Gastroenterological Center


Gastroenterological Center

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Jiang X.,Gastroenterological Center | Jiang X.,Nanjing Southeast University | Hiki N.,Gastroenterological Center | Nunobe S.,Gastroenterological Center | And 4 more authors.
Gastric Cancer | Year: 2011

Total gastrectomy or proximal gastrectomy is usually performed either as an open procedure or laparoscopically for the treatment of early gastric cancer (EGC) in the upper stomach. However, quality of life after either total or proximal gastrectomy is not so satisfactory. The authors report a novel surgical procedure, laparoscopy-assisted subtotal gastrectomy (LAsTG), by which a very small remnant stomach is preserved, for the surgery of selected EGCs in the upper stomach. Twenty-three patients with EGC in the upper stomach underwent LAsTG. After lymph node dissection and mobilization of the stomach, the stomach was transected about 2 cm proximal to the tumor and a very small remnant stomach was preserved. An anvil was inserted transorally into the remnant stomach by using the OrVil™ system. The reconstruction method was Roux-en-Y, and hemidouble-stapling gastrojejunostomy with a circular stapler was performed intracorporeally. There were no intraoperative complications or conversions to open surgery. Mean operation time and blood loss were 266.7 min and 54.6 ml, respectively. The overall incidence of early postoperative complications was 17.4%, and two patients underwent reoperation because of duodenal stump leakage and stenosis of the Y-anastomosis, respectively. During the follow-up period, two patients experienced gastrojejunostomy stenosis and both were treated successfully by endoscopic balloon dilation. LAsTG may be performed in selected patients with EGC in the upper stomach. With the described method, a very small remnant stomach can be preserved. © 2011 The International Gastric Cancer Association and The Japanese Gastric Cancer Association.

Jiang X.,Gastroenterological Center | Jiang X.,Nanjing Southeast University | Hiki N.,Gastroenterological Center | Nunobe S.,Gastroenterological Center | And 5 more authors.
British Journal of Cancer | Year: 2012

Background: The inflammation-based Glasgow prognostic score (GPS) has been shown to be a prognostic factor for a variety of tumours. This study investigates the significance of the modified GPS (mGPS) for the prognosis of patients with gastric cancer. Methods: The mGPS (0=C-reactive protein (CRP)≤10 mg l-1, 1CRP10 mg l-1 and 2CRP10 mg l -1 and albumin35 g l-1) was calculated on the basis of preoperative data for 1710 patients with gastric cancer who underwent surgery between January 2000 and December 2007. Patients were given an mGPS of 0, 1 or 2. The prognostic significance was analysed by univariate and multivariate analyses. Results: Increased mGPS was associated with male patient, old age, low body mass index, increased white cell count and neutrophils, elevated carcinoembryonic antigen and CA19-9 and advanced tumour stage. Kaplan-Meier analysis and log-rank test revealed that a higher mGPS predicted a higher risk of postoperative mortality in both relative early-stage (stage I; P<0.001) and advanced-stage cancer (stage II, III and IV; P<0.001). Multivariate analysis demonstrated the mGPS to be a risk factor for postoperative mortality (odds ratio 1.845; 95% confidence interval 1.184-2.875; P=0.007). Conclusion: The preoperative mGPS is a simple and useful prognostic factor for postoperative survival in patients with gastric cancer. © 2012 Cancer Research UK All rights reserved.

Yamamoto T.,Yokohama City University | Oshima T.,Gastroenterological Center | Yoshihara K.,Gastroenterological Center | Yamanaka S.,Respiratory Center | And 9 more authors.
Oncology Letters | Year: 2010

Claudin-7 is a tight junction protein that plays an important role in tumorigenesis, tumor invasion and metastasis. We examined the clinical significance of claudin-7 expression in 75 postsurgical non-small cell lung cancer (NSCLC) patients. Claudin-7 expression was measured immunohistochemically and was found to be high in 25 patients (33.3%) and low in 50 (66.7%). Survival was significantly poorer in patients with claudin-7-low than in those with claudin-7-high NSCLCs (P=0.024). In particular, survival was significantly poorer in patients with claudin-7-low than in those with claudin-7-high squamous cell carcinomas (P=0.011). A reduced expression of claudin-7 was associated with poor outcome in NSCLCs. Claudin-7 may thus be a useful biomarker and a potential therapeutic target in patients with NSCLC.

Ishibe A.,Gastroenterological Center | Ota M.,Gastroenterological Center | Kanazawa A.,Gastroenterological Center | Watanabe J.,Gastroenterological Center | And 8 more authors.
Hepato-Gastroenterology | Year: 2015

Background/Aims: Anastomotic leakage is major complication of colorectal surgery. Total parenteral nutrition (TPN) and fasting are conservative treatments for leakage in the absence of peritonitis in Japan. Elemental diet (ED) jelly is a completely digested formula and is easily absorbed without secretion of digestive juices. The purpose of this study was to assess the safety of ED jelly in management of anastomotic leakage. Methodology: Six hundred and two patients who underwent elective surgery for left side colorectal cancer from January 2008 to December 2011 were included in the study. Pelvic drainage was performed for all patients. Sixty-three (10.5%) patients were diagnosed with an anastomotic leakage, and of these, 31 (5.2%) without diverting stoma were enrolled in this study. Results: Sixteen patients received TPN (TPN group) and 15 patients received ED jelly (ED group). The duration of intravenous infusion was significantly shorter in the ED group than in the TPN group (15 days versus 25 days, P = 0.008). In the TPN group, catheter infection was occurred in 2 patients who required re-insertion of the catheter. Conclusion: Conservative management of anastomotic leakage after colorectal surgery with ED jelly appears to be a safe and useful approach. © H.G.E. Update Medical Publishing S.A., Athens-Stuttgart.

