58 results on '"Wataru Izumo"'
Search Results
2. Distal Bile Duct Metastasis after Colorectal Cancer Surgery: A Case Report
- Author
-
Kyohei Ogawa, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Toru Furukawa, Yoji Nagashima, Masakazu Yamamoto, and Hiroto Egawa
- Subjects
Gastroenterology ,Surgery - Published
- 2022
3. A case of pathologically complete response after preoperative chemotherapy in a pancreatic acinar cell carcinoma patient with portal vein tumor thrombosis
- Author
-
Wataru Izumo, Ryota Higuchi, Toru Furukawa, Takehisa Yazawa, Shuichiro Uemura, Yukiko Takayama, Kyoko Shimizu, Katsutoshi Tokushige, Hiroto Egawa, and Masakazu Yamamoto
- Subjects
Male ,Pancreatic Neoplasms ,Venous Thrombosis ,Carcinoma, Acinar Cell ,Portal Vein ,Antineoplastic Combined Chemotherapy Protocols ,Gastroenterology ,Humans ,General Medicine ,Aged - Abstract
Preoperative treatment is being proposed as a standard treatment for pancreatic ductal adenocarcinoma though few cases show a pathologically complete response. On the other hand, there is no consensus regarding preoperative chemotherapy for pancreatic acinar cell carcinoma (ACC). The present study described a rare case of ACC in the pancreatic head with portal vein tumor thrombosis (PVTT) treated with preoperative chemotherapy using modified FOLFIRINOX, which achieved a pathologically complete response. A 65-year-old man was referred for consideration of treatment strategy. Contrast-enhanced abdominal computed tomography revealed a pancreatic tumor and PVTT. The pancreatic tumor was diagnosed as ACC by an endoscopic ultrasound-guided fine-needle aspiration biopsy. Initially, the tumor was assessed as unresectable due to the presence of PVTT, and therefore, a chemotherapy using modified FOLFIRINOX was administered. After 14 courses of the chemotherapy, imaging studies revealed that the tumor and PVTT showed marked reduction in size; thus, the patient underwent pancreaticoduodenectomy with combined resection of the portal vein (PV). A pathological examination uncovered a complete degeneration of the primary tumor and the PV embolus without any residue of carcinoma. The patient did not receive adjuvant chemotherapy and survived with no evidence of recurrence for 33 months after surgery. The chemotherapy using modified FOLFIRINOX could give a complete response in patients with pancreatic ACC with PVTT.
- Published
- 2022
4. Evaluation of Early Prognostic Factors in Patients With Pancreatic Ductal Adenocarcinoma Receiving Gemcitabine Together With Nab-paclitaxel
- Author
-
Wataru Izumo, Masahiro Shiihara, Ryota Higuchi, Shuichiro Uemura, Masakazu Yamamoto, Toru Furukawa, Yutaro Matsunaga, and Takehisa Yazawa
- Subjects
Oncology ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,business.industry ,Internal medicine ,medicine ,In patient ,business ,Gemcitabine ,Research Article ,Nab-paclitaxel ,medicine.drug - Abstract
Background: Gemcitabine together with nab-paclitaxel (GnP) has been shown to improve outcomes in patients with pancreatic ductal adenocarcinoma (PDAC). However, the predictive markers for treatment effects remain unclear. This study aimed to identify early prognostic factors in patients with PDAC receiving GnP. Patients and Methods: We analyzed 113 patients who received GnP for PDAC and evaluated the relationship between clinical factors and outcomes. Results: The median survival time (MST) was 1.2 years. In multivariate analysis, baseline carbohydrate antigen 19-9 (CA19-9) ≥747 U/ml [hazard ratio (HR)=1.9], baseline controlling nutrition status (CONUT) score ≥5 (HR=3.7) and changing rate of CA19-9 after two GnP cycles ≥0.69 (HR=3.7) were independent risk factors for poor prognosis. When examining outcomes according to pre-chemotherapeutic measurable factors (baseline CA19-9 and CONUT), the MSTs of patients with pre-chemotherapeutic zero risk factors (pre-low-risk group, n=63) and one or more risk factors (pre-high-risk group, n=50) were 1.7 and 0.65 years (p
