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1. DEVELOPMENT, STABILITY, AND CLINICAL CORRELATIONS OF ALLOGENEIC MICROCHIMERISM AFTER SOLID ORGAN TRANSPLANTATION1

Author

Pichlmayr R, Joachim Hundrieser, Kurt Wonigeit, Thorsten Wahlers, Klaus H.W. Böker, Gereon Raddatz, M. Hisanaga, Uthoff K, and H. J. Schlitt

Subjects
Heart transplantation, Transplantation, medicine.medical_specialty, business.industry, medicine.medical_treatment, Microchimerism, Liver transplantation, Organ transplantation, Statistical significance, Immunology, Medicine, Clinical significance, business, Nested polymerase chain reaction
Abstract

To assess the development, stability, and clinical relevance of donor-type microchimerism, skin and blood were analyzed in heart (n = 53) and liver (n = 18) transplant recipients by nested polymerase chain reaction. Microchimerism was detectable in 40 (75%) and 13 (72%) patients after heart and liver transplantation, respectively. In heart transplantation, chimerism-positive patients showed a lower frequency of acute rejection as compared with negative patients, although this was only of borderline statistical significance. Repeated intraindividual analyses demonstrated variable patterns of microchimerism over time, but changes did not correlate to the clinical state. In liver transplantation, chimeric state showed no clear correlation with the patients' immunological situation. Our results demonstrate that peripheral microchimerism frequently develops after different types of organ transplantation and represents a dynamic process but without diagnostic value to predict the immunological risk for individual patients.

Published
1996
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2. Fabrication of 3-dimensionally shaped Si diaphragm dynamic focusing mirror

Author

T. Koumura, T. Hattori, and M. Hisanaga

Subjects
Fabrication, Materials science, Silicon, business.industry, chemistry.chemical_element, Plasma, Photoresist, law.invention, Optics, chemistry, law, Specific energy, Dry etching, Photolithography, business, Diaphragm (optics)
Abstract

To obtain a dynamic focusing mirror with optically ideal or parabolic deformation, a thin Si diaphragm with a 3-D specific thickness profile has been fabricated by a unique processing method. The specific thickness profile which allows optically ideal deformation is determined by the finite-element method (FEM). The mirror is approximately 10 mm in diameter and 9- mu m in thickness. Its specific profile of the mirror is created by a dry-etching method. Photoresist on a Si substrate is first exposed to a specific energy profile through a mask made by the dither method. The photoresist is then developed to form a specific curved profile which complies with the optical energy profile. The curved profile is transcribed to the Si substrate by dry etching in CF/sub 4//O/sub 2/ plasma. The processed 3-D profile matches the design with less than 2% deviation. >

Published
2002
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3. Clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer

Author

Y, Nakajima, M, Nagao, S, Ko, H, Kanehiro, M, Hisanaga, Y, Aomatsu, N, Ikeda, T, Shibaji, S, Ogawa, and H, Nakano

Subjects
Logistic Models, Lung Neoplasms, Liver Neoplasms, Hepatectomy, Humans, Postoperative Period, Colorectal Neoplasms, Prognosis, Tomography, X-Ray Computed, Retrospective Studies
Abstract

Surgical resection of hepatic colorectal metastasis may produce long-term survival and cure; however, a significant proportion of patients will have intrahepatic and/or extrahepatic recurrence with a poor prognosis. The aim of this study was to define clinical predictors of recurrence site after hepatectomy in terms of stratifying patients for adequate adjuvant trials to improve the prognosis.Clinical, pathologic, and outcome data for 70 consecutive patients undergoing hepatectomy for colorectal metastasis isolated to the liver were reviewed retrospectively, and all data were analyzed by the logistic multivariate regression model.Recurrence in the remnant liver was seen in 60% of patients, and recurrence in the lung was found in 34% of patients. Number of liver tumors was the only significant and independent predictor of recurrence in the remnant liver (P = 0.048). All patients with three or more tumors experienced recurrence. Location of liver tumors lying adjacent to the hepatic vein, which was confirmed by preoperative imaging techniques, was the only significant and independent predictor of recurrence in the lung (P = 0.020).Number and location of liver tumors would be the significant and independent clinical predictors of recurrence site after hepatectomy for metastatic colorectal cancer. This might be useful for justification and selection of effective adjuvant trials after surgery.

Published
2002

4. Pancreatic adenocarcinoma in a patient with Peutz-Jeghers syndrome: report of a case and literature review

Author

S, Hirao, M, Sho, H, Kanehiro, M, Hisanaga, N, Ikeda, H, Tsurui, Y, Nakajima, and H, Nakano

Subjects
Male, Pancreatic Neoplasms, Peutz-Jeghers Syndrome, Humans, Adenocarcinoma, Middle Aged, Carcinoma, Pancreatic Ductal, Pancreaticoduodenectomy
Abstract

We present a rare case of pancreatic adenocarcinoma in a 47-year-old man with the Peutz-Jeghers syndrome. The patient underwent pancreatoduodenectomy with partial resection of the portal vein. We also review the current literature concerning Peutz-Jeghers syndrome associated with malignant tumors, especially pancreatic cancer. To our knowledge, this is the first report of a Peutz-Jeghers syndrome patient with pancreatic cancer having pancreatoduodenectomy and pathologically diagnosed with invasive ductal adenocarcinoma of the pancreas. The Peutz-Jeghers syndrome patients with pancreatic cancer were relatively young. As the pancreatic cancer in these patients was advanced and most were unresectable at diagnosis, the prognoses of these patients were extremely poor. Surgical resection offers the only chance for cure or long-term survival for Peutz-Jeghers syndrome patients, if the tumor is localized without distant metastasis. Therefore, screening even for young patients with Peutz-Jeghers syndrome is necessary for early detection of cancer.

Published
2000

5. [Endoscopic diagnosis of Barrett's adenocarcinoma]

Author

H, Yoshio, Y, Takashi, H, Mitsuyo, Y, Nobuhiko, T, Tatsurou, S, Kazuhiko, H, Yoko, I, Shigemasa, M, Hisanaga, H, Osamu, S, Katsuyoshi, U, Seishi, H, Matsushita, and T, Masahiko

Subjects
Male, Barrett Esophagus, Esophageal Neoplasms, Humans, Esophagoscopy, Adenocarcinoma, Aged
Abstract

Biopsy specimens can reveal that esophageal cancer is an adenocarcinoma but they cannot show that its origin is Barrett's mucosa. Therefore we must show during endoscopy that the tumor exists in Barrett's mucosa. We reported that Barrett's esophagus could be clearly diagnosed at endoscopy as the columnar mucosa lying on the longitudinal vessels in the lower esophagus. We define Barrett's esophagus as "the columnar mucosa in the esophagus which exists continuously more than 2 cm in circumference from the stomach." Short-segment Barrett's esophagus (SSBE) is "the columnar mucosa which exists in the esophagus continuously from the stomach but its length has a part under 2 cm in length." Endoscopically Barrett's adenocarcinoma is visualized as a lesion with a reddish and uneven mucosal surface. Barrett's adenocarcinomas occur in the SSBE as well. Endoscopic observation at periodic intervals is necessary not only for cases with Barrett's esophagus but also with SSBE. A further examination is necessary to determine the application of EMR for superficial Barrett's adenocarcinoma.

Published
1999

6. The serum interleukin 8 level reflects hepatic mitochondrial redox state in hyperthermochemohypoxic isolated liver perfusion with use of a venovenous bypass

Author

T, Yamada, M, Hisanaga, Y, Nakajima, H, Kanehiro, Y, Aomatsu, S, Ko, T, Kin, K, Nishio, M, Sho, M, Nagao, A, Harada, K, Matsushima, and H, Nakano

Subjects
Male, Time Factors, Tumor Necrosis Factor-alpha, Interleukin-8, Liver Neoplasms, Antineoplastic Agents, Mitochondria, Liver, Hyperthermia, Induced, Middle Aged, Combined Modality Therapy, Chemotherapy, Cancer, Regional Perfusion, Hepatectomy, Humans, Female, Lactic Acid, Isotonic Solutions, Hypoxia, Oxidation-Reduction, Aged, Interleukin-1, Liver Circulation
Abstract

We have recently developed a simple method of hyperthermochemohypoxic isolated liver perfusion (HILP) as a regional therapy for unrecognized liver micrometastases. However, little is known about the influence of HILP on cytokine production and liver function. We investigated the influence of HILP on interleukin 8 (IL-8) production and the hepatic mitochondrial function and assessed the relationship between these 2 parameters. We also measured the serum tumor necrosis factor-alpha (TNF-alpha) and interleukin 1 beta (IL-1 beta) levels to examine the involvement of HILP-induced cytokines in the tumor response.Sixteen patients with metastatic liver tumors were randomly assigned to undergo hepatectomy with HILP (group A, n = 9) or hepatectomy alone (group B, n = 7). The isolated liver was perfused for 30 minutes with Ringer's lactate solution containing chemotherapeutic agents warmed to 42 degrees C to 43 degrees C without oxygenation.The serum IL-8 levels in group A were markedly increased, with peaks at 3 hours after reperfusion, which was significantly higher than levels in group B (P.01). In group A the arterial ketone body ratio, which reflects the hepatic mitochondrial redox state, decreased during perfusion and was gradually restored to the preperfusion level 1 hour after reperfusion. However, in group B it decreased during hepatectomy but rapidly recovered 5 minutes after hepatectomy. There was a significant negative correlation between the peak serum IL-8 level and the initial velocity of arterial ketone body ratio recovery for the first 5 minutes after reperfusion r = -0.83, P.001). The serum TNF-alpha and IL-1 beta were temporarily detected only in 3 of 9 patients in group A.We have shown that HILP resulted in augmented IL-8 release but not TNF-alpha and IL-1 beta and that the serum IL-8 level reflects the hepatic mitochondrial redox state. These findings suggest that IL-8 production may be associated with hepatic mitochondrial impairment during ischemia. This work may contribute to new therapeutic strategies not only for hepatic ischemia reperfusion injury but also for metastatic liver tumors.