Kobayashi N.,Yokohama City University | Sugimori K.,Gastroenterological Center | Shimamura T.,Yokohama City University | Hosono K.,Yokohama City University | And 8 more authors.
Pancreatology | Year: 2012

Background: The preoperative diagnosis of branch duct intraductal papillary mucinous neoplasm (IPMN) of the pancreas can be very difficult, since low-risk and high-risk lesions can be difficult to differentiate even after cytological analysis. The purpose of this study was to evaluate the preoperative diagnostic value of endoscopic ultrasonography (EUS) in differentiating low-risk and high-risk IPMNs. Methods: We retrospectively identified 36 patients who underwent preoperative EUS for branch duct IPMNs. The pathological diagnosis after surgical resection was low-grade dysplasia (n = 26), moderate dysplasia (n = 1), high-grade dysplasia or carcinoma in situ (n = 5), and invasive carcinoma (n = 4). We divided the patients into two groups: low risk (low-grade dysplasia or moderate dysplasia) and high risk (high-grade dysplasia or carcinoma). We focused on the diameter of the cystic dilated branch duct, the main pancreatic duct, and the mural nodule as measured using the EUS findings. Results: The cystic dilated branch duct diameter (31.5 mm vs. 41.9 mm, P = 0.0225) was significantly correlated with low-risk and high-risk IPMNs, but the main pancreatic duct diameter (5.37 mm vs. 5.44 mm, P = 0.9418) was not significantly correlated with the low-risk and high-risk IPMNs. The mural nodule diameter of the papillary protrusions (4.3 mmvs. 16.4 mm, P < 0.0001) and the width diameter of the mural nodule (5.7 mmvs. 23.2 mm, P < 0.0001) were significantly correlated with low-risk and highrisk IPMNs. Conclusions: The mural nodule of papillary protrusions diameter and width diameter observed using EUS was a reliable preoperative diagnostic finding capable of distinguishing low-risk and high-risk IPMNs. Copyright © 2012, IAP and EPC. Published by Elsevier India, a division of Reed Elsevier India Pvt. Ltd.

Akiyoshi T.,Gastroenterological Center | Kuroyanagi H.,Gastroenterological Center | Oya M.,Gastroenterological Center | Ueno M.,Gastroenterological Center | And 3 more authors.
Surgical Endoscopy and Other Interventional Techniques | Year: 2010

Background: Laparoscopic colon resection for left-sided colon cancer is being performed with increasing frequency worldwide. The purpose of this study is to evaluate the influence of patient- and procedure-related factors on difficulty of laparoscopic surgery for left-sided colon cancer. Methods: Two hundred sixty consecutive patients underwent laparoscopic surgery for left-sided colon cancer from July 2005 to December 2008. Gender, body mass index (BMI), tumor location, tumor size, previous abdominal surgery, tumor depth, tumor stage, splenic flexure mobilization, type of anastomosis, and site of arterial division were analyzed as potential variables that affect difficulty of laparoscopic surgery. Dependent variables were operative time, intraoperative blood loss, intra- and postoperative complications, and proximal and distal tumor margin. Univariate and multivariate analyses were performed to determine predictive significance of variables. Results: Multivariate analysis showed that male gender (P = 0.0183) and splenic flexure mobilization (P < 0.0001) were independently predictive of longer operative time. Splenic flexure mobilization was related to greater intraoperative blood loss (P = 0.0006), intraoperative complications (P = 0.0111, odds ratio: 7.22), and wider distal tumor margin (P = 0.0048). Conclusions: Male gender and splenic flexure mobilization were independent predictors of difficulty of laparoscopic surgery for left-sided colon cancer. In contrast, our findings also showed that BMI, tumor location, previous abdominal surgery, tumor stage, type of anastomosis, and site of arterial division did not have an adverse impact on difficulty of laparoscopic surgery for left-sided colon cancer in our clinical setting. Our data support the safety of performing laparoscopic surgery for left-sided colon cancer in well-selected patients by well-experienced surgical teams. © 2010 Springer Science+Business Media, LLC.

Akiyoshi T.,Gastroenterological Center | Kobunai T.,Teikyo University | Watanabe T.,Teikyo University | Watanabe T.,University of Tokyo
Surgery Today | Year: 2012

Preoperative radiotherapy or chemoradiotherapy (CRT) has become a standard treatment for patients with locally advanced rectal cancer. However, there is a wide spectrum of responses to preoperative CRT, ranging from none to complete. There has been intense interest in the identification of molecular biomarkers to predict the response to preoperative CRT, in order to spare potentially non-responsive patients from unnecessary treatment. However, no specific molecular biomarkers have yet been definitively proven to be predictive of the response to CRT. Instead of focusing on specific factors, microarray-based gene expression profiling technology enables the simultaneous analysis of large numbers of genes, and might therefore have immense potential for predicting the response to preoperative CRT. We herein review published studies using a microarray-based analysis to identify gene expression profiles associated with the response of rectal cancer to radiation or CRT. Although some studies have reported gene expression signatures capable of high predictive accuracy, the compositions of these signatures have differed considerably, with little gene overlap. However, considering the promising data regarding gene profiling in breast cancer, the microarray analysis could still have potential to improve the management of locally advanced rectal cancer. Increasing the number of patients analyzed for more accurate prediction and the extensive validation of predictive classifiers in prospective clinical trials are necessary before such profiling can be incorporated into future clinical practice. © 2012 Springer.

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