人, 小寺泰弘

日本外科学会定期学術集会抄録集 Vol. 120回 page： SF - 1 2020.8

局所進行直腸癌に対する術前化学療法の効果と限界

小倉淳司, 上原圭介, 相場利貞, 山東雅紀, 田中綾, 大原規範, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 梛野正人

日本外科学会定期学術集会抄録集 Vol. 120回 page： SF - 8 2020.8

大腸癌術後腹壁瘢痕ヘルニアの発生リスク因子についての検討

大原規彰, 上原圭介, 相場利貞, 小倉淳司, 山東雅紀, 田中綾, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 梛野正人

日本外科学会定期学術集会抄録集 Vol. 120回 page： SF - 3:[Y] 2020.8

大腸癌局所再発に対する外科治療【International】局所再発直腸癌の外科治療遠隔転移の有無や既往は手術適応に影響するか(Surgical treatment for locally recurrent rectal cancer: Does the presence or history of distant metastasis affect surgical indications?)

上原圭, 相場利貞, 小倉淳司, 山東雅紀, 田中綾, 大原規範, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 梛野正人

日本外科学会定期学術集会抄録集 Vol. 120回 page： WS - 5 2020.8

下部進行直腸癌に対する予防的側方郭清-あり vs なし-【なし】下部進行直腸癌に対する予防的側方郭清ありvsなし "なし派"の立場からいかに選択的に側方郭清を行っていくか?

日本外科学会定期学術集会抄録集 Vol. 120回 page： DB - 3 2020.8

特集大腸外科手術におけるトラブルシューティング Ⅰ.術中出血　8)骨盤内臓全摘術における術中出血の予防と対処法

相場利貞, 上原圭介, 小倉淳司, 江畑智希, 横山幸浩, 梛野正人

手術 Vol. 74 ( 8 ) page： 1131 - 1137 2020.7

相場利貞, 上原圭介, 小倉淳司, 山東雅紀, 田中綾, 大原規彰, 佐藤雄介, 服部憲史, 中山吾郎, 江畑智希, 横山幸浩, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 小寺泰弘, 梛野正人

日本消化器病学会雑誌 Vol. 117 ( 臨増総会 ) page： A322 - A322 2020.7

特集進行直腸癌のベストプラクティス II. 各論 5.局所再発直腸癌の再発部位を意識した治療戦略

小倉淳司, 上原圭介, 相場利貞, 江畑智希, 横山幸浩, 國料俊男, 伊神剛, 深谷昌秀, 水野隆史, 山口淳平, 宮田一志, 尾上俊介, 渡辺伸元, 梛野正人

外科 Vol. 82 ( 7 ) page： 742 - 748 2020.6

局所再発直腸癌の再発部位を意識した治療戦略 Invited Reviewed

⼩倉淳司、上原圭介、相場利貞、江畑智希、横⼭幸浩、國料俊男、伊神剛、深⾕昌秀、⽔野隆史、⼭⼝淳平、宮⽥⼀志、尾上俊介、渡辺伸元、梛野正⼈

外科 Vol. 82 page： 742 - 748 2020.6

特集 taTMEのすべて経肛門的側方リンパ節郭清

相場利貞, 上原圭介, 小倉淳司, 江畑智希, 梛野正人

臨床外科 Vol. 75 ( 5 ) page： 576 - 581 2020.5

Cranial-first approach for safe laparoscopic surgery in right-sided colon cancer. Reviewed International journal

Ryutaro Kobayashi, Atsushi Ogura, Satoru Kawai, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Tsukasa Aritake, Natsuki Nagano, Satoaki Kamiya

Techniques in coloproctology Vol. 24 ( 5 ) page： 489 - 490 2020.5

特集大腸癌手術におけるリンパ節郭清の理論と手技直腸癌に対する経肛門手術による側方リンパ節郭清

小倉淳司, 上原圭介, 相場利貞, 梛野正人

手術 Vol. 74 ( 3 ) page： 321 - 326 2020.3

直腸癌に対する経肛門手術による側方リンパ節郭清 Invited Reviewed

小倉淳司、上原圭、相場利貞、梛野正人

手術 Vol. 74 page： 321 - 326 2020.3

Current Status of Neoadjuvant Chemotherapy for Locally Advanced Colorectal Cancer

Uehara Kay, Aiba Toshisada, Ogura Atsushi, Murata Yuki, Sato Yusuke, Hattori Norifumi, Nakayama Goro, Kodera Yasuhiro, Ebata Tomoki

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 73 ( 10 ) page： 417 - 423 2020