Published
1999

7. Hyperthermo-chemo-hypoxic isolated liver perfusion for hepatic metastases: a possible adjuvant approach

Author

Y, Nakajima, M, Horikawa, T, Kin, T, Ohyama, H, Kanehiro, M, Hisanaga, K, Nishio, M, Nagao, M, Sho, T, Yamada, K, Ohashi, S, Ko, and H, Nakano

Subjects
Male, Liver Neoplasms, Alanine Transaminase, Bilirubin, Hyperthermia, Induced, Middle Aged, Survival Rate, Chemotherapy, Adjuvant, Chemotherapy, Cancer, Regional Perfusion, Humans, Female, Aspartate Aminotransferases, Neoplasm Recurrence, Local, Hypoxia, Aged, Retrospective Studies
Abstract

As a possible intraoperative adjuvant approach to treating hepatic metastases we developed a method of hyperthermo-chemo-hypoxic isolated liver perfusion in combination with hepatic resection. This method was applied to 11 patients with colorectal hepatic metastases between 1992 and 1995. One patient died on postoperative day 14 of hepatic failure (9% mortality), the cause of which was live temperature that reached 42.9 degree C, which seems to be the maximum limit for thermal toxic effect on the human liver. The other 10 patients tolerated the perfusion well, with mild hepatic and non systemic toxicity after minor or even major hepatic resection; the serum aminotransferase and total bilirubin levels returned to normal levels by postoperative day 14. Only one of eight patients (13%) for whom cytotoxic drugs were added to the perfusate (mitomycin C 10 micrograms/ml or cisplatin 2 micrograms/ml) had hepatic recurrence by 19 months after the perfusion (mean follow-up 25.8 months; median 23 months; range 8-57 months). Two patients were alive with no evidence of disease at 13 and 57 months, respectively after the perfusion; the other five patients had postperfusion extrahepatic recurrences (median: 19 months; range 7-20 months). In contrast, hepatic metastases recurred 7 and 20 months after the perfusion, respectively, in the two patients not given a cytotoxic drug.

Published
1998

8. Development of microchimerism in pediatric patients after living-related liver transplantation

Author

M, Ueda, J, Hundrieser, M, Hisanaga, K, Tanaka, K, Wonigeit, R, Pichlmayr, H J, Schlitt, and Y, Yamaoka

Subjects
Male, Transplantation Chimera, Adolescent, Cell Survival, Biopsy, Incidence, Stem Cells, Infant, HLA-DR Antigens, Polymerase Chain Reaction, Liver Transplantation, Blood, Child, Preschool, Y Chromosome, Living Donors, Humans, Transplantation, Homologous, Cell Lineage, Female, Longitudinal Studies, Child, Follow-Up Studies, HLA-DRB1 Chains, Skin
Abstract

Microchimerism has been suggested to play an important role in the long-term acceptance of allogeneic organ grafts by transplant patients and for the maintenance of a state of donor-specific low responsiveness. In order to elucidate the kinetics of the development of chimerism we have performed a follow-up analysis in 10 pediatric patients with living-related liver transplantation (LRLTx). Blood samples obtained during the first 6 months and at 18 months post-transplant and skin biopsies taken at one month were analysed for the presence of donor cells by PCR using donor-specific HLA-DRB1 primer pairs or primers for a Y chromosome-specific sequence. Furthermore 13 long-term patients more than 2 yr after LRLTx were studied at two different time points. In the follow-up studies donor cells could be demonstrated in the blood of all patients immediately after transplantation. After a gradual decline all patients became chimerism-negative for several weeks or months. At 6 months, however, in five of eight patients tested and at 18 months in six of nine patients donor cells had reappeared. This biphasic pattern in the development of chimerism is proposed to reflect the occurrence of different donor-derived cell populations in the recipient. The population giving rise to the first wave of chimerism probably represents matured cells with a limited lifespan which are released from the graft into the circulation of the recipient during the first weeks after transplantation. The population of cells occurring with the second wave of chimerism is likely to have been generated by donor-derived cells with stem cell potential located either in the graft or in the hematopoetic organs of the recipient after emigration from the graft. This model may be able to explain fluctuations in the incidence and degree of microchimerism described in other patient populations during the first year post-transplant. Of the 13 long-term patients, chimerism could be demonstrated in 11. In seven patients it was detected in both blood and skin, in three patients the results obtained for blood and skin were discordant. In one patient only blood was analysed. It is not clear whether the negative results really reflected the absence of chimerism or whether the number of donor cells was below the level of detectability.

Published
1997

9. Frequency and clinical correlations of allogeneic microchimerism after heart, liver, and lung transplantation

Author

M. Hisanaga, H. Nakano, Joachim Hundrieser, R. Pichimayr, Y. Nakajima, H. Kanehiro, H. J. Schlitt, and Kurt Wonigeit

Subjects
Graft Rejection, medicine.medical_specialty, Time Factors, Transcription, Genetic, medicine.medical_treatment, Polymerase Chain Reaction, Organ transplantation, Immune tolerance, Medicine, Lung transplantation, Humans, Transplantation, Homologous, In patient, Skin, Transplantation, Graft acceptance, Transplantation Chimera, Lung, business.industry, Histocompatibility Testing, Incidence, Microchimerism, HLA-DR Antigens, Liver Transplantation, surgical procedures, operative, medicine.anatomical_structure, Immunology, Heart Transplantation, Surgery, business, Follow-Up Studies, HLA-DRB1 Chains, Lung Transplantation
Abstract

T HE DEVELOPMENT, migration, and persistence of allogeneic cells into the recipient tissues, that is, microchimerism, has recently been postulated to be linked to stable graft acceptance or even for the presence of graft-specific tolerance.‘*2 An association of microchimerism with functional tolerance has also been suggested by animal models in which persistent chimerism correlates with drug-free graft acceptance.” However, all data about microchimerism after clinical organ transplantation that have been published so far were obtained in a very limited number of patients in the stable long-term course, usually more than 20 years, and in several patients who have been off immunosuppression.‘.’ So far, little is known about microchimerism in the earlier phase after transplantation and in patients with a less stable immunologic state. In the present study, donor-type microchimerism was analyzed in heart (n = 53) liver (n = 18) and lung (n = 52) transplanted patients at various time points after transplantation ranging from 1 week to 12 years in order to assess its frequency and clinical correlations after these different types of organ transplantation.

Published
1997

12. Donor-type microchimerism after heart transplantation--a dynamic process

Author

H J, Schlitt, J, Hundrieser, M, Hisanaga, K, Uthoff, M, Karck, M, Achtelik, T, Wahlers, K, Wonigeit, and R, Pichlmayr

Subjects
Time Factors, Chimera, T-Lymphocytes, DNA, HLA-DR Antigens, Flow Cytometry, Polymerase Chain Reaction, Tissue Donors, Killer Cells, Natural, Random Allocation, Heart Transplantation, Humans, Transplantation, Homologous, Follow-Up Studies, HLA-DRB1 Chains, Skin
Published
1995

15. Patterns of donor-type microchimerism after heart transplantation

Author

Rudolf Pichlmayr, M. Hisanaga, Joachim Hundrieser, Thorsten Wahlers, Hans-Jürgen Schlitt, Uthoff K, Kurt Wonigeit, and Matthias Karck

Subjects
Heart transplantation, medicine.medical_specialty, Transplantation Chimera, business.industry, medicine.medical_treatment, Gene Amplification, HLA-DR1 Antigen, Microchimerism, General Medicine, Polymerase Chain Reaction, Organ transplantation, Transplantation, Immunology, Immune Tolerance, Medicine, Heart Transplantation, Humans, business
Abstract

Allogeneic microchimerism of donor-type has been demonstrated in stable patients in the long-term after organ transplantation. We have analysed microchimerism in skin and blood of 47 heart-transplanted patients after transplantation with polymerase-chain-reaction amplification specific for donor HLA-DRB1. Microchimerism was detectable in 50% of the patients in the first 6 months, in 100% between 6 months and 2 years, and in 58% in the third postoperative year or later. The state of chimerism was not related to acute or chronic rejections. Patterns of microchimerism after heart transplantation may be dynamic, but any association with clinical and immunological variables remains to be elucidated.