- Published
- 2021
5. Impact of the controlling nutritional status score on severe postoperative complications of pancreaticoduodenectomy for pancreatic cancer
- Author
-
Ryota Higuchi, Wataru Izumo, Masahiro Shiihara, Takehisa Yazawa, Masakazu Yamamoto, Toru Furukawa, and Shuichiro Uemura
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Nutritional Status ,Pancreaticoduodenectomy ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,Pancreatic cancer ,medicine ,Humans ,Risk factor ,Retrospective Studies ,business.industry ,Postoperative complication ,Vascular surgery ,Prognosis ,medicine.disease ,Pancreatic Neoplasms ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Surgery ,Complication ,business ,Abdominal surgery - Abstract
The controlling nutritional status (CONUT) score is a useful biomarker to evaluate undernutrition. However, there have been few reports describing the correlation between postoperative complications and the CONUT score for pancreatic cancer. Therefore, this study aimed to assess the impact of the CONUT score on the postoperative complications of pancreaticoduodenectomy (PD) in patients with pancreatic cancer. We retrospectively analyzed 206 consecutive patients with pancreatic cancer who underwent PD over a 12-year duration at our institution. The patients were divided into two groups based on preoperative CONUT scores; their clinicopathological characteristics and surgical outcomes were compared. Furthermore, we compared the CONUT score with preoperative clinical factors and several nutritional biomarkers for postoperative complications using univariate and multivariate analyses. Postoperative complications of Clavien–Dindo grade ≥ IIIa and those of Clavien–Dindo grade ≥ IIIb occurred in 29 (14.1%) and 9 (4.4%) patients, respectively. The high CONUT score (≥5) group indicated that patients with an undernutrition status had a higher postoperative complication rate, poorer relapse-free survival, and overall survival rates than the low CONUT score (≤4) group. Among preoperative clinical factors, a high CONUT score was an independent risk factor for severe postoperative complications. The CONUT score may be a useful parameter in the identification of patients undergoing pancreatic surgery who are susceptible to postoperative complications.
- Published
- 2021
6. Resectional surgery in gallbladder cancer with jaundice—how to improve the outcome?
- Author
-
Yutaro Matsunaga, Toru Furukawa, Wataru Izumo, Takehiro Ota, Masakazu Yamamoto, Yasuto Sato, Takehisa Yazawa, Erika Nagano, Shuichirou Uemura, Rahul K. Chaudhary, and Ryota Higuchi
- Subjects
medicine.medical_specialty ,business.industry ,Hazard ratio ,030230 surgery ,Jaundice ,Vascular surgery ,medicine.disease ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,medicine ,Radical surgery ,Gallbladder cancer ,medicine.symptom ,business ,Survival rate ,Abdominal surgery - Abstract
To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors. A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature. The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p < 0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-a-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien–Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p < 0.05) and 13% (p = 0.07) for those with EBD. M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed.