Language：Japanese Publisher：The Japan Society of Coloproctology

The current Japanese standard treatment for colorectal cancer is still upfront surgery followed by adjuvant chemotherapy, however, the treatment results are unsatisfactory. For further improvement, an alternative method is to shift part of adjuvant chemotherapy to the preoperative period. Neoadjuvant chemotherapy (NAC) could be introduced at any institution, unlike chemoradiation (CRT), and has gradually become widespread in daily practice. On the other hand, NAC without CRT for poor-risk rectal cancer could be generally accepted in Western countries. Although long-term results after NAC and data for comparison with chemoradiation or upfront surgery are lacking, a few clinical trials recently demonstrated it. Survival after NAC and CRT might be equivalent, however, local control after NAC seemed to be inferior to that after CRT. NAC could be a treatment option in selected patients with colorectal cancer. Moreover, treatment for locally advanced colorectal cancer should be personalized.

DOI： 10.3862/jcoloproctology.73.417

直腸癌局所再発・肝転移に対して積極的外科手術により得られた長期生存例に発症した下行結腸stoma部癌の一例

小倉淳司, 上原圭介, 相場利貞, 田中綾, 山東雅紀, 米川佳彦, 大原規彰, 渡辺伸元, 尾上俊介, 宮田一志, 山口淳平, 水野隆史, 深谷昌秀, 伊神剛, 横山幸浩, 江畑智希, 服部憲史, 中山吾郎, 小寺泰弘, 梛野正人

日本消化器病学会東海支部例会プログラム抄録集 Vol. 131回 page： 65 - 65 2019.11

Cranial-first approach of laparoscopic left colectomy for T4 descending colon cancer invading the Gerota's fascia. International journal

Atsushi Ogura, Ryutaro Kobayashi, Satoru Kawai, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Tsukasa Aritake, Natsuki Nagano, Satoaki Kamiya

Surgical case reports Vol. 5 ( 1 ) page： 159 - 159 2019.10

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

BACKGROUND: The safety and feasibility of laparoscopic colectomy for T4 colorectal cancer remain controversial. We believe that setting a "Goal" that will guide the surgeons in returning from the deep layer could be the key to safe en bloc resection of neighboring organs. For descending colon cancer, the cranial-first approach makes it possible to clearly visualize the pancreas and origin of the transverse mesocolon, leading to safe splenic flexure mobilization and complete mesocolic excision, which is the strongest advantage of this approach. CASE PRESENTATION: A 75-year-old woman was diagnosed with T4 descending colon cancer invading the Gerota's fascia. We performed laparoscopic left colectomy using the cranial-first approach to set a "Goal" at the inferior border of the pancreas for safe resection of the Gerota's fascia. The total operative time was 233 min, and the estimated blood loss was 98 ml. She was discharged after surgery without postoperative complications. Pathological findings revealed the invasion into the Gerota's fascia, and the resection margin was negative for cancer. CONCLUSIONS: The cranial-first approach of laparoscopic left colectomy appears to be safe and feasible and could be a promising method for selected patients with T4 descending colon cancer invading the Gerota's fascia.

DOI： 10.1186/s40792-019-0720-8

Cranial-first approach for laparoscopic surgery with splenic flexure mobilization.

Cranial-first approach for laparoscopic surgery with splenic flexure mobilization. Reviewed

Ogura A, Kobayashi R, Aritake T, Maeda T, Kawai K, Takagi K, Kawai S, Kamiya S

Techniques in Coloproctology Vol. 23 ( 7 ) page： 693-694 2019.7

Ogura A, Kobayashi R, Aritake T, Maeda T, Kawai K, Takagi K, Kawai S, Kamiya S

Techniques in coloproctology Vol. 23 ( 7 ) page： 693 - 694 2019.7

Complete Resection without Any Ostomies by Laparoscopic Extended Surgery for Locally Advanced T4 Sigmoid Colon Cancer Invading the Urinary Bladder and Ureter. Reviewed International journal

Atsushi Ogura, Tsukasa Aritake, Satoru Kawai, Shigeki Yamamoto, Kenji Takagi, Kiyotaka Kawai, Takashi Maeda, Ryutaro Kobayashi, Natsuki Nagano, Satoaki Kamiya

Case reports in surgery Vol. 2019 page： 9598183 - 9598183 2019

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

The feasibility and safety of laparoscopic surgery for locally advanced colorectal cancer remain controversial due to the high rate of incomplete resection and conversion to open surgery. Especially for T4 colorectal cancer, laparoscopic techniques are still demanding mainly because of the difficulty in distinguishing between inflammation and tumor involvement, which often lead surgeons to do overtreatment in surgery. We believe laparoscopic magnified and multidirectional approach might be useful for pathologically complete resection and minimizing an unnecessary extended surgery for these cases. A 49-year-old man was diagnosed with locally advanced T4 sigmoid colon cancer invading the urinary bladder and ureter. We performed laparoscopic anterior resection with en bloc resection of the urinary bladder and the left ureter. Total operative time was 462 min, and the estimated blood loss was 50 ml. This patient was discharged on the 28th day after surgery without any ostomies and urinary functional disorders. The magnified view by laparoscopic techniques from multiple directions would enable surgeons to set surgical landmarks for another approach, which is the key for safe and feasible laparoscopic surgery in patients with locally advanced T4 colorectal cancer.