Published
1994

17. Warm ischemic pancreas as potential graft for islet transplantation

Author

M, Hisanaga, Y, Nakajima, H, Kanehiro, Y, Aomatsu, A, Yoshimura, M, Horikawa, J, Taki, S, Ko, K, Ohashi, and H, Nakano

Subjects
Male, Time Factors, Mesocricetus, Cell Survival, Islets of Langerhans Transplantation, Temperature, Cell Separation, Islets of Langerhans, Glucose, Ischemia, Cricetinae, Insulin Secretion, Animals, Insulin, Pancreas
Published
1994

18. [DNA analysis of peripheral blood mononuclear cells for early detection of hepatic graft rejection]

Author

J, Taki, Y, Nakajima, M, Hisanaga, H, Kanehiro, and H, Nakano

Subjects
Graft Rejection, Immunosuppression Therapy, Dogs, Predictive Value of Tests, Cell Cycle, Cyclosporine, Leukocytes, Mononuclear, Animals, DNA, Flow Cytometry, Tacrolimus, Liver Transplantation
Abstract

We evaluated the significance of flow cytometric DNA content measurement of peripheral blood mononuclear cells for early detection of hepatic allograft rejection. A total of 15 orthotopic liver transplantation was performed using canine model. Animals were divided in two groups consisting of 5 dogs as untreated controls, and administered cyclosporine (n = 6) or FK506 (n = 4). Blood mononuclear cells DNA contents were analyzed by Propidium iodine method using FACScan. In untreated controls (n = 5), SG2M% of the mononuclear cells value significantly elevated on day 5 or 6 to 15.6 +/- 0.7% (mean +/- SE) compared to pretransplantation value (10.2 +/- 0.6%) (p0.01). At the time of SG2M% elevation, microscopic examination of the graft revealed acute mild rejection. These changes in SG2M% and histological finding were observed one or two days earlier than biochemical changes indicative of liver injury. On the other hand, non-rejected case under sufficient immunosuppression, SG2M% remained low levels (3.8 +/- 1.1%) in comparison with pretransplant values (8.8 +/- 0.6%) (p0.05). The rejecting cases under insufficient immunosuppression, SG2M% significantly elevated to 13.6 +/- 1.3% (p0.01). When steroid pulse therapy was successfully performed, it subsequently decreased to 5.6 +/- 0.7% (p0.01), and histological rejection reaction was disappeared. We concluded that serial measurement of DNA content of peripheral blood mononuclear cells may serve as an useful means for monitoring the immunological status of hepatic recipients.

Published
1993

19. [Chronic encapsulated intracerebral hematoma associated with cavernous angioma: case report and review of the literature]

Author

S, Okuno, M, Hisanaga, A, Miyasaki, S, Tsunoda, and T, Sakaki

Subjects
Adult, Male, Hematoma, Hemangioma, Cavernous, Adolescent, Brain Neoplasms, Chronic Disease, Humans, Female, Middle Aged, Aged, Cerebral Hemorrhage
Abstract

We reported a case of chronic encapsulated intracerebral hematoma associated with cavernous angioma. A 71-year old female was admitted with a history of frontal headaches at intervals of about 3 months for the last one year. Plain CT scan showed a round mass of heterogeneous high density in the left medial frontal lobe. The outer surface of the mass was enhanced with contrast material. MRI demonstrated the mass as a high signal intensity on T1-weighted image and low intensity with laminated structure on T2-weighted image. MR angiogram depicted the mass as a mottled high signal intensity. The left internal carotid artery angiogram revealed no abnormal shadows and vessels. These findings suggested some form of a thrombus although its underlying pathogenesis was unclear. On January 20, 1992, a bifrontal craniotomy was performed. A whitish well-demarcated mass was seen in the left cingulate gyrus through a small corticotomy. We could not identify any branches feeding the mass. The cross-section of the mass disclosed a uniform thrombus encapsulated by a thick wall. Histological studies of the wall confirmed a cavernous angioma within the outer collagenous layers. Chronic encapsulated hematoma, which was first reported by Hirsh in 1981, has represented a separate entity and 25 such cases have been documented in the literature. These reports suggested that the compression and/or destruction of the surrounding tissue caused by the hemorrhage would mask the existence of the cavernous angioma or vascular malformation. If an encapsulated hematoma were encountered during an operation, surgeons should pay attention not to overlook the residual capsule encompassing the cavernous angioma or vascular malformation.

Published
1993

20. [Experimental study of multi-visceral transplantation in dogs]

Author

K, Kido, Y, Nakajima, H, Kanehiro, M, Hisanaga, and H, Nakano

Subjects
Graft Rejection, Perfusion, Postoperative Care, Pancreatic Function Tests, Dogs, Intraoperative Care, Liver Function Tests, Transplantation Immunology, Animals, Organ Transplantation
Abstract

The purpose of the present study was to examine the technical, functional and immunologic aspects in the multivisceral transplantation using canine model. After removal of upper abdominal organs en bloc, the composite graft including the liver, pancreas, spleen and duodenum was orthotopically transplanted in 35 dogs. Ten recipients survived more than 3 days, and 6 more than 6 days. Cause of early death was massive lymphatic leakage, and late death was due to acute rejection or other complications. As technical considerations, perfusion of the graft should be only via aorta to prevent pancreatic edema, and reperfusion should be at first with arterial blood flow to minimize the ischemic damage of the graft. Hepatic and pancrease-endocrine functions were recovered by 3 days, after grafting, and 2-3 days later pancreas-exocrine function was restored. Thereafter the hepatic function was progressively deteriorated again from 6 to 8th day, although the pancreatic function was well maintained until death. At autopsy this hepatic dysfunction was histologically confirmed to be caused by severe acute rejection. On the other hand, the pancreas and duodenum were morphologically almost normal. The results demonstrated the dissociation in functional recovery after grafting and extent of rejection reaction among each grafted organ in the multivisceral transplantation.

Published
1993

21. Microencapsulated islets in agarose gel as bioartificial pancreas for discordant xenotransplantation

Author

Y, Aomatsu, H, Iwata, T, Takagi, H, Amemiya, Y, Nakajima, H, Kanehiro, M, Hisanaga, T, Fukuoka, and H, Nakano

Subjects
Blood Glucose, Graft Rejection, Mice, Inbred BALB C, Sepharose, Graft Survival, Transplantation, Heterologous, Islets of Langerhans Transplantation, Capsules, Guanidines, Diabetes Mellitus, Experimental, Mice, Diabetes Mellitus, Type 1, Dogs, Mice, Inbred NOD, Insulin Secretion, Animals, Diffusion Chambers, Culture, Insulin, Immunosuppressive Agents
Published
1992

22. [Germinoma with granulomatous reaction arising from the corona radiata; case report and review of articles]

Author

S, Okuno, M, Hisanaga, S, Chitoku, T, Sakaki, and S, Tsunoda

Subjects
Adult, Cerebral Cortex, Diagnosis, Differential, Male, Granuloma, Brain Neoplasms, Amphotericin B, Humans, Dysgerminoma, Combined Modality Therapy, Magnetic Resonance Imaging
Abstract

We report a rare case of germinoma with granulomatous reaction arising from the corona radiata. This 20-year-old man was admitted to our hospital complaining of progressive motor weakness on the right side. CT demonstrated a poorly demarcated high density area in the left corona radiata, which was heterogeneously enhanced after administration of contrast medium. Moreover, the continuity of the mass to the ventricular wall was confirmed on MRI. At the first operation, subtotal removal of the tumor was performed through a fronto-parietal craniotomy. The diagnosis for the specific neoplasm was not established histologically, but granuloma caused by fungal infection was the most likely cause of the lesion. We tried amphotericin B (AmB), and remission of the tumor was obtained. However, during the following 3 months, the size of the tumor gradually enlarged again. AmB was repeatedly administered, but this time the treatment was ineffective. Six months later, on May 21, 1990, the second operation was performed and histological examination revealed typical germinoma consisting of two-cell pattern. Subsequently, the patient underwent focal irradiation of 33 Gy to the tumor site, and the tumor completely disappeared. As intracranial germinomas are observed to be successfully cured by radiotherapy and/or chemotherapy, choice of the therapeutic management must be carefully determined according to the histological diagnosis, especially in young people. A variety of locations of germinomas and the accompanying granulomatous reactions could create some diagnostic confusion, so great care must be taken in the treatment of much intracranial germinomas.

