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Kitai T.,Nara Social Insurance Hospital | Kitai T.,Kyoto University | Kawashima M.,Nara Social Insurance Hospital | Fujii H.,Nara Social Insurance Hospital | And 2 more authors.
Surgery Today | Year: 2011

Purpose: Surgical site infections (SSI) in an abdominoperineal resection (APR) occur more frequently than in other types of operations for patients with colorectal cancer. Perineal wounds are the most vulnerable sites, and they may be caused by stool contamination. Indocyanine green (ICG) fluorescence imaging, by which sensitive detection was possible, was used as a marker of perineal wound contamination. Method: Indocyanine green was transanally injected to the rectum before operation, and fluorescence images were obtained during the operation in three patients who underwent APR. Results: One subject, in whom gross contamination was not visible, had an SSI, and a trace of ICG fluorescence was detectable in the perianal skin. The other two subjects, in whom skin preparation was completely performed until ICG contamination was eliminated, were free from SSI. Conclusions: Our results suggested that a trace of stool contamination remained in the perineal skin field even after the usual antiseptic skin preparation. Furthermore, meticulous skin preparation is required to minimize stool contamination in APR patients. © 2011 Springer.


Kitai T.,Nara Social Insurance Hospital | Kitai T.,Kyoto University | Kawashima M.,Nara Social Insurance Hospital
Breast Cancer | Year: 2012

Background: Indocyanine green (ICG) fluorescence navigation is a useful option in sentinel node biopsy (SNB) for breast cancer. However, several technical difficulties still exist. Since the sentinel node (SN) cannot be recognized over the skin, subcutaneous lymphatic vessels (LVs) must be carefully dissected without injury. In addition, the dissecting procedures are often interrupted by turning off the operating light during fluorescence observation. In this report, we introduce a new approach using the axillary compression technique to overcome these problems. Materials and methods: In the original procedure of the ICG fluorescence method, the subcutaneous lymphatic drainage pathway from the breast to the axilla was observed in fluorescence images, but no signal could be obtained in the axilla. When the axillary skin was compressed against the chest wall using a plastic device, the signals from the deeper lymphatic structures could be observed. By tracing the compression-inducible fluorescence signal towards the axilla, transcutaneous detection and direct approach to the SN were achieved. The benefit of this approach is that there is no risk of injury of LVs, and the procedures are interrupted less frequently by fluorescence observation. The axillary compression technique was used in 50 patients with early breast cancer. Results: SNs were successfully removed in all patients. Transcutaneous detection and direct approach were possible in 47 patients. This approach was also effective in obese patients. Conclusions: Axillary compression technique is a simple way to facilitate the surgical procedures of ICG fluorescence-navigated SNB for breast cancer. © 2011 The Japanese Breast Cancer Society.


Nishimura Y.,Kinki University | Hiraoka M.,Kyoto University | Koike R.,Kinki University | Nakamatsu K.,Kinki University | And 7 more authors.
Japanese Journal of Clinical Oncology | Year: 2012

Objective: Long-term survival and late toxicities of a randomized Phase II study of chemoradiotherapy for esophageal cancer were analyzed. Methods: Eligible patients were <75 years old and performance status 0-2, and had Stages II-IVA esophageal cancer. For arm A (short-term infusion), cisplatin 70 mg/m. 2 Days 1 and 29 and 5-fluorouracil 700 mg/m. 2 Days 1-5 and 29-33 were given concurrently with radiotherapy of 60 Gy/30 fr/7 weeks (1 week split). For arm B (protracted infusion), cisplatin 7 mg/m. 2 Days 1-5, 8-12, 29-33 and 36-40, and 5-fluorouracil 250 mg/m. 2 Days 1-14 and 29-42 were given with the same radiotherapy. Two cycles of consolidation cisplatin/5-fluorouracil chemotherapy were given to both arms. Results: Between 2001 and 2006, 91 patients were enrolled; 46 were randomized to arm A, and 45 to arm B. The 2- and 5-year overall survival rates for arm A were 46 and 35% (95% confidence interval: 22-48%), while those for arm B were 44 and 22% (11-35%), respectively. Excluding four patients with early death, seven (17%) patients in arm A and eight (18%) in arm B showed late toxicities of Grade 3 or more. Most of the toxicities were cardiac or pleural toxicities. Patients with severe late toxicities often had coexistent hypothyroidism. There were three patients with a secondary malignancy possibly related to treatment. Conclusions: Low-dose protracted infusion chemotherapy with radiotherapy is not superior to full-dose short-term infusion chemotherapy with radiotherapy for esophageal cancer. Late toxicities, including cardiac and pleural toxicities, hypothyroidism and secondary malignancy, should be carefully monitored. © The Author 2012. Published by Oxford University Press. All rights reserved.