DOI： 10.1155/2019/9598183

Prognostic implications of MRI-detected lateral nodal disease and extramural vascular invasion in rectal cancer

Innovativeな大腸癌診断・治療　直腸癌に対する側方郭清の意義−術前（化学）放射線療法との比較 Invited Reviewed

小倉淳司、上原圭介、相場利貞、川井　覚、梛野正人

外科 Vol. 10 page： 1042 - 1049 2019

Schaap D. P., Ogura A., Nederend J., Maas M., Cnossen J. S., Creemers G. J., van Lijnschoten I., Nieuwenhuijzen G. A. P., Rutten H. J. T., Kusters M.

BRITISH JOURNAL OF SURGERY Vol. 105 ( 13 ) page： 1844 - 1852 2018.12

Endoscopic criteria to evaluate tumor response of rectal cancer to neoadjuvant chemoradiotherapy using magnifying chromoendoscopy. International journal

Akiko Chino, Tsuyoshi Konishi, Atsushi Ogura, Hiroshi Kawachi, Hiroki Osumi, Toshiyuki Yoshio, Teruhito Kishihara, Daisuke Ide, Shoichi Saito, Masahiro Igarashi, Takashi Akiyoshi, Masashi Ueno, Junko Fujisaki

European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology Vol. 44 ( 8 ) page： 1247 - 1253 2018.8

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

BACKGROUND AND AIMS: Precise endoscopic assessment of complete response to neoadjuvant chemoradiotherapy before surgery is important for optimizing surgical and non-surgical treatment. We prospectively evaluated the accuracy of the newly proposed endoscopic criteria to identify complete response, using magnifying chromoendoscopy. METHODS: New endoscopic criteria were created to define endoscopic complete response, near complete response and incomplete response, using magnifying chromoendoscopy. The criteria contained notable endoscopic findings, including shape of the scar, state of the ulcer, finding of white moss, presence of residual protruded nodules, regenerated pits of the scar, presence of neoplastic pit patterns, and extension of rectal wall. Seventy-nine patients with rectal cancer who received neoadjuvant chemoradiotherapy were prospectively evaluated 1-3 days before resection. Diagnostic accuracy to identify pathological complete response and interobserver agreement among a supervising colonoscopist and two trainees were investigated. RESULTS: Pathological complete response was obtained in 17 patients (21.5%). The diagnostic accuracy of endoscopic complete response was 85%, with a sensitivity of 47%, specificity of 97%, positive predictive value of 80% and negative predictive value of 77%. The kappa-value for interobserver agreement across 3 doctors was 0.57 (standard error, 0.74; 95% confidence interval, 0.39-0.76). CONCLUSION: The newly proposed endoscopic criteria using magnifying chromoendoscopy achieved excellent diagnostic accuracy to determine good responders to neoadjuvant chemoradiotherapy in rectal cancer, with fair interobserver agreement. The criteria could be clinically useful to select patients for non-surgical management.

DOI： 10.1016/j.ejso.2018.04.013

Pretreatment Serum Carbohydrate Antigen 19-9 Concentration Is a Predictor of Survival of Patients Who Have Undergone Curative Resection of Stage IV Rectal Cancer. International journal

Hisanori Miki, Takashi Akiyoshi, Atsushi Ogura, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Hisashi Noma, Akio Saiura, Yosuke Fukunaga, Masashi Ueno