Published
1992

24. Immunosuppressive effect in combination therapy of cyclosporine A, FK 506, and 15-deoxyspergualin on pancreatic islet xenotransplantation

Author

M, Ueno, Y, Nakajima, M, Segawa, M, Hisanaga, H, Yabuuchi, A, Yoshimura, and H, Nakano

Subjects
Graft Rejection, Immunosuppression Therapy, Male, Mesocricetus, T-Lymphocytes, Graft Survival, Transplantation, Heterologous, Islets of Langerhans Transplantation, Rats, Inbred Strains, Thymus Gland, Guanidines, Tacrolimus, Diabetes Mellitus, Experimental, Rats, Cricetinae, Cyclosporine, Animals, Drug Therapy, Combination, Immunosuppressive Agents
Published
1992

25. [A case of intracranial germinoma responsive to amphotericin B]

Author

S, Okuno, M, Hisanaga, A, Miyasaki, S, Tsunoda, and T, Sakaki

Subjects
Adult, Male, Brain Neoplasms, Amphotericin B, Humans, Dysgerminoma, Infusions, Intravenous, Magnetic Resonance Imaging
Abstract

A 20-year-old man was admitted to our institution complaining of gradually worsening motor weakness in the right extremities. On admission, the radiological examination revealed a mass located in the left parietal region. On April 4, 1988, a left fronto-parietal craniotomy was performed and the tumor was subtotally removed. The pathological findings of the surgical specimen confirmed no specific tumor, but the presence of a small mingled Candida glabrata supported the diagnosis of fungal granuloma. Amphotericin B (AmB) was administered intravenously for the later enlargement of the tumor. MRI 4 weeks after the beginning of this treatment demonstrated the tumor to be prominently decreased in size. At discharge 3 months later, there was no tumor except only a minimal one in the paraventricular region. However, the recurrence of the tumor was discovered again over the next 8 months. AmB was administered as before, but the tumor continued to be enlarged. In May, 1990, surgery was performed again, and the histological diagnosis was germinoma accompanied with considerable granulomatous reaction. Subsequently, local irradiation was given and complete remission was maintained up to the present time 8 months after irradiation. AmB is a polyene antifungal antibiotic, that has also been reported to enhance the response of antitumor drugs to some tumors on the basis of increased tumor cell permeability. Recent investigations revealed that AmB had immunoadjuvant properties mediated through activated lymphocytes and macrophages, which resulted in an increased host resistance against infectious diseases and even tumors in vivo or in vitro studies. We reported a rare case of intracranial germinoma which responded well to AmB probably through its own antitumor effect caused by immunoadjuvant properties. We discussed the possibility of AmB to be used as immunoadjuvant agent or in combination with other antitumor drugs for the effective treatment of some tumors.

Published
1992

26. Neuroepithelial cyst of the lateral ventricle. Clinical features and treatment

Author

H, Nakase, Y, Ishida, T, Tada, T, Sakaki, K, Goda, S, Tunoda, M, Tominaga, M, Hisanaga, K S, Lee, and I G, Yun

Subjects
Adult, Arachnoid Cysts, Male, Brain Diseases, Cysts, Humans, Infant, Female, Middle Aged, Cerebral Ventriculography, Tomography, X-Ray Computed, Magnetic Resonance Imaging, Cerebral Ventricles
Abstract

This report concerns eight patients with noncolloid neuroepithelial cyst of the lateral ventricle, including four surgical and four conservative cases. Of the surgical patients, two had headache, one had orbital pain, and one had seizures. In the conservative group there were no symptoms due to the cysts and no changes in computed tomography scan during follow-up for an average of 1.4 years. Magnetic resonance imaging was performed in five cases and showed a cyst with an intensity similar to cerebrospinal fluid, while a cyst membrane was also detected in three cases. Our findings suggest that (1) the majority of symptomatic neuroepithelial cysts in the lateral ventricle are located in the trigone; (2) the cause of symptoms suggestive of obstruction, such as headache, is an isolated ventricle that demonstrates dilatation of the inferior horn on computed tomography and magnetic resonance imaging; (3) the operative indication is obstructive symptoms; and (4) cyst-peritoneal shunt is an effective procedure.

Published
1992

27. [Postoperative intracranial hemorrhage due to vitamin K deficiency: report of two cases]

Author

T, Eguchi, H, Nakase, T, Morimoto, T, Tada, T, Sakaki, and M, Hisanaga

Subjects
Male, Postoperative Complications, Humans, Female, Intracranial Aneurysm, Vitamin K Deficiency, Child, Cerebrospinal Fluid Shunts, Aged, Cerebral Hemorrhage, Hydrocephalus
Abstract

Vitamin K deficient hemorrhagic diathesis is well known as a cause of infantile intracranial hemorrhage. Its occurrence, however, as a post-surgical complication is rare and has never been reported previously. Two cases are presented here which illustrate the existence of such a hazard. Case 1. A 73-year-old woman admitted with subarachnoid hemorrhage (WFNS IV) underwent microsurgical exploration of a left internal carotid aneurysm, and neck clipping of the aneurysm was performed. She had an uneventful postoperative course, but her neurological condition deteriorated suddenly on the fifth postoperative day. CT scan revealed a large epidural hematoma. Case 2. A 6-year-old boy was admitted due to the dysfunction of a ventriculo-peritoneal shunt system that had previously been placed for hydrocephalus. This dysfunction was thought to be caused by meningitis. Twelve days after ventricular drainage and antibiotic therapy, sudden intraventricular hemorrhage occurred. In both cases, PT and APTT were markedly prolonged, FDP slightly increased and fibrinogen slightly decreased. SFMC was positive in case 2. After the administration of vitamin K, PT and APTT were immediately normalized. Recent reports emphasize the adverse effect of antibiotics that leads to vitamin K deficient hemorrhagic diathesis, especially, in patients in a cachectic state. In these two cases, such a cachectic condition was not observed. We presume that the cause of vitamin K deficiency would be, along with the administration of antibiotics, a preliminary condition of disseminated intravascular coagulation which is encountered in some neurological disorders including subarachnoid hemorrhage. We conclude that attention should be paid for these pitfalls in perioperative neurosurgical care.

Published
1992

28. Prominent prolongation of islet xenograft survival in combination therapy with FK 506 and 15-deoxyspergualin

Author

H, Yabuuchi, Y, Nakajima, M, Segawa, H, Kanehiro, Y, Murao, M, Hisanaga, A, Yoshimura, T, Wada, K, Nakagawa, and H, Nakano

Subjects
Mesocricetus, Graft Survival, Transplantation, Heterologous, Rats, Inbred Strains, Thymus Gland, Guanidines, Tacrolimus, Anti-Bacterial Agents, Diabetes Mellitus, Experimental, Rats, Cricetinae, Animals, Drug Therapy, Combination, Immunosuppressive Agents
Published
1991

29. Goal setting with pregnant teen-agers

Author

R, Enos and M, Hisanaga

Subjects
Outcome and Process Assessment, Health Care, Adolescent, Pregnancy, Pregnancy in Adolescence, Humans, Female, Contraception Behavior, Goals, Social Adjustment
Published
1979

30. [An autopsy case of multicentric glioma of multiple histopathology]

Author

H, Nakase, M, Hisanaga, and H, Iwanaga

Subjects
Male, Neoplasms, Multiple Primary, Brain Neoplasms, Humans, Glioma, Astrocytoma, Middle Aged, Tomography, X-Ray Computed
Abstract

An autopsy case is described of an 66-year-old man with multicentric glioma of multiple histopathology, i.e. protoplasmic astrocytoma and glioblastoma. Enhanced CT scan revealed three separate lesions in the right cerebral hemisphere, pons, and cerebellar vermis. Initial diagnosis by CT included metastatic and primary brain tumor, multiple abscess, fungal infection, parasites, tuberculoma, and so on. Biopsy of the right frontal mass revealed astrocytoma grade-2. An autopsy revealed gelatinous, clear marginal mass in the right frontal, parietooccipital and cerebellar vermis; an opaque marginal mass with necrosis in dorsal pons was found. At microscopic examination, the right frontal tumor exhibited continuity with both the paraventricular and the right parietooccipital tumor. The right cerebral hemisphere and cerebellar vermis tumors showed protoplasmic astrocytoma; the dorsal pons tumor showed glioblastoma. CSF examination revealed no tumor cells. Tumor invasion of the internal capsule and the meninges was also not found. Accordingly, we diagnosed as multicentric astrocytoma of multiple histopathology. Only 11 case reports of multicentric glioma were recorded in Japan; only one of which was of multiple histopathology. Worldwide, only 7 case reports of multicentric glioma of multiple histopathology were recorded; this is the first case of protoplasmic astrocytoma and glioblastoma. Seen in terms of pathogenesis of multicentric glioma, this case is thought to be very interesting.

Published
1987

33. Effect of endoscopic surgical skill qualification system for laparoscopic rectal surgery: Japanese multicenter analysis.