- Published
- 2021
7. Assessment of Preoperative Clinicophysiologic Findings as Risk Factors for Postoperative Pancreatic Fistula After Pancreaticoduodenectomy
- Author
-
Naoki Orimoto, Masakazu Yamamoto, Kiyotaka Nishida, Shuji Suzuki, Mitsugi Shimoda, Wataru Izumo, Jiro Shimazaki, Masahiro Shiihara, and Yukio Oshiro
- Subjects
medicine.medical_specialty ,business.industry ,Pancreatic fistula ,medicine.medical_treatment ,Medicine ,Surgery ,business ,medicine.disease ,Pancreaticoduodenectomy - Abstract
Objective Postoperative pancreatic fistula (POPF) is one of the severe complications that develop after pancreaticoduodenectomy (PD). This study aimed to assess the utility of preoperative clinicophysiologic findings as risk factors for POPF after PD. Summary of Background Data We enrolled 350 patients who underwent PD between 2007 and 2012 at Tokyo Women's Medical University. Methods In total, 350 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups as follows: group A (no fistula/biochemical leak group, 289 patients) and group B (grade B/C of POPF group 61 patients). Variables, including operative characteristics, length of stay in hospital, morbidity, mortality, and data regarding preoperative clinicophysiologic parameters, were collected and analyzed as predictors of POPF for univariate and multivariate analyses. Results There were 213 male and 137 female patients. The mean age was 65.4 years (range, 21–87 years). Univariate analysis showed that sex (P = 0.047), amylase level (P = 0.032), prognostic nutritional index (PNI; P = 0.001), and C-reactive protein/albumin ratio (P = 0.005) were independent risk factors for POPF. In contrast, multivariate analysis showed that sex (P = 0.045) and PNI (P = 0.012) were independent risk factors for POPF. Conclusions Our results show that PNI (≤48.64 U/mL) and male sex were risk factors for POPF after PD, and especially, PNI can be suggested as an effective biomarker for POPF.
- Published
- 2021
8. Narrowing of the remnant portal vein diameter and decreased portal vein angle are risk factors for portal vein thrombosis after perihilar cholangiocarcinoma surgery
- Author
-
Yutaro Matsunaga, Yasuto Sato, Takehisa Yazawa, Ryota Higuchi, Shuichiro Uemura, Wataru Izumo, Hiroto Egawa, Manh Thau Cao, Satoru Morita, Masakazu Yamamoto, and Toru Furukawa
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,medicine ,Hepatectomy ,Humans ,Retrospective Studies ,Venous Thrombosis ,Portal Vein ,business.industry ,Vascular surgery ,medicine.disease ,Surgery ,Cardiac surgery ,Portal vein thrombosis ,Venous thrombosis ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,business ,Klatskin Tumor ,Abdominal surgery ,Artery - Abstract
To evaluate the incidence, risk factors, management options, and outcomes of portal vein thrombosis following major hepatectomy for perihilar cholangiocarcinoma.A total of 177 perihilar cholangiocarcinoma patients who (1) underwent major hepatectomy and (2) underwent investigating the portal vein morphology, which was measured by rotating the reconstructed three-dimensional images after facilitating bone removal using Aquarius iNtuition workstation between 2002 and 2018, were included. Risk factors were evaluated using the Kaplan-Meier method and Cox proportional hazard models.Six patients developed portal vein thrombosis (3.4%) within a median time of 6.5 (range 0-22) days. Portal vein and hepatic artery resection were performed in 30% and 6% patients, respectively. A significant difference in the probability of the occurrence of portal vein thrombosis (PV) within 30 days was found among patients with portal vein resection, a postoperative portal vein angle100°, remnant portal vein diameter5.77 mm, main portal vein diameter13.4 mm, and blood loss (log-rank test, p = 0.003, p = 0.06, p0.0001, p = 0.01, and p = 0.03, respectively). Decreasing the portal vein angle and narrowing of the remnant PV diameter remained significant predictors on multivariate analysis (p = 0.027 and 0.002, respectively). Reoperation with thrombectomy was performed in four patients, and the other two patients were successfully treated with anticoagulants. All six patients subsequently recovered and were discharged between 25 and 70 days postoperatively.Narrowing of the remnant portal vein diameter and a decreased portal vein angle after major hepatectomy for perihilar cholangiocarcinoma are significant independent risk factors for postoperative portal vein thrombosis.