Digestive surgery Vol. 35 ( 5 ) page： 389 - 396 2018

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

BACKGROUND: To evaluate whether pretreatment carcinoembryonic antigen and carbohydrate antigen (CA)19-9 are useful predictors of survival in patients with stage IV rectal cancer who have undergone curative resection. METHODS: In this retrospective study, data on 73 patients who had undergone curative resection of stage IV rectal cancer were reviewed. Associations between various clinicopathological factors and survival outcomes were analyzed. RESULTS: According to univariate analysis, elevated pretreatment CA19-9 (p = 0.0028), R1 resection (p = 0.0318), and mucinous or poorly differentiated adenocarcinoma (p = 0.0228) were significantly associated with poor overall survival (OS), and lymph node metastasis (p = 0.0211) was significantly associated with poor disease-free survival (DFS). Multivariate analyses showed that elevated pretreatment serum CA19-9 concentration (hazard ratios [HR] 3.33; 95% CI 1.24-9.42; p = 0.0174) was an independent predictor for OS and lymph node metastasis (HR 2.26; 95% CI 1.15-4.82; p = 0.0164) was an independent predictor for DFS. Among 55 patients with recurrences after curative resection, the rate of complete resection of recurrences was significantly higher in patients with normal pretreatment CA19-9 than in those with elevated CA19-9 (p = 0.049). Post-recurrence survival was significantly worse in patients with elevated pretreatment CA19-9 than in those with normal CA19-9 (p = 0.0196). CONCLUSIONS: Pretreatment CA19-9 is good predictor of survival after curative resection of stage IV rectal cancer.

DOI： 10.1159/000480247

Skeletal muscle loss is an independent negative prognostic factor in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy. International journal

Yasuhiro Takeda, Takashi Akiyoshi, Kiyoshi Matsueda, Hironori Fukuoka, Atsushi Ogura, Hisanori Miki, Yukiharu Hiyoshi, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Yosuke Fukunaga, Masashi Ueno

PloS one Vol. 13 ( 4 ) page： e0195406 2018

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

BACKGROUND: The impact of body composition on the short- or long-term outcomes of patients with surgically treated advanced rectal cancer after neoadjuvant chemoradiotherapy remains unclear. This study examined the correlation between low skeletal muscle mass and morbidity and survival in patients with advanced lower rectal cancer. METHODS: We enrolled 144 clinical stage II/III patients with advanced lower rectal cancer who underwent neoadjuvant chemoradiotherapy followed by curative resection between 2004 and 2011. The cross-sectional skeletal muscle area at the third lumbar vertebra (L3) level was evaluated by computed tomography before chemoradiotherapy, and this was normalized by the square of the height to obtain the skeletal muscle index. Low skeletal muscle mass was defined as the sex-specific lowest quartile of the L3 skeletal muscle index. The association between low skeletal muscle mass and morbidity, relapse-free survival, or overall survival was assessed. RESULTS: Low skeletal muscle mass was identified in 37 (25.7%) patients. Age and body mass index were associated with low skeletal muscle mass. By multivariate analysis, we found that low skeletal muscle mass was independently associated with poor overall survival (hazard ratio = 2.93; 95%CI: 1.11-7.71; p = 0.031) and relapse-free survival (hazard ratio = 2.15; 95%CI: 1.06-4.21; p = 0.035), but was not associated with the rate of postoperative complications. CONCLUSIONS: Low skeletal muscle mass is an independent negative prognostic factor for relapse-free and overall survival in patients with advanced lower rectal cancer treated with neoadjuvant chemoradiotherapy.

DOI： 10.1371/journal.pone.0195406

A Case of Early Gallbladder Carcinoma with Acute Cholecystitis Caused by Tumor Impaction in the Neck

UNO Masanori, KAMIYA Satoaki, KAWAI Satoru, TAKAGI Kenji, MAEDA Takashi, OGURA Atsushi, MATSUURA Akihiro

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) Vol. 79 ( 11 ) page： 2346 - 2349 2018

Language：Japanese Publisher：Japan Surgical Association

A 64-year-old woman was admitted to our hospital with epigastralgia and nausea. Physical examination revealed mild tenderness in the right upper abdomen. CT revealed edematous thickening of the gallbladder wall, and we diagnosed the patient as having acute cholecystitis. Because a mass was found in the gallbladder neck, we considered that the acute cholecystitis was caused by impaction of the mass. Although we started the patient on antibiotic treatment, the right upper abdominal pain and inflammatory findings only worsened. Emergency laparotomy was performed on the third day of hospitalization. We incised the cystic duct near the junction of the common bile duct and resected the gallbladder. In the resected specimen, a soft pedunculated tumor measuring 3 cm in diameter was found in the gallbladder neck. No additional resection or lymph node dissection was performed. Histopathological examination revealed early gallbladder carcinoma and no cancer progression in the cystic duct stump. Gallbladder carcinoma often manifests with non-specific subjective symptoms, and early cancer cases are often found incidentally in specimens obtained after cholecystectomy performed for cholelithiasis. This report describes a rare case of early gallbladder carcinoma with acute cholecystitis caused by tumor impaction in the neck, with a review of the literature.