Author

Ono R, Nonaka T, Tominaga T, Ishii M, Hisanaga M, Araki M, Sumida Y, Shiraishi T, Hashimoto S, Noda K, Takeshita H, Fukuoka H, To K, Tanaka K, Sawai T, and Matsumoto K

Subjects
Humans, Female, Male, Japan, Retrospective Studies, Aged, Middle Aged, Postoperative Complications epidemiology, Postoperative Complications etiology, Propensity Score, Treatment Outcome, East Asian People, Laparoscopy methods, Clinical Competence, Rectal Neoplasms surgery
Abstract

Background: Laparoscopic rectal surgery is often technically difficult. The Endoscopic Surgical Skill Qualification System (ESSQS) was established in Japan as an objective measure of skill for laparoscopic surgeons. However, the advantages of the ESSQS qualification for laparoscopic rectal surgery have been limited. The aim of this multicenter study was to assess the effects of the ESSQS on short- and long-term outcomes for laparoscopic rectal cancer surgery., Methods: We retrospectively reviewed 933 rectal cancer patients who underwent laparoscopic surgery between 2016 and 2023. Patients were divided into two groups: those for whom surgery was performed by an ESSQS-qualified surgeon (Expert group, n = 568); and those for whom surgery was performed by an ESSQS-unqualified surgeon (Non-expert group, n = 365). After propensity score matching, 299 patients from each group were matched. Short- and long-term outcomes were compared between groups., Results: Before matching, the Expert group showed greater frequencies of poor performance status (PS) (PS ≥ 3, 10.6% vs 4.1%, p < 0.001), lower rectum cancer (32.0% vs 18.4%, p < 0.001), preoperative treatment (17.3% vs 8.2%, p < 0.001), and pelvic lymph node dissection (30.8% vs 21.4%, p = 0.001). After matching, the Expert group showed lower frequencies of open conversion (0.3% vs 2.3%, p = 0.034) and postoperative complications (18.1% vs 26.1%, p = 0.037). Relapse-free survival (p = 0.811) and overall survival (p = 0.374) were similar between groups., Conclusion: Superior results such as lower conversion rates and postoperative complication rates were obtained for laparoscopic rectal surgery performed by ESSQS-qualified surgeons., Competing Interests: Declarations. Disclosures: Rika Ono, Takashi Nonaka, Tetsuro Tominaga, Mitsutoshi Ishii, Makoto Hisanaga, Masato Araki, Yorihisa Sumida, Toshio Shiraishi, Shintaro Hashimoto, Keisuke Noda, Hiroaki Takeshita, Hidetoshi Fukuoka, Kazuo To, Kenji Tanaka, Terumitsu Sawai MD, Keitaro Matsumoto have no conflicts of interest or financial ties to disclose., (© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Published
2025
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34. Operator Experience With Robot-Assisted Laparoscopic Rectal Resection and the Impact of Using an Extra Arm on Surgical Outcomes.

Author

Tominaga T, Nonaka T, Takamura Y, Oishi K, Shiraishi T, Hashimoto S, Noda K, Ono R, Hisanaga M, Sawai T, and Matsumoto K

Subjects
Humans, Male, Female, Middle Aged, Aged, Treatment Outcome, Retrospective Studies, Adult, Rectal Neoplasms surgery, Robotic Surgical Procedures, Laparoscopy methods, Operative Time, Clinical Competence
Abstract

Introduction: Although robot-assisted surgery has been rapidly gaining popularity in recent years, few reports have examined the impact of individual robotic arm movements on surgical outcomes. This study investigated the relationship between extra arm (EA) usage and experience of surgeons in robot-assisted surgery., Methods: A total of 176 robot-assisted rectal resections were performed by three surgeons from 2018 to 2022. Each surgeon's first 20 cases categorized in the Early group and the 21st-40th cases in the Late group. Sixty cases in the Early group and 60 cases in the Late group were included to compare patient background, EA motion, and surgical outcomes., Results: More anastomoses were performed closer to the anus in the Late group (p = 0.001). Console time was significantly shorter in the Late group (196 min vs. 153 min, p = 0.020). EA injuries, improper grasping, and intraoperative problems (intraoperative bleeding, misidentification of layers) were significantly less frequent in the Late group (p = 0.001)., Conclusions: As experience with robot-assisted surgery increases, appropriate and safe use of an EA was achieved, and operative time and intraoperative problems were reduced., (© 2024 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Published
2025
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35. Comparison of robotic and laparoscopic approaches in short- and long-term outcomes of lateral pelvic lymph node dissection for advanced rectal cancer: a Japanese multicenter study.

Author

Ishii M, Tominaga T, Nonaka T, Takamura Y, Oishi K, Hashimoto S, Shiraishi T, Noda K, Ono R, Hisanaga M, Takeshita H, Fukuoka H, Oyama S, Sawai T, and Matsumoto K

Subjects
Humans, Male, Female, Middle Aged, Aged, Retrospective Studies, Japan, Treatment Outcome, Adult, Aged, 80 and over, Neoplasm Staging, East Asian People, Robotic Surgical Procedures methods, Lymph Node Excision methods, Rectal Neoplasms surgery, Rectal Neoplasms pathology, Rectal Neoplasms mortality, Laparoscopy methods, Pelvis
Abstract

Background: Lateral pelvic lymph node dissection (LPND) is a challenging surgical technique with complex anatomy and narrow pelvic manipulation. The outcomes of robotic and laparoscopic surgery for LPND are still unclear., Methods: We retrospectively reviewed 169 consecutive patients who underwent rectal cancer surgery with LPND between 2016 and 2023. Patients were divided into two groups according to whether LPND was performed by robotic surgery (R group, n = 40) or laparoscopic surgery (L group, n = 129). Clinicopathological feature and outcomes were compared between groups., Results: Frequency of surgery with combined resection of adjacent structures (5.0% vs. 19.4%, p = 0.023), frequency of patients with distant metastasis (5.0% vs. 19.4%, p = 0.028), and estimated blood loss from bilateral LPND (74 mL vs. 132 mL, p = 0.013) were all lower in the R group than in the L group. Type of surgical approach did not correlate with postoperative complications. Median follow-up was 31.0 months (range, 1.0-69.0 months). No patients in the R group experienced local recurrence, compared to 4.6% in the L group. Multivariate analysis revealed laparoscopic surgery (odds ratio 3.687, 95% confidence interval 1.505-6.033; p = 0.004) as an independent predictor of poor relapse-free survival., Conclusions: Robotic surgery for LPND appears to have good prognostic value in some, but not all, oncologic cases. However, large prospective studies are desirable to validate these findings., Competing Interests: Declarations. Competing interests: The authors declare no competing interests., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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36. Surgical risk and cause of death among octogenarian and nonagenarian patients with colorectal cancer: a Japanese multicenter study.

Author

Hashimoto S, Nonaka T, Tominaga T, Shiraishi T, Noda K, Ono R, Hisanaga M, Takeshita H, Fukuoka H, Fukuoka KT, Tanaka K, Kunizaki M, Sawai T, and Matsumoto K

Abstract

Background: The number of elderly people undergoing surgery for colorectal cancer has been increasing. We examine prognosis, including risks of surgery by age and cancer- and noncancer-related deaths., Methods: This study retrospectively reviewed 1830 patients who underwent curative resection colorectal surgery. Patients were divided into oldest-old (>85 years old, n = 49), elderly (75-84 years old, n = 637), and young (<75 years old, n = 1144) patient groups., Results: Physical status was poorer (P < .001), postoperative complications were more frequent (49.0% vs. 20.9% vs. 18.4%; P < .001), and adjuvant chemotherapy was less frequent (0% vs. 44.3% vs. 83.5%; P < .001) as patients got older. Multivariate analysis revealed oldest-old [odds ratio (OR) 4.373, 95% confidence interval (CI) 2.362-8.110; P < .001] as independent predictors of postoperative complications. Elderly patients [hazard ratio (HR) 2.494, 95%CI 1.707-3.642; P < .001], oldest-old patients (HR 5.969, 95%CI 3.229-11.035; P < .001), poor physical status (HR 2.546, 95%CI 1.694-3.827; P < .001), and postoperative complications (HR 1.805, 95%CI 1.252-2.602; P = .001) were predictive factors for noncancer-specific survival., Conclusions: Elderly patients had many complications and a higher risk of dying from other causes. Surgical risk and general condition must be considered when deciding the appropriateness of surgery and adjuvant therapy., (Published by Oxford University Press 2024.)

Published
2024
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37. Risk Factors for Gangrenous Cholecystitis and the Outcomes of Early Cholecystectomy: A Retrospective Study of a Single-Center City General Hospital.

Author

Yamashita M, Tanaka T, Sumida Y, Yamazaki S, Hara Y, Fukuda A, Hisanaga M, Wakata K, Araki M, and Eguchi S

Subjects
Humans, Retrospective Studies, Male, Female, Risk Factors, Aged, Middle Aged, Aged, 80 and over, Hospitals, General, Adult, Treatment Outcome, Gangrene surgery, Cholecystectomy, Cholecystitis, Acute surgery, Cholecystitis, Acute pathology
Abstract

Gangrenous cholecystitis (GC) is classified as moderate acute cholecystitis according to the Tokyo Guidelines from 2018 (TG18). We evaluated the risk factors for GC and the outcomes of early cholecystectomy. A total of 136 patients who underwent emergency cholecystectomy for acute cholecystitis were retrospectively analyzed; 58 of these patients (42.6%) were diagnosed with GC (GC group) based on our retrospective pathologic diagnosis. We comparatively evaluated the patient backgrounds and surgical outcomes between the GC group and non-GC group. The GC group was significantly older and included more hypertensive patients than the non-GC group. The GC group was prescribed more antibiotics as initial treatment than the non-GC group, and they had more days between onset and surgery. The preoperative white blood cell count and C-reactive protein values were significantly higher in the GC group than in the non-GC group, and these values were predictive factors for GC. Cholecystectomy required a longer operation time and caused greater blood loss in the GC group. The GC group also had longer hospitalization times than the non-GC group; however, no significant differences were observed in terms of postoperative complications. In conclusion, gangrenous changes should be assessed when diagnosing cholecystitis, and appropriate treatment, such as surgery or drainage, should be undertaken., Competing Interests: No potential conflict of interest relevant to this article was reported.