- Published
- 2021
9. Evaluation of preoperative prognostic factors in patients with resectable invasive intraductal papillary mucinous carcinoma
- Author
-
Toru Furukawa, Takehisa Yazawa, Masahiro Shiihara, Ryota Higuchi, Shuichiro Uemura, Masakazu Yamamoto, and Wataru Izumo
- Subjects
Male ,medicine.medical_specialty ,Multivariate analysis ,CA-19-9 Antigen ,Kaplan-Meier Estimate ,030230 surgery ,Risk Assessment ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Medicine ,Mucinous carcinoma ,Neoplasm Invasiveness ,In patient ,Risk factor ,Aged ,Retrospective Studies ,Aged, 80 and over ,Tumor size ,business.industry ,Standard treatment ,Hazard ratio ,Middle Aged ,Prognosis ,medicine.disease ,Adenocarcinoma, Mucinous ,Pancreatic Neoplasms ,Survival Rate ,Chemotherapy, Adjuvant ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Preoperative Period ,Tubular Adenocarcinoma ,Female ,Surgery ,Neoplasm Recurrence, Local ,business ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
Background Upfront surgery is the standard treatment for resectable invasive intraductal papillary mucinous carcinoma; however, recurrence is common. Therefore, we investigated the recurrence, surgical outcome, and preoperative prognostic factors for recurrence in patients with resectable invasive intraductal papillary mucinous carcinoma. Methods We analyzed 111 patients who underwent upfront surgery for resectable invasive intraductal papillary mucinous carcinoma between 2000 and 2017 and evaluated the relationship among clinicopathologic factors, recurrence, and outcomes. Results The 5-year recurrence-free survival and disease-specific survival rates were 61% and 74%, respectively. The median time to recurrence was 1.1 years. In multivariate analysis, carbohydrate antigen 19-9 ≥83 U/mL (hazard ratio: 2.8 and 3.1), tumor size ≥2.2 cm (hazard ratio: 3.5 and 4.7), and pathologic tubular adenocarcinoma grade 2 (hazard ratio: 3.1 and 5.2) were risk factors for a shorter recurrence-free survival and disease-specific survival, respectively. Lymph node metastasis (hazard ratio: 3.9) was also a risk factor for a shorter disease-specific survival. When examining outcomes according to preoperatively measurable factors (carbohydrate antigen 19-9 ≥83 U/mL and tumor size ≥2.2 cm), the 5-year recurrence rates in patients with none (n = 47), 1 (n = 46), and both (n = 18) risk factors were 17%, 48%, and 78%, respectively. Five-year disease-specific survival rates in patients with none, 1, and both preoperative risk factors were 95%, 69%, and 31%, respectively. Conclusion Carbohydrate antigen 19-9 ≥83 U/mL and tumor size ≥2.2 cm were independent preoperative risk factors for poor outcomes in patients with resectable invasive intraductal papillary mucinous carcinoma.
- Published
- 2020
10. Prognostic Factors for Surgically Resected Intraductal Papillary Neoplasm of the Bile Duct: A Retrospective Cohort Study
- Author
-
Masakazu Yamamoto, Takehiro Ota, Wataru Izumo, Ryota Higuchi, Shuichiro Uemura, Takehisa Yazawa, Masahiro Shiihara, Yutaro Matsunaga, and Toru Furukawa
- Subjects
medicine.medical_specialty ,Multivariate analysis ,030230 surgery ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Surgical oncology ,Internal medicine ,medicine ,Humans ,Retrospective Studies ,business.industry ,Bile duct ,Carcinoma in situ ,Hazard ratio ,Cancer ,Retrospective cohort study ,Prognosis ,medicine.disease ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Oncology ,Dysplasia ,030220 oncology & carcinogenesis ,Surgery ,Bile Ducts ,Neoplasm Recurrence, Local ,business - Abstract
To date, postoperative prognostic factors for intraductal papillary neoplasm of the bile duct (IPNB) have not been well-established. This study aimed to examine the histopathologic features and postoperative prognosis of the two IPNB subclassifications, as well as factors affecting prognosis, based on the authors’ experience at a single institution. The study enrolled 83 patients who underwent surgical resection for pathologically diagnosed IPNB at the authors’ institution. The clinicopathologic features and postoperative outcomes for these patients were examined. The study also investigated postoperative prognostic factors for IPNB using uni- and multivariate analyses. More than half of the tumors (64%) diagnosed as IPNB were early-stage cancer (UICC Tis or T1). However, none were diagnosed as benign. The multivariate analysis showed that lymph node metastasis (hazard ratio [HR], 5.78; p = 0.002) and bile duct margin status with carcinoma in situ (D-CIS; HR, 5.10; p = 0.002) were independent prognostic factors, whereas MUC6 expression showed only a marginal influence on prediction of prognosis (HR, 0.32; p = 0.07). The tumor recurrence rate and the proportion of locoregional recurrence were significantly greater among the patients with D-CIS than among those with negative bile duct margins, including those patients with low-grade dysplasia. The patients with D-CIS showed a significantly poorer prognosis than those with negative bile duct margins (5-year survival, 38% versus 87%; p = 0.0002). Evaluation of resected IPNBs showed cancer in all cases. Avoiding positive biliary stumps during surgery, including resection of carcinoma in situ, would improve the prognosis for patients with IPNB.