DOI： 10.3919/jjsa.79.2346

The significance of extended lymphadenectomy for colorectal cancer with isolated synchronous extraregional lymph node metastasis. International journal

Atsushi Ogura, Takashi Akiyoshi, Yukiko Takatsu, Jun Nagata, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

Asian journal of surgery Vol. 40 ( 4 ) page： 254 - 261 2017.7

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

BACKGROUND/OBJECTIVE: The significance of extended lymphadenectomy for colorectal cancer with extraregional lymph node metastasis, such as para-aortic lymph node metastasis, has not been established. The purpose of this study was to evaluate the significance of extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis. METHODS: Between July 2004 and December 2013, 16 patients with synchronous extraregional lymph node metastasis without other organ metastases underwent curative resection and extended lymphadenectomy (R0 group). The clinical characteristics and survival outcomes of the R0 group were compared with those of 12 patients with extraregional lymph node metastasis who underwent palliative surgery (control group). RESULTS: In the R0 group, the 5-year cancer-specific survival (CSS) rate was 70.3% and the 5-year relapse-free survival (RFS) rate was 60.5%. The 5-year CSS differed significantly between the R0 and control groups (70.3% vs. 12.5%; p = 0.0003). Univariate analyses revealed that the total numbers of metastatic lymph nodes and metastatic regional lymph nodes present were significantly associated with RFS (p = 0.019 for both). CONCLUSION: Findings from our study suggest that extended lymphadenectomy for colorectal cancer with synchronous isolated extraregional lymph node metastasis might be effective in carefully selected patients.

DOI： 10.1016/j.asjsur.2015.10.003

Does the depth of mesorectal invasion have prognostic significance in patients with ypT3 lower rectal cancer treated with preoperative chemoradiotherapy? International journal

Atsushi Ogura, Takashi Akiyoshi, Noriko Yamamoto, Hiroshi Kawachi, Yuichi Ishikawa, Hisashi Noma, Masato Nagino, Yosuke Fukunaga, Masashi Ueno

International journal of colorectal disease Vol. 32 ( 3 ) page： 349 - 356 2017.3

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

PURPOSE: The prognostic significance of the depth of mesorectal invasion (DMI) in patients with ypT3 rectal cancer who undergo preoperative chemoradiotherapy (CRT) is unclear. The purpose of this study was to evaluate the prognostic significance of DMI in ypT3 rectal cancer. METHODS: A total of 168 (y)pT3 patients were evaluated, of whom 93 received preoperative CRT and 75 underwent surgery alone. Patients were subdivided into two groups according to the DMI (T3ab = DMI ≤5 mm and T3cd = DMI >5 mm). Oncologic outcomes were compared between the T3ab and T3cd groups and the ypT3ab and ypT3cd groups. RESULTS: Relapse-free survival was significantly different between the pT3ab and pT3cd groups (74.1 vs 38.5%, P = 0.0192) but not between the ypT3ab and ypT3cd groups (65.9 vs 61.5%, P = 0.513). Multivariate analysis showed that DMI was an independent predictor of recurrence in pT3 patients (hazard ratio [HR] = 2.980, 95% confidence interval [CI] 1.227-7.025; P = 0.0169) and that ypN+ was an independent predictor of recurrence in ypT3 patients (HR = 3.487, 95% CI 1.570-8.827; P = 0.0016). CONCLUSIONS: DMI was not a significant predictive factor for recurrence in patients with ypT3 rectal cancer who underwent preoperative CRT, and ypN+ was the only independent predictive factor for recurrence.

DOI： 10.1007/s00384-016-2716-1

Feasibility of Laparoscopic Total Mesorectal Excision with Extended Lateral Pelvic Lymph Node Dissection for Advanced Lower Rectal Cancer after Preoperative Chemoradiotherapy. International journal

Atsushi Ogura, Takashi Akiyoshi, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno, Hiroya Kuroyanagi