Kawashima M.,Nara Social Insurance Hospital | Kitai T.,Nara Social Insurance Hospital
Japanese Journal of Cancer and Chemotherapy | Year: 2012

A 62-year-old woman had suffered from interstitial pneumonitis caused by collagen disease and had received steroids and immunosuppressants for twenty years. She was diagnosed as pseudomyxoma peritonei by CT examination and underwent palliative cytoreduction two years ago, but peritoneal relapse occurred one year later. At her first visit to our office, she complained of abdominal distension and respiratory distress of Hugh-Jones classification 2-3. CT showed interstitial pneumonitis and a massive intra-abdominal mucinous tumor. Complete cytoreduction by peritonectomy procedures, combined with intraperitoneal chemotherapy with 50mg of cisplatin, was performed. The duration of the operation was 860 minutes and the blood loss was 7, 000 mL. Postoperative steroidal replacement was performed and neither acute exacerbation of interstitial pneumonitis nor any other severe complication occurred. Today, in the 3-year follow-up period, she is doing well without any sign of recurrence of pseudomyxoma peritonei.


Kitai T.,Kyoto University | Kawashima M.,Kyoto University | Yamanaka K.,Kyoto University | Ichijima K.,Nara Social Insurance Hospital | And 3 more authors.
Surgery Today | Year: 2011

Purpose: It has been reported that complete cytoreduction using peritonectomy combined with intraperitoneal chemotherapy improves the prognosis of patients with pseudomyxoma peritonei (PMP); however, this treatment strategy remains controversial, especially at nonspecialized institutes, because of its high morbidity rate. Methods: We reviewed the clinical records of 15 consecutive patients with PMP, treated in nonspecialized hospitals and observed by one of us between 1999 and 2010. Cytoreductive surgery was done using peritonectomy procedures with intraperitoneal chemotherapy and was performed with curative intent, |in accordance with Sugarbaker. Results: All patients had mucinous tumors disseminated in the peritoneal cavity. Complete cytoreduction was achieved in 12 patients. Morbidity was 40% (6/15) and mortality was 0% (0/15). After a median follow-up period of 43 months, the 12 patients who underwent complete cytoreduction were disease-free with good quality of life, and 1 of the 3 patients who underwent incomplete cytoreduction was alive with disease. Conclusions: These findings suggest that peritonectomy with intraperitoneal chemotherapy for PMP can provide prognostic benefit, even at nonspecialized hospitals. Considering the treatment risk, it should ideally be performed at a referral center, or at least by an experienced surgeon. © 2011 Springer.


PubMed | Nara Social Insurance Hospital and Kishiwada City Hospital
Type: | Journal: International journal of clinical oncology | Year: 2017

A combination of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy (CRS+HIPEC) is effective for some peritoneal malignancies. However, the indications for elderly patients remain unclear, with substantial postoperative morbidity and mortality being problematic.Clinical data were analyzed in 42 patients undergoing CRS+HIPEC for peritoneal malignancy. The primary tumor was located in the appendix in 32 cases and elsewhere in 10 cases. Operative results and survival data were compared between patients aged 70 and <70years.Fourteen patients were older than 70years. Elderly patients had a higher peritoneal cancer index (32.0 vs. 21.5), higher CA19-9 level (189.0 vs. 28.1), and higher frequency of grade 4-5 complications (5/9 vs. 2/26) than the younger patients. Grade 4-5 respiratory failure occurred in three elderly patients. There was a significant difference of postoperative survival between the elderly patients and younger patients, with 5-year survival rates being 41.3 and 74.2%, respectively (p=0.0166). The poor prognosis of elderly patients was related to the higher frequency of grade 4-5 complications.Elderly patients were referred for treatment with more advanced disease than younger patients. An age 70years was associated with more frequent grade 4-5 complications and worse survival. Performing CRS+HIPEC in elderly patients should be considered carefully due to the risk of severe complications, especially respiratory failure.