Published
2024
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38. Prognostic impact of postoperative management by an intensive care unit intensivist after colonic perforation.

Author

Tominaga T, Nonaka T, Yano H, Sato S, Ichinomiya T, Sekino M, Shiraishi T, Hashimoto S, Noda K, Ono R, Hisanaga M, Ishii M, Oyama S, Ishimaru K, Hara T, and Matsumoto K

Subjects
Humans, Male, Female, Prognosis, Aged, Middle Aged, Postoperative Care methods, Critical Care, APACHE, Retrospective Studies, Aged, 80 and over, Intestinal Perforation surgery, Intestinal Perforation mortality, Intensive Care Units, Colonic Diseases surgery, Colonic Diseases mortality
Abstract

Purpose: Postoperative management for colonic perforation is an important prognostic factor, but whether intensivists perform postoperative management varies between institutions., Methods: We investigated 291 patients with colonic perforation between 2018 and 2022. Patients were divided into those managed by an intensivists (ICU group; n = 40) and those not managed by an intensivists (non-ICU group; n = 251). We examined how management by intensivists affected prognosis using inverse probability weighting, and clarified which patients should consult an intensivists., Results: The ICU group showed a significantly higher shock index (1.15 vs. 0.75, p < 0.01), higher APACHE II score (16.0 vs. 10.0, p < 0.001), and more severe comorbidities (Charlson Comorbidity Index 5.0 vs. 1.0, p < 0.001) and general peritonitis (85% vs. 38%, p < 0.001). Adjusted risk differences were - 24% (-34% to -13%) for 6-month mortality rate. Six-month mortality was improved by ICU intensivist management in patients with general peritonitis (risk difference - 22.8; 95% confidence interval - 34 to -11); APACHE II score ≥20 (-0.79; -1.06 to -0.52); lactate ≥1.6 (-0.38; -0.57 to -0.29); shock index ≥1.0 (-40.01; -54.87 to -25.16); and catecholamine index ≥10 (-41.16; -58.13 to -24.19)., Conclusions: Intensivists were involved in treating patients in poor general condition, but prognosis was extremely good. Appropriate case consultation with intensivists is important., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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39. Laparoscopic colectomy for patients with poor American Society of Anesthesiology classifications.

Author

Noda K, Nonaka T, Tominaga T, Takamura Y, Oishi K, Hashimoto S, Shiraishi T, Ono R, Ishii M, Hisanaga M, Takeshita H, Fukuoka H, Oyama S, Ishimaru K, Kunizaki M, Sawai T, and Matsumoto K

Subjects
Humans, Male, Female, Retrospective Studies, Aged, Middle Aged, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology, Length of Stay statistics & numerical data, Aged, 80 and over, Anesthesiology, Societies, Medical, Adult, Blood Loss, Surgical statistics & numerical data, Treatment Outcome, Laparoscopy, Colectomy methods, Postoperative Complications epidemiology, Postoperative Complications etiology, Operative Time
Abstract

Introduction: The American Society of Anesthesiologists (ASA) classification is used to assess the fitness of a patient for surgery. Whether laparoscopic surgery is appropriate for colorectal cancer patients with poor ASA performance status (PS) remains unclear., Methods: Among 4585 patients who underwent colorectal surgery between 2016 and 2023, this study retrospectively reviewed all 458 patients with ASA-PS ≥3. Patients were divided into two groups: patients treated by open surgery (O group, n = 80); and patients treated by laparoscopic surgery (L group, n = 378). We investigated the impact of surgical approach on postoperative complications in patients with colorectal cancer and ASA-PS ≥3., Results: Operation time was longer (170 min vs. 233 min, p < .001), blood loss was less (156 mL vs. 23 mL, p < .001), postoperative complications were less frequent (40.0% vs. 25.1%, p = .008), and hospital stay was shorter (23 days vs. 14 days, p < .001) in L group. Univariate analysis revealed rectal cancer, open surgery, longer operation time, and blood loss as factors significantly associated with postoperative complications. Multivariate analysis revealed open surgery (odds ratio [OR] 2.100, 95% confidence interval [CI] 1.164-3.788; p = .013) and longer operation time (OR 1.747, 95% CI 1.098-2.778; p = .018) as independent predictors of postoperative complications., Conclusion: Laparoscopic surgery provides favorable outcomes for colorectal cancer patients with poor ASA-PS., (© 2024 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Published
2024
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40. Short-term outcomes of delta-shaped anastomosis versus functional end-to-end anastomosis using linear staplers for colon cancer.

Author

Ono R, Tominaga T, Ishii M, Hisanaga M, Araki M, Sumida Y, Nonaka T, Hashimoto S, Shiraishi T, Noda K, Takeshita H, Fukuoka H, Oyama S, Ishimaru K, Sawai T, and Matsumoto K

Subjects
Humans, Female, Male, Retrospective Studies, Middle Aged, Aged, Treatment Outcome, Surgical Staplers, Surgical Stapling methods, Colon surgery, Colectomy methods, Colectomy adverse effects, Operative Time, Laparoscopy methods, Laparoscopy adverse effects, Laparoscopy statistics & numerical data, Anastomosis, Surgical methods, Anastomosis, Surgical adverse effects, Colonic Neoplasms surgery, Postoperative Complications etiology, Postoperative Complications epidemiology, Propensity Score
Abstract

Background: Several methods are used for reconstruction in colon cancer surgery, including hand-sewn or stapled anastomosis. However, few reports have compared short-term outcomes among reconstruction methods. This study compared short-term outcomes between delta-shaped anastomosis (Delta) and functional end-to-end anastomosis (FEEA)., Methods: We retrospectively reviewed 1314 consecutive patients who underwent colorectal surgery with FEEA or Delta reconstruction between January 2016 and December 2023. Patients were divided into two groups according to reconstruction by FEEA (F group; n = 1242) or Delta (D group; n = 72). Propensity score matching was applied to minimize the possibility of selection bias and to balance covariates that could affect postoperative complications. Short-term outcomes were compared between groups., Results: Postoperative complications occurred in 215 patients (17.3%) in F group and 8 patients (11.1%) in D group. Before matching, transverse colon cancer was more frequent (p = 0.002), clinical N-positive status was less frequent (44.1% versus 16.7%, p < 0.001), distant metastasis was less frequent (11.7% versus 1.4%, p = 0.003), and laparoscopic approach was more frequent (87.8% versus 100%, p < 0.001) in D group. After matching, no differences in any clinical factor were evident between groups. Blood loss was significantly lower (28 mL versus 10 mL, p = 0.002) in D group, but operation time and postoperative complication rates were similar between groups., Conclusions: Delta and FEEA were both considered safe as reconstruction methods. Further studies are needed to clarify appropriate case selection for Delta and FEEA., (© 2024. Springer Nature Switzerland AG.)

Published
2024
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41. The C-reactive protein-albumin-lymphocyte (CALLY) index is a useful predictor of postoperative complications in patients with a colonic stent for obstructive colorectal cancer: a Japanese multicenter study.

Author

Shiraishi T, Nonaka T, Tominaga T, Takamura Y, Oishi K, Hashimoto S, Noda K, Ono R, Hisanaga M, Takeshita H, Ishii M, Oyama S, Ishimaru K, Kunizaki M, Sawai T, and Matsumoto K

Abstract

Purpose: The C-reactive protein-albumin-lymphocyte (CALLY) index is a novel score that offers a good reflection of nutritional status, inflammatory response, and immune system status. The CALLY index is reported to correlate with the prognosis of various carcinomas. The purpose of the present study was to investigate the association between the CALLY index and the short-term prognosis of obstructive colorectal cancer managed with a colonic stent., Methods: The subjects of this retrospective study were 263 patients who underwent colorectal resection after colonic stenting for obstructive colorectal cancer between 2016 and 2023. Patients were classified into a group with a low CALLY index (CALLY-L group, n = 85) and a group with a high (CALLY-H group, n = 178) CALLY index., Results: The CALLY-L group had greater blood loss (53 mL vs 20 mL, p = 0.002) and higher poor performance status (PS3; 20% vs 10.1%, p = 0.033), open surgery (21.2% vs 7.3%, p = 0.001), distant metastases (41.2% vs 20.8%, p = 0.01), and postoperative complications (30.6% vs. 18.5%, p = 0.039) than the CALLY-H group. Multivariate analysis identified a prolonged operative time (odds ratio 1.983, 95% confidence interval 1.013-3.881; p = 0.045), greater blood loss (odds ratio 2.572, 95% confidence interval 1.291-5.129; p = 0.007) and a low CALLY index (odds ratio 1.961, 95% confidence interval 1.013-3.795; p = 0.045) as independent predictors of complications., Conclusion: The CALLY index may be a useful predictor of postoperative complications of obstructive colorectal cancer., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Published
2024
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42. Effect of the lymphocyte-to-monocyte ratio on the prognosis of patients with obstructive colorectal cancer with a colonic stent: a retrospective multicenter study in Japan.