World journal of surgery Vol. 41 ( 3 ) page： 868 - 875 2017.3

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

BACKGROUND: The feasibility of additional lateral pelvic lymph node dissection (LPLND) compared with total mesorectal excision (TME) alone in patients treated with preoperative chemoradiotherapy (CRT) is controversial, especially in laparoscopic surgery. This study was performed to evaluate the feasibility of adding laparoscopic LPLND to TME in patients with advanced lower rectal cancer and swollen LPLNs treated with preoperative CRT. METHODS: We reviewed 327 patients with lower rectal cancer without distant metastasis who underwent preoperative CRT followed by laparoscopic TME. Laparoscopic LPLND was added in patients with swollen LPLNs before CRT. Outcomes were compared between patients with (n = 107) and without (n = 220) LPLND. RESULTS: LPLN metastasis was found in 26 patients (24.3 %) in the LPLND group. The operation time was significantly longer, and total blood loss was significantly greater in the LPLND than TME group (461 vs. 298 min and 115 vs. 30 mL, respectively; P < 0.0001). The major complication rate was similar in the LPLND and TME groups (9.3 vs. 5.5 %, respectively; P = 0.188), and there were no conversions to open surgery. The LPLND and TME groups also showed a similar 3-year relapse-free survival rate (84.7 vs. 82.0 %, respectively; P = 0.536) and local recurrence rate (3.2 vs. 5.2 %, respectively; P = 0.569) despite significantly more patients with pathological lymph node metastasis in the LPLND than TME group (37.4 vs. 22.3 %, respectively; P < 0.0001). CONCLUSIONS: Additional laparoscopic LPLND is feasible in patients with advanced lower rectal cancer and clinically swollen LPLNs treated with preoperative CRT, with no significant increase in major complications compared with TME alone.

DOI： 10.1007/s00268-016-3762-0

Report of a Case with Appendiceal Intussusception Induced by Appendiceal Endometriosis

Takeda Yasuhiro, Nagasaki Toshiya, Fukuoka Hironori, Ogura Atsushi, Miki Hisanori, Hiyoshi Yukiharu, Akiyoshi Takashi, Konishi Tsuyoshi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Ueno Masashi

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 70 ( 7 ) page： 463 - 468 2017

Language：Japanese Publisher：The Japan Society of Coloproctology

A 45-year-old female was admitted to our hospital suffering from bloody stool and lower abdominal pain. Colonoscopy showed a solid tumor with a diameter of 30 mm, like a submucosal tumor, located at the appendiceal orifice. Enhanced abdominal CT scan showed the enhanced tumor located at the base of the appendix and two swollen lymph nodes in the mesocolon. Laparoscopic ileocecal resection was performed as a diagnostic therapy. The resected specimen revealed the findings of complete intussusception of the appendix. Histopathological examination showed the presence of endometrial tissue within the submucosal and muscular layers of the appendix. We report this very rare case with appendiceal intussusception induced by appendiceal endometriosis, and review the relevant literature.

DOI： 10.3862/jcoloproctology.70.463

Pathological Complete Response after Preoperative Systemic Chemotherapy and Chemoradiotherapy for Anal Canal Adenocarcinoma with Pagetoid Spread:A Case Report

Fukuoka Hironori, Nagasaki Toshiya, Miki Hisanori, Hiyoshi Yukiharu, Ogura Atsushi, Akiyoshi Takashi, Fujimoto Yoshiya, Nagayama Satoshi, Fukunaga Yosuke, Takamatsu Manabu, Ueno Masashi

Nippon Daicho Komonbyo Gakkai Zasshi Vol. 70 ( 2 ) page： 81 - 87 2017

Language：Japanese Publisher：The Japan Society of Coloproctology

A 50-year-old woman presented with swollen right inguinal lymph nodes. Physical examination revealed an anorectal tumor and a reddish flat elevated lesion that had spread to the perianal skin. Histological examination of biopsy specimens from the anorectal tumor and perianal skin revealed anal canal adenocarcinoma with pagetoid spread, and imaging findings showed right lateral pelvic lymph node metastases and right inguinal lymph node metastases. The patient underwent preoperative systemic chemotherapy and chemoradiotherapy. After treatment, she underwent laparoscopic abdominoperineal resection with right lateral pelvic lymph node dissection, right inguinal lymph node dissection, and flap transplantation for reconstruction of the perineal wound. Pathological examination revealed no remnant cancer cells, and the patient was diagnosed as pathological complete response. Anorectal adenocarcinoma with pagetoid spread is relatively rare and has a poor prognosis. The optimal therapeutic strategy for the disease has not been established. Therefore, we suspect that preoperative systemic chemotherapy and chemoradiotherapy should be considered as therapeutic options for anorectal adenocarcinoma with pagetoid spread.

DOI： 10.3862/jcoloproctology.70.81

Patient-centered outcomes to decide treatment strategy for patients with low rectal cancer. International journal

Michitaka Honda, Takashi Akiyoshi, Hisashi Noma, Atsushi Ogura, Toshiya Nagasaki, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

