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Itami, Japan

Kato M.,Osaka University | Nishida T.,Osaka University | Yamamoto K.,Toyonaka Municipal Hospital | Hayashi S.,Toyonaka Municipal Hospital | And 15 more authors.
Gut | Year: 2013

Background: After endoscopic submucosal dissection (ESD) of early gastric cancer (EGC), patients are at high risk for synchronous or metachronous multiple gastric cancers. Objective: To elucidate the time at which multiple cancers develop and to determine whether scheduled endoscopic surveillance might control their development. Design: A multicentre retrospective cohort study from 12 hospitals was conducted. Patients with EGC who underwent ESD with en bloc margin-negative curative resection were included. Synchronous cancer was classified as concomitant cancer or missed cancer. The cumulative incidence of metachronous cancers and overall survival rate were calculated using the Kaplan-Meier method. Results: From April 1999 to December 2010, 1258 patients met the inclusion criteria. Synchronous or metachronous multiple cancers were detected in 175 patients (13.9%) during a mean of 26.8 months. Among the 110 synchronous cancers, 21 were missed at the time of the initial ESD. Many of the missed lesions existed in the upper third of the stomach and the miss rate was associated with the endoscopist's inexperience (<500 oesophagogastroduodenoscopy cases). The cumulative incidence of metachronous cancers increased linearly and the mean annual incidence rate was 3.5%. The incidence rate did not differ between patients with or without Helicobacter pylori eradication. Four lesions (0.32%) were detected as massively invading cancers during the follow-up. Conclusions: Nineteen per cent of synchronous cancers were not detected until the initial ESD. The incidence rate of metachronous cancer after ESD was constant. Scheduled endoscopic surveillance showed that almost all recurrent lesions were treatable by endoscopic resection. Source

Miyashiro I.,Japan National Cardiovascular Center Research Institute | Hiratsuka M.,Itami City Hospital | Sasako M.,Hyogo College of Medicine | Sano T.,Cancer Institute Hospital of Japanese Foundation for Cancer Research | And 5 more authors.
Gastric Cancer | Year: 2014

Background: To evaluate the feasibility and accuracy of diagnosis using sentinel node (SN) biopsy in T1 gastric cancer, a multicenter trial was conducted by the Japan Clinical Oncology Group (JCOG). Methods: Sentinel node biopsy with indocyanine green (ICG) was performed in patients with T1 gastric cancer. Green-stained nodes (GNs), representing SNs, were removed first, and gastrectomy with lymphadenectomy was then performed. GNs in one plane (with the largest dimension) were histologically examined intraoperatively by frozen section with hematoxylin and eosin (H&E) stain. All harvested lymph nodes (GNs and non-GNs) were histologically examined by paraffin section after surgery. The primary endpoint was to determine the proportion of false negatives, which was defined as the number of patients with negative GNs by frozen section divided by those with positive GNs and/or positive non-GNs by paraffin section. The sample size was set at 1,550, based on the expected and threshold value as 5 and 10 % in the proportion of false negatives. Results: Accrual was suspended when 440 patients were enrolled because the proportion of false negatives was high. In the primary analysis, the proportion of false negatives was 46 % (13/28) after a learning period with 5 patients for each institution. Seven of 13 patients had nodal metastases outside the lymphatic basin. False negatives remained at 14 % (4/28) even by examining additional sections of GNs by paraffin section. Conclusions: The proportion of false negatives was much higher than expected. Intraoperative histological examination using only one plane is not an appropriate method for clinical application of SN biopsy in gastric cancer surgery. © 2013 The International Gastric Cancer Association and The Japanese Gastric Cancer Association. Source

Ryo M.,Osaka University | Funahashi T.,Osaka University | Nakamura T.,Osaka University | Kihara S.,Osaka University | And 4 more authors.
Internal Medicine | Year: 2014

Objective A cluster of multiple risk factors has been noted to constitute the background of cardiovascular disease. The purpose of this study was to evaluate the relationship between the visceral fat area (VFA) or subcutaneous fat area (SFA) and a cluster of obesity-related cardiovascular risk factors, including hyperglycemia, dyslipidemia and elevated blood pressure, in middle-aged Japanese men and women. Methods A total of 571 subjects (m=434; f=137; age: 53±9 years) who underwent health examinations with evaluations of body fat distribution using computed tomography scans and assessments of 75-g oral glucose tolerance tests were enrolled in this study. Results The VFA and SFA were linearly correlated with the number of risk factors in both men and women. The area under the receiver-operating characteristic curve of VFA (m=0.741, f=0.763) was significantly higher than that of SFA (m=0.636, f=0.689) with respect to the clustering of risk factors (one or more). The men exhibited larger VFA values and smaller SFA values than the women in similar body mass index (BMI) categories. Men with a VFA of ≥100 cm2 irrespective of BMI and women with a VFA of ≥100 cm2 and a BMI of ≥25 kg/m2 demonstrated a high prevalence of diabetes mellitus and impaired glucose tolerance. Men and women with a VFA of ≥100 cm2 irrespective of BMI demonstrated a high prevalence of type IIb dyslipidemia. Conclusion These results suggest that the absolute value of VFA rather than SFA is more closely associated with a cluster of risk factors irrespective of sex and is a good marker for selecting subjects to whom weight reduction should be recommended in order to prevent cardiovascular disease in the general population. © 2014 The Japanese Society of Internal Medicine. Source