Author

Shiraishi T, Tominaga T, Nonaka T, Takamura Y, Oishi K, Hashimoto S, Noda K, Ono R, Hisanaga M, Takeshita H, Ishii M, Oyama S, Ishimaru K, Kunizaki M, Sawai T, and Matsumoto K

Abstract

Purpose: The prognostic value of the lymphocyte-to-monocyte (LMR) ratio has been reported for various cancers, including colorectal cancer (CRC). The insertion of colonic stents is considered effective for patients with surgically indicated obstructive CRC, but their LMR can vary depending on factors such as inflammation associated with stent dilation and improvement of obstructive colitis. However, the usefulness of the LMR in patients with obstructive CRC and colonic stents and the optimal timing for its measurement remain unclear. We conducted this study to investigate the relationship between the pre-stent LMR and the mid-term prognosis of patients with obstructive CRC and stents as a bridge to surgery (BTS)., Methods: The subjects of this retrospective multicenter study were 175 patients with pathological stage 2 or 3 CRC. Patients were divided into a low pre-stent LMR group (n = 87) and a high pre-stent LMR group (n = 83)., Results: Only 3-year relapse-free survival differed significantly between the low and high pre-stent LMR groups (39.9% vs. 63.6%, respectively; p = 0.015). The pre-stent LMR represented a prognostic factor for relapse-free survival in multivariate analyses (hazard ratio 2.052, 95% confidence interval 1.242-3.389; p = 0.005), but not for overall survival., Conclusions: A low pre-stent LMR is a prognostic factor for postoperative recurrence in patients with obstructive CRC and a colonic stent as a BTS., (© 2024. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Published
2024
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43. Risk factors for pulmonary complications after colorectal cancer surgery: a Japanese multicenter study.

Author

Tominaga T, Nonaka T, Takamura Y, Oishi K, Hashimoto S, Shiraishi T, Noda K, Ono R, Ishii M, Hisanaga M, Takeshita H, Fukuoka H, Oyama S, Ishimaru K, Kunizaki M, Sawai T, and Matsumoto K

Subjects
Humans, Male, Risk Factors, Female, Aged, Japan epidemiology, Aged, 80 and over, Middle Aged, Lung Diseases etiology, Lung Diseases epidemiology, Retrospective Studies, Colorectal Surgery adverse effects, East Asian People, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology, Postoperative Complications etiology
Abstract

Purpose: Pulmonary complications (PC) are a serious condition with a 20% mortality rate. However, few reports have examined risk factors for PC after colorectal surgery. This study investigated the frequency, characteristics, and risk factors for PC after colorectal cancer surgery., Methods: Between January 2016 and December 2022, we retrospectively reviewed 3979 consecutive patients who underwent colorectal cancer surgery in seven participating hospitals. Patients were divided into patients who experienced PC (PC group, n = 54) and patients who did not (non-PC group, n = 3925). Clinical and pathological features were compared between groups., Results: Fifty-four patients (1.5%) developed PC, of whom 2 patients (3.7%) died due to PC. Age was greater (80 years vs 71 years; p < 0.001), frequency of chronic obstructive pulmonary distress was greater (9.3% vs 3.2%; p = 0.029), performance status was poorer (p < 0.001), the proportion of underweight was higher (42.6% vs 13.4%, p < 0.001), frequency of open surgery was greater (24.1% vs 9.3%; p < 0.001), and blood loss was greater (40 mL vs 22 mL; p < 0.001) in the PC group. Multivariate analysis revealed male sex (odds ratio (OR) 2.165, 95% confidence interval (CI) 1.176-3.986; p = 0.013), greater age (OR 3.180, 95%CI 1.798-5.624; p < 0.001), underweight (OR 3.961, 95%CI 2.210-7.100; p < 0.001), and poorer ASA-PS (OR 3.828, 95%CI 2.144-6.834; p < 0.001) as independent predictors of PC., Conclusion: Our study revealed male sex, greater age, underweight, and poorer ASA-PS as factors associated with development of PC, and suggested that pre- and postoperative rehabilitation and pneumonia control measures should be implemented for patients at high risk of PC., (© 2024. The Author(s).)

Published
2024
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44. Impact of institutional volume on short- and long-term outcomes after laparoscopic colectomy.

Author

Takamura Y, Tominaga T, Nonaka T, Oishi K, Noda K, Hashimoto S, Shiraishi T, Ono R, Hisanaga M, Takeshita H, Ishii M, Fukuoka H, To K, Tanaka K, Sawai T, and Nagayasu T

Subjects
Humans, Retrospective Studies, Colectomy methods, Postoperative Complications etiology, Treatment Outcome, Colonic Neoplasms pathology, Laparoscopy methods
Abstract

Introduction: The impact of institutional volume on postoperative outcomes after laparoscopic colectomy is still being debated. This study aimed to investigate whether differences in postoperative outcomes of laparoscopic colon resection exist between high- and low-volume centers., Methods: Data were reviewed for 1360 patients who underwent laparoscopic colectomy for colon cancer between 2016 and 2022. Patients were divided according to whether they were treated at a high-volume center (≥100 colorectal surgeries annually; n = 947) or a low-volume center (<100 colorectal surgeries annually; n = 413). Propensity score matching was applied to balance covariates and minimize selection biases that could affect outcomes. Finally, 406 patients from each group were matched., Results: After matching, patients from high-volume centers showed a higher number of retrieved lymph nodes (19 vs. 17, p < .001) and more frequent involvement of expert surgeons (98.3% vs. 88.4%, p < .001). Postoperative complication rates were similar between groups (p = .488). No significant differences between high- and low-volume centers were seen in relapse-free survival (88.8% each, p = .716) or overall survival (85.7% vs. 82.8%, p = .480)., Conclusion: The present study suggests that in appropriately educated organizations, relatively safe procedures and good prognosis may be obtained for laparoscopic colectomy cases, regardless of institutional volume., (© 2024 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Published
2024
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45. Short- and Long-term Outcomes After Colonic Stent Insertion as a Bridge to Surgery in Elderly Colorectal Cancer Patients.

Author

Shiraishi T, Tominaga T, Ono R, Noda K, Hashimoto S, Oishi K, Takamura Y, Nonaka T, Hisanaga M, Ishii M, Takeshita H, To K, Ishimaru K, Sawai T, and Nagayasu T

Subjects
Humans, Aged, Aged, 80 and over, Retrospective Studies, Neoplasm Recurrence, Local, Stents adverse effects, Postoperative Complications etiology, Treatment Outcome, Colorectal Neoplasms surgery, Colorectal Neoplasms complications, Intestinal Obstruction etiology, Intestinal Obstruction surgery
Abstract

Background/aim: Colonic stents have been inserted as a bridge to surgery in patients with resectable colorectal cancer, allowing bowel decompression for systemic assessment and better preparation to avoid stoma construction. However, reports of short- and long-term prognoses for elderly patients remain limited., Patients and Methods: This retrospective study reviewed 175 consecutive patients who underwent colonic stent insertion for bowel obstruction followed by curative colectomy. Patients were divided into those >80 years old (Old, n=49) and those <80 years old (Young, n=126). After propensity score matching, 41 patients in each group matched., Results: Before matching, performance status was poorer (p<0.001), postoperative complication rate was higher (p=0.009), adjuvant chemotherapy rate was lower (p<0.001), and hospital stay was longer (p<0.001) in the Old group. After matching, adjuvant chemotherapy rate was lower (9.8% vs. 39.0%; p=0.003) and hospital stay was longer (14 vs. 12 days; p=0.029) in the Old group. Five-year relapse-free survival (42.9% vs. 68.8%; p=0.200), overall survival (66.3% vs. 87.7%; p=0.081), and cancer-specific survival (68.2% vs. 87.7%; p=0.129) rates were comparable between groups., Conclusion: Colorectal resection after colonic stent insertion is useful for elderly patients, with potential to reduce postoperative complication rates and achieve good long-term results with appropriate case selection., (Copyright © 2024 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2024
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46. Correlations of age with clinicopathological features, perioperative outcomes and the prognosis in patients with colorectal cancer: a Japanese multicenter study.

Author

Tominaga T, Nonaka T, Hashimoto S, Shiraishi T, Noda K, Hisanaga M, Takeshita H, Fukuoka H, Sawai T, and Nagayasu T

Subjects
Adult, Female, Humans, Middle Aged, Age Factors, Japan epidemiology, Neoplasm Staging, Postoperative Complications epidemiology, Postoperative Complications pathology, Prognosis, Retrospective Studies, Male, Colorectal Neoplasms pathology, Neoplasm Recurrence, Local pathology
Abstract

Purpose: Colorectal cancer is not common in patients under 40 years old, and its associations with clinical features and the prognosis remain uncertain., Methods: Using a multicenter database, we retrospectively reviewed 3015 patients who underwent colorectal surgery between 2016 and 2021. Patients were divided by age into those < 40 years old (young; n = 52), 40-54 years old (middle-aged; n = 254) and > 54 years old (old; n = 2709). We then investigated age-related differences in clinicopathological features, perioperative outcomes and the prognosis., Results: The proportion of young patients increased annually from 0.63% in 2016 to 2.10% in 2021. Female patients were more frequent, the performance status was better, tumors were larger, clinically node-positive and poorly differentiated adenocarcinomas were more frequent, postoperative complications were less frequent, and the hospital stay was shorter in young patients than in older patients. Young age was an independent predictor of a low risk of postoperative complications (odds ratio, 0.204; 95% confidence interval, 0.049-0.849; p = 0.028). With pathologically node-positive status, adjuvant chemotherapy was more frequent in young patients (100%) than in middle-aged (73.7%) or old (51.8%) patients (p < 0.001), and the 3-year relapse-free survival was better in the young group than in others., Conclusion: Despite higher rates of advanced tumors in younger patients, adequate adjuvant chemotherapy appears to improve the relapse-free survival., (© 2023. The Author(s) under exclusive licence to Springer Nature Singapore Pte Ltd.)