Journal of surgical oncology Vol. 114 ( 5 ) page： 630 - 636 2016.10

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

BACKGROUND: For patients with low-lying rectal cancer, the feasibility of anus-preserving surgery in combination with neoadjuvant chemoradiotherapy (NACRT) has been not well established from the perspective of patient-centered outcomes. METHODS: We investigated 278 patients with low-lying rectal adenocarcinoma from 2005 to 2012. We compared their symptoms and QOL scores of patients who underwent anus-preserving surgery with (n = 88) and without (n = 143) NACRT according to the Wexner scale, EORTC QLQ C-30, CR29, and the modified fecal incontinence quality life scale (mFIQL). Furthermore, to assess the rationale for intersphincteric resection (ISR) with NACRT, we also compared QOL of patients who underwent ISR with NACRT (n = 31) and abdominoperineal resection (APR, n = 47). RESULTS: The adjusted mean differences of the Wexner score estimates of the patients who underwent ISR and very low anterior resection (VLAR) with or without NACRT were 5.29 (P = 0.004) and 2.67 (P = 0.009), respectively. No significant difference was observed in the QOL scores of two treatment groups. Furthermore, there were no significant differences in the QOL or function scores of patients who underwent ISR with NACRT and APR. CONCLUSION: The incontinence was significantly worse in patients who receive NACRT. However, there were no significant differences in their QOL or function scores. J. Surg. Oncol. 2016;114:630-636. © 2016 Wiley Periodicals, Inc.

DOI： 10.1002/jso.24376

Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. Reviewed

Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M.

World Journal of Surgery Vol. 2016 ( 40 ) page： 1236-1243 2016.5

Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies.

4. Ogura A, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Fukunaga Y, Ueno M.

World Journal of Surgery Vol. 40 ( 5 ) page： 1236-1243 2016.5

Safety of Laparoscopic Pelvic Exenteration with Urinary Diversion for Colorectal Malignancies. International journal

Atsushi Ogura, Takashi Akiyoshi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Yosuke Fukunaga, Masashi Ueno

World journal of surgery Vol. 40 ( 5 ) page： 1236 - 43 2016.5

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

BACKGROUND: Although the feasibility of laparoscopic surgery for colorectal cancer has been demonstrated, the safety of laparoscopic pelvic exenteration (PE) with urinary diversion for colorectal malignancies remains poorly studied. The present study aimed to examine the safety and feasibility of laparoscopic PE in patients with colorectal malignancies. METHODS: Thirty-one consecutive patients who underwent anterior or total PE with urinary diversion for colorectal malignancies between July 2004 and April 2015 at our institution were included in the study. Perioperative outcomes were compared between patients undergoing laparoscopic (n = 13) and open (n = 18) PE. RESULTS: There were no conversions to open surgery. The estimated blood loss (930 vs. 3003 ml; P = 0.001) and total volume of blood transfusion (0 vs. 1990 ml; P = 0.002) were significantly lower in patients undergoing laparoscopic compared with open PE. R0 resection was performed in all patients. The operation time (laparoscopic, 829 min vs. open, 875 min; P = 0.660), complication rate (laparoscopic, 61.5 % vs. open, 83.3 %; P = 0.171), and postoperative hospital days (laparoscopic, 29 days vs. open, 33 days; P = 0.356) were similar in both groups. Three patients undergoing laparoscopic PE readmitted within 30 days due to ileus, although the rate of readmission did not differ significantly (laparoscopic, 23.1 % vs. open, 5.6 %; P = 0.284). CONCLUSION: Laparoscopic PE performed by experienced laparoscopic pelvic surgeons should be considered as a safe and preferred option in selected patients with colorectal malignancies, with a significant advantage in terms of reduced blood loss compared with open surgery.

DOI： 10.1007/s00268-015-3364-2

Recurrent colorectal cancer after endoscopic resection when additional surgery was recommended. Reviewed

Takatsu Y, Fukunaga Y, Hamasaki S, Ogura A, Nagata J, Nagasaki T, Akiyoshi T, Konishi T, Fujimoto Y, Nagayama S, Ueno M

World Journal of Gastroenterology Vol. 22 ( 7 ) page： 2336-2341 2016.2

Recurrent colorectal cancer after endoscopic resection when additional surgery was recommended. International journal

Yukiko Takatsu, Yosuke Fukunaga, Shunsuke Hamasaki, Atsushi Ogura, Jun Nagata, Toshiya Nagasaki, Takashi Akiyoshi, Tsuyoshi Konishi, Yoshiya Fujimoto, Satoshi Nagayama, Masashi Ueno

World journal of gastroenterology Vol. 22 ( 7 ) page： 2336 - 41 2016.2

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

AIM: To evaluate the type of recurrence after endoscopic resection in colorectal cancer patients and whether rescue was possible by salvage operation. METHODS: Among 4972 patients who underwent surgical resection at our institution for primary or recurrent colorectal cancers from January 2005 to February 2015, we experienced eight recurrent colorectal cancers after endoscopic resection when additional surgical resection was recommended. RESULTS: The recurrence patterns were: intramural local recurrence (five cases), regional lymph node recurrence (three cases), and associated with simultaneous distant metastasis (three cases). Among five cases with lymphatic invasion observed histologically in endoscopic resected specimens, four cases recurred with lymph node metastasis or distant metastasis. All cases were treated laparoscopically and curative surgery was achieved in six cases. Among four cases located in the rectum, three cases achieved preservation of the anus. Postoperative complications occurred in two cases (enteritis). CONCLUSION: For high-risk submucosal invasive colorectal cancers after endoscopic resection, additional surgical resection with lymphadenectomy is recommended, particularly in cases with lymphovascular invasion.