PubMed | Nara Social Insurance Hospital
Type: Case Reports | Journal: Hinyokika kiyo. Acta urologica Japonica | Year: 2012

A 77-year-old man visited our hospital with a chief complaint of asymptomatic gross hematuria. He was diagnosed with right renal pelvic tumor (7 cm) involving right renal hilar and inter-aortocaval lymph node metastases by radiological evaluation, and cytologic examination of urine indicated small cell carcinoma. After neoadjuvant chemotherapy with gemcitabine and cisplatin, right nephroureterctomy with bladder cuff, and right renal hilar and inter-aortocaval lymph node dissection was performed. Histological examination of the specimen revealed a small cell carcinoma of the renal pelvis (ypT3N2). After the operation, adjuvant chemotherapy with etopside and carboplatin was administered in combination with radiation therapy. At 5 months after the operation, there has been no evidence of recurrence. To our knowledge, this is the 38th report of a small cell carcinoma originating from the kidney in the literature.


PubMed | Nara Social Insurance Hospital
Type: Case Reports | Journal: Gan to kagaku ryoho. Cancer & chemotherapy | Year: 2012

A 62-year-old woman had suffered from interstitial pneumonitis caused by collagen disease and had received steroids and immunosuppressants for twenty years. She was diagnosed as pseudomyxoma peritonei by CT examination and underwent palliative cytoreduction two years ago, but peritoneal relapse occurred one year later. At her first visit to our office, she complained of abdominal distension and respiratory distress of Hugh-Jones classification 2-3. CT showed interstitial pneumonitis and a massive intra-abdominal mucinous tumor. Complete cytoreduction by peritonectomy procedures, combined with intraperitoneal chemotherapy with 50 mg of cisplatin, was performed. The duration of the operation was 860 minutes and the blood loss was 7, 000 mL. Postoperative steroidal replacement was performed and neither acute exacerbation of interstitial pneumonitis nor any other severe complication occurred. Today, in the 3-year follow-up period, she is doing well without any sign of recurrence of pseudomyxoma peritonei.


PubMed | Nara Social Insurance Hospital
Type: Case Reports | Journal: Hinyokika kiyo. Acta urologica Japonica | Year: 2012

A 60-year-old man visited our hospital with a complaint of right renal incidentaloma which was pointed out on abdominal ultrasonography for a medical check-up. Abdominal computed tomography showed a renal tumor in the right kidney, which was a slightly high-dense relative to the renal parenchyma and was enhanced in the arterial phase. The tumor had grown gradually from 1.4 to 1.7 cm in diameter. After the observation for 4 years, he underwent pure laparoscopic non-ischemic partial nephrectomy using a microwave tissue coagulator. Histological examination of the specimen revealed a leiomyoma of the kidney. This is the 5th case of successful laparoscopic partial nephrectomy for renal leiomyoma in Japan within the retrieved references.


PubMed | Nara Social Insurance Hospital
Type: Clinical Trial | Journal: Breast cancer (Tokyo, Japan) | Year: 2012

Indocyanine green (ICG) fluorescence navigation is a useful option in sentinel node biopsy (SNB) for breast cancer. However, several technical difficulties still exist. Since the sentinel node (SN) cannot be recognized over the skin, subcutaneous lymphatic vessels (LVs) must be carefully dissected without injury. In addition, the dissecting procedures are often interrupted by turning off the operating light during fluorescence observation. In this report, we introduce a new approach using the axillary compression technique to overcome these problems.In the original procedure of the ICG fluorescence method, the subcutaneous lymphatic drainage pathway from the breast to the axilla was observed in fluorescence images, but no signal could be obtained in the axilla. When the axillary skin was compressed against the chest wall using a plastic device, the signals from the deeper lymphatic structures could be observed. By tracing the compression-inducible fluorescence signal towards the axilla, transcutaneous detection and direct approach to the SN were achieved. The benefit of this approach is that there is no risk of injury of LVs, and the procedures are interrupted less frequently by fluorescence observation. The axillary compression technique was used in 50 patients with early breast cancer.SNs were successfully removed in all patients. Transcutaneous detection and direct approach were possible in 47 patients. This approach was also effective in obese patients.Axillary compression technique is a simple way to facilitate the surgical procedures of ICG fluorescence-navigated SNB for breast cancer.

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