Published
2024
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47. Risk factors for infection of totally implantable central venous access ports among patients requiring port removal.

Author

Hara Y, Sumida Y, Yamazaki S, Takei D, Yamashita M, Fukuda A, Hisanaga M, Tanaka T, Wakata K, Miyazaki T, Araki M, Yano H, and Nakamura A

Abstract

Background: Totally implantable central venous access ports, are required for various purposes, ranging from chemotherapy to nutrition. Port infection is a common complication. In many patients with port infection, the ports are removed because antibiotics are ineffective. We evaluated the risk factors associated with port removal due to port infection., Methods: By retrospective chart review, we collected data of 223 patients who underwent port removal for any reason. Port infection was defined as infection symptoms, such as fever; elevated white blood cell counts or C-reactive protein levels; or redness at the port site, in the absence of other infections, which improved with port removal. The characteristics of patients with or without port infection were compared using univariate (chi-squared test, t -test) and multivariate logistic regression analyses., Results: We compared 172 patients without port infection to 51 patients with port infection. Univariate analysis identified sex ( p  = 0.01), body mass index (BMI) ⩽20 kg/m 2 ( p  = 0.00004), diabetes mellitus ( p  = 0.04), and purpose of use ( p  = 0.0000003) as significant variables. However, male sex ( p  = 0.03, 95% confidence interval [CI]: 0.01-0.23), BMI ⩽20 kg m 2 ( p  = 0.002, 95% CI: 0.06-0.29), and purpose of use (total parenteral nutrition (TPN); p  = 0.000005, 95% CI: 0.31-0.76) remained significant using multivariate analysis. Moreover, the patients with short bowel syndrome and difficulty in oral intake tended to be infected easily. Additionally, Staphylococcus species were the most common microbes involved in port infection., Conclusions: Male sex, BMI ⩽20 kg/m 2 , and purpose of use as a TPN were risk factors for port infection. Ports should not be used for long duration of TPN or used only in exceptional cases., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2024
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48. Prognostic value of lymph node distribution after laparoscopic colectomy with Japanese D3 dissection.

Author

Noda K, Tominaga T, Nonaka T, Ono R, Oishi K, Takamura Y, Ishii M, Hisanaga M, Takeshita H, Oyma S, Ishimaru K, and Nagayasu T

Subjects
Humans, Prognosis, Japan, Colectomy, Lymph Nodes, Laparoscopy, Colorectal Neoplasms surgery
Abstract

Purpose: Positive pathologic lymph nodes in colorectal cancer represent an important prognostic indicator. Whether lymph node distribution or the number of metastatic nodes is more strongly associated with survival prediction remains controversial., Methods: Among 3449 colorectal cancer surgeries performed at Nagasaki University Hospital and five affiliated institutions from April 2016 to March 2022, we investigated 604 patients who underwent laparoscopic radical resection and were diagnosed with pathological stage III cancer. Patients were divided into two groups according to whether they had central vessel metastasis (LND3 group, n=42) or not (LND1/2 group, n=562). After adjusting for background factors using propensity score matching, the LND3 group included 42 patients and the LND1/2 group included 40 patients. Patient background characteristics and prognosis were compared between these two groups., Results: Before matching, frequencies of right-side colon cancer (64.3% vs 38.1%, p=0.001), multivisceral resection (11.9% vs 4.4%, p=0.039), clinical N2 status (40.5% vs 22.6%, p=0.032), and pathological N2 (73.8% vs 22.6%, p<0.001) were all greater, and the number of lymph nodes retrieved was higher (24 vs 19, p=0.042) in the LND3 group. After matching, no differences in any clinical factors were evident between groups. Five-year RFS (44.8% vs 77.1%, p=0.004) and OS (43.1% vs 83.2%, p<0.001) were worse in the LND3 group. Adjuvant chemotherapy improved RFS (adjuvant chemotherapy (+) vs adjuvant chemotherapy (-): 62.1% vs 27.7%, p=0.047) in the LND3 group., Conclusion: LND3-positive patients show poorer prognosis than LND1/2 patients and should be treated with an appropriate perioperative treatment strategy., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Published
2024
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49. Short-term outcomes after laparoscopic colorectal cancer surgery in patients over 90 years old: a Japanese multicenter study.

Author

Yamashita M, Tominaga T, Nonaka T, Hisanaga M, Takeshita H, Fukuoka H, To K, Tanaka K, Sawai T, and Nagayasu T

Subjects
Aged, 80 and over, Humans, Colectomy adverse effects, Colectomy methods, Japan epidemiology, Postoperative Complications epidemiology, Retrospective Studies, Treatment Outcome, Colorectal Neoplasms surgery, Laparoscopy adverse effects, Laparoscopy methods
Abstract

Background: The effect of laparoscopic surgery on short-term outcomes in colorectal cancer patients over 90 years old has remained unclear., Methods: We reviewed 87 colorectal cancer patients aged over 90 years who underwent surgery between 2016 and 2022. Patients were divided into an open surgery group (n = 22) and a laparoscopic surgery group (n = 65). The aim of this study was to investigate the effect of laparoscopic surgery on postoperative outcome in elderly colorectal cancer patients, as compared to open surgery., Results: Seventy-eight patients (89.7%) had comorbidities. Frequency of advanced T stage was lower with laparoscopic surgery (p = 0.021). Operation time was longer (open surgery 146 min vs. laparoscopic surgery 203 min; p = 0.002) and blood loss was less (105 mL vs. 20 mL, respectively; p < 0.001) with laparoscopic surgery. Length of hospitalization was longer with open surgery (22 days vs. 18 days, respectively; p = 0.007). Frequency of infectious complications was lower with laparoscopic surgery (18.5%) than with open surgery (45.5%; p = 0.021). Multivariate analysis revealed open surgery (p = 0.026; odds ratio, 3.535; 95% confidence interval, 1.159-10.781) as an independent predictor of postoperative infectious complications., Conclusions: Laparoscopic colorectal resection for patients over 90 years old is a useful procedure that reduces postoperative infectious complications., (© 2023. The Author(s).)

Published
2024
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50. Risk factors for reoperation within 30 days in laparoscopic colorectal cancer surgery: A Japanese multicenter study.

Author

Oishi K, Tominaga T, Ono R, Noda K, Hashimoto S, Shiraishi T, Takamura Y, Nonaka T, Ishii M, Fukuoka H, Hisanaga M, Takeshita H, To K, Tanaka K, Sawai T, and Nagayasu T

Subjects
Female, Humans, Japan epidemiology, Postoperative Complications etiology, Reoperation, Retrospective Studies, Risk Factors, Treatment Outcome, Male, Colorectal Neoplasms surgery, Colorectal Neoplasms complications, Laparoscopy adverse effects
Abstract

Introduction: Thirty-day reoperation rate reflects short-term surgical outcomes following surgery. Laparoscopic surgery for colorectal cancer reportedly has positive effects on postoperative complications. This retrospective study investigated risk factors for 30-day reoperation rate among patients after laparoscopic colorectal cancer surgery using a multicenter database., Methods: Participants comprised 3037 patients who had undergone laparoscopic resection of colorectal cancer between April 2016 and December 2022 at the Nagasaki University and six affiliated centers, classified into those who had undergone reoperation within 30 days after surgery (RO group; n = 88) and those who had not (NRO group; n = 2949). Clinicopathological characteristics were compared between groups., Results: In the RO group, anastomotic leakage occurred in 57 patients (64.8%), intestinal obstruction in 12 (13.6%), and intraabdominal abscess in 5 (5.7%). Female patients were more frequent, preoperative treatment less frequent, body mass index (BMI) lower, operation time longer, blood loss greater, and hospital stay longer in the RO group (p < .05 each). Multivariate analysis revealed BMI (odds ratio, 0.415; 95% confidence interval, 0.218-0.787; p = .021) and poor performance status (odds ratio, 1.966; 95% confidence interval, 1.106-3.492; p = .021) as independent predictors of reoperation., Conclusion: Perioperative measures are warranted for patients with low BMI and poor performance status undergoing laparoscopic colorectal surgery., (© 2023 Asia Endosurgery Task Force and Japan Society of Endoscopic Surgery and John Wiley & Sons Australia, Ltd.)

Published
2024
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