DOI： 10.3748/wjg.v22.i7.2336

Laparoscopic anterior pelvic exenteration for advanced sigmoid colon cancer--a video vignette.

Akiyoshi T, Ogura A, Sakura M, Ueno M

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland Vol. 17 ( 5 ) page： 454 - 454 2015.5

Endoscopic evaluation of clinical response after preoperative chemoradiotherapy for lower rectal cancer: the significance of endoscopic complete response. Reviewed

Ogura A, Chino A, Konishi T, Akiyoshi T, Kishihara T, Tamegai Y, Ueno M, Igarashi M.

International Journal of Colorectal Disease Vol. 30 ( 3 ) page： 367-373 2015.3

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

PURPOSE:
The management of rectal cancer is a significant oncologic challenge because rectal cancer has a poor prognosis among the various types of colorectal cancer. There have been several recent reports on a nonoperative approach for advanced lower rectal cancer, and this may be best for local disease control. However, objective evaluation of tumor response after preoperative chemoradiotherapy has not been standardized. The purpose of this study is to evaluate our method of endoscopic evaluation of complete response.

METHODS:
This is a retrospective chart review. All patients received a long course of preoperative chemoradiotherapy (5-fluorouracil-based chemotherapy and 45-50.4 Gy) followed by radical surgical resection from May 2005 to March 2012 in The Cancer Institute Hospital of Japanese Foundation for Cancer Research. One hundred fifty-seven patients were reviewed consecutively. Criteria for endoscopic complete response were defined with a focus on the degree of ulcer healing and pit pattern without magnification.

RESULTS:
Endoscopic CR (E-CR) evaluation with our definitions reflected histopathologic response evaluation with an accuracy of 91.7 %, sensitivity of 27.8 %, specificity of 100 %, positive predictive value (PPV) of 100 %, and negative predictive value (NPV) of 91.4 % (p < 0.001). Our criteria of E-CR led all cases of y-clinical CR (ycCR) to pathological CR.

CONCLUSIONS:
Endoscopic evaluation focused on the degree of ulcer healing, and pit pattern without magnification is useful for judging ycCR.

Endoscopic evaluation of clinical response after preoperative chemoradiotherapy for lower rectal cancer: the significance of endoscopic complete response. International journal

Atsushi Ogura, Akiko Chino, Tsuyoshi Konishi, Takashi Akiyoshi, Teruhito Kishihara, Yoshiro Tamegai, Masashi Ueno, Masahiro Igarashi

International journal of colorectal disease Vol. 30 ( 3 ) page： 367 - 73 2015.3

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

PURPOSE: The management of rectal cancer is a significant oncologic challenge because rectal cancer has a poor prognosis among the various types of colorectal cancer. There have been several recent reports on a nonoperative approach for advanced lower rectal cancer, and this may be best for local disease control. However, objective evaluation of tumor response after preoperative chemoradiotherapy has not been standardized. The purpose of this study is to evaluate our method of endoscopic evaluation of complete response. METHODS: This is a retrospective chart review. All patients received a long course of preoperative chemoradiotherapy (5-fluorouracil-based chemotherapy and 45-50.4 Gy) followed by radical surgical resection from May 2005 to March 2012 in The Cancer Institute Hospital of Japanese Foundation for Cancer Research. One hundred fifty-seven patients were reviewed consecutively. Criteria for endoscopic complete response were defined with a focus on the degree of ulcer healing and pit pattern without magnification. RESULTS: Endoscopic CR (E-CR) evaluation with our definitions reflected histopathologic response evaluation with an accuracy of 91.7 %, sensitivity of 27.8 %, specificity of 100 %, positive predictive value (PPV) of 100 %, and negative predictive value (NPV) of 91.4 % (p < 0.001). Our criteria of E-CR led all cases of y-clinical CR (ycCR) to pathological CR. CONCLUSIONS: Endoscopic evaluation focused on the degree of ulcer healing, and pit pattern without magnification is useful for judging ycCR.

DOI： 10.1007/s00384-014-2105-6