Hashimoto M.,Hyogo College of Medicine | Tanaka F.,University of Occupational and Environmental Health Japan | Yoneda K.,Hyogo College of Medicine | Takuwa T.,Hyogo College of Medicine | And 8 more authors.
Interactive Cardiovascular and Thoracic Surgery | Year: 2014

OBJECTIVES Circulating tumour cells (CTCs) are tumour cells shed from a primary tumour and circulate in the peripheral blood after passing through the drainage vein. In previous studies, we showed that high numbers of CTCs were detected in the drainage pulmonary venous blood of most patients with resectable primary lung cancer, whereas only low numbers of CTCs were detected in the peripheral blood of some patients. Accordingly, this prospective study was conducted to assess changes in CTCs in the drainage pulmonary vein (PV) during lung cancer surgery. METHODS A total of 30 consecutive peripheral-type primary lung cancer patients who underwent lobectomy (or right upper and middle bilobectomy) through open thoracotomy were included. For each patient, 2.5 ml of blood was sampled from the lobar PV of the primary tumour site before and after surgical manipulation for lobectomy. The CTCs were evaluated quantitatively with the CellSearch® system. RESULTS Before surgical manipulation, CTCs were detected in PV blood in the majority of patients (22 of 30, 73.3%), although CTCs were detected in peripheral blood in only two patients (6.7%). The median number of CTCs in the PV (pvCTC-count) before surgical manipulation was 4.0 cells/2.5 ml, and there was no significant correlation between pvPV-count and any clinicopathological characteristic, including tumour size, progression and histological type. After surgical manipulation, at the time of completion of the lobectomy, the pvCTC-count significantly increased (median, 60.0 cells/2.5 ml; P = 0.001). The increase in pvCTC-count was significantly associated with microscopic lymphatic tumour invasion (ly); pvCTC-count significantly increased in ly-positive patients (pvCTC-count before and after surgical manipulation, 4.0 and 90.5 cells/2.5 ml, respectively; P = 0.006), but not in ly-negative patients (3.5 and 7.0 cells/2.5 ml, respectively; P = 0.153). The increase in pvCTC-count was not significantly associated with any other clinicopathological factor or with any surgical procedure, including the sequence of vessel interruption. CONCLUSIONS We documented a significant increase in CTC count in drainage PV blood after surgical manipulation, especially in tumours with lymphatic invasion. We are awaiting survival data at 5 year follow-up examination, which may provide clinical significance of the pvCTC-count. © 2014 The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved. Source

Miyashiro I.,Japan National Cardiovascular Center Research Institute | Hiratsuka M.,Itami City Hospital | Kishi K.,Japan National Cardiovascular Center Research Institute | Takachi K.,The Mutual | And 4 more authors.
Annals of Surgical Oncology | Year: 2013

Background: Reliable indicators that can intraoperatively determine the absence of nodal metastasis are in great demand to avoid unnecessary lymphadenectomy. However, little has been reported about the intraoperative diagnostic performance of sentinel node (SN) biopsy. Methods: Sentinel node biopsy by subserosal or submucosal injection of indocyanine green (ICG) was performed in 241 patients with American Joint Committee on Cancer tumor, node, metastasis staging system, 7th edition, clinical T1 (n = 190) and T2 (n = 51) gastric cancer by two experienced surgeons. All nodes that stained green (green node, GN), representing SNs, were excised before gastrectomy and were sliced into 2-mm sections for intraoperative histological examinations with hematoxylin and eosin staining. The sliced GNs were also examined simultaneously by imprint cytology. Results: The GNs were detectable in 240 patients (3.8 ± 2.4 nodes per patient; range 1-17 nodes; median 3 nodes), and the success rate of detection was 99.6 % (240 of 241). Of 240 patients with a successful detection, 29 were found to have lymph node (LN) metastases; 16 were diagnosed with LN metastases in both GNs and non-GNs, 12 in GNs alone, and 1 in non-GNs alone. The false-negative rate based on the SN concept was 3.4 % (1 of 29). However, two patients with cT1 gastric cancer were diagnosed as intraoperative GN negative but were later confirmed as GN positive by histological examinations of paraffin sections. As an intraoperative diagnosis, the false-negative rate was 10.3 % (3 of 29). Conclusions: Sentinel node biopsy using ICG could be performed intraoperatively within reasonable limits under certain conditions, such as multiplanes for detection, combination use of imprint cytology, and open surgery by experienced surgeons. © 2012 Society of Surgical Oncology. Source

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