- Published
- 2020
11. Retrospective evaluation of risk factors of postoperative varices after pancreaticoduodenectomy with combined portal vein resection
- Author
-
Toru Furukawa, Ryota Higuchi, Wataru Izumo, Takehisa Yazawa, Shuichiro Uemura, Masakazu Yamamoto, and Masahiro Shiihara
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Left gastric vein ,Jejunostomy ,Anastomosis ,Pancreaticoduodenectomy ,Varicose Veins ,Pancreatic Fistula ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Risk Factors ,medicine ,Humans ,Vein ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,Portal Vein ,business.industry ,Incidence ,Gastroenterology ,Middle Aged ,medicine.disease ,Surgery ,Pancreatic Neoplasms ,medicine.anatomical_structure ,Splenic Vein ,Splenic vein ,030220 oncology & carcinogenesis ,Inferior mesenteric vein ,Portal hypertension ,Female ,030211 gastroenterology & hepatology ,Tomography, X-Ray Computed ,Varices ,business ,Vascular Surgical Procedures - Abstract
Combined portal vein (PV) resection is performed for pancreatic head cancer to achieve clear resection margins. This can be complicated by the formation of varices due to sinistral portal hypertension after pancreaticoduodenectomy (PD) with combined PV resection. However, clinical strategies to prevent varices formation due to sinistral portal hypertension remain controversial. Moreover, the critical vein among splenic vein (SPV), inferior mesenteric vein, left gastric vein, or middle colonic vein requiring preservation to prevent the development of varices remains unclear.We retrospectively analyzed patients with pancreatic cancer who underwent PD with combined PV resection over 18 years at our institution. Varices were evaluated using enhanced computed tomography (CT) and endoscopy. Preoperative types of porto-mesenterico-splenic confluence, venous drainage, and venous resection types were determined by operative records and CT findings.Of the 108 subjects, the incidence of postoperative varices was observed in 24.1% of cases over 5.6 months. These varices were classified into five types based on location, as pancreaticojejunostomy anastomotic (11.5%), gastrojejunostomy anastomotic (11.5%), esophageal (11.5%), splenic hilar-gastric (23.1%), and right colonic (65.4%) varices. No case of variceal bleeding occurred. Multivariate analysis showed SPV ligation as the greatest risk factor of varices (P 0.001), with a higher incidence of left-sided varices in patients with all the SPV venous drainage sacrificed (60%) than in the others (16.7%). Therefore, sacrificing all the SPV venous drainage was the only independent risk factor of varices (P = 0.049).Preservation of SPV venous drainage should be considered during SPV ligation to prevent post-PD varices.
- Published
- 2020
12. Comparison of patients with invasive intraductal papillary mucinous carcinoma and invasive ductal carcinoma of the pancreas: a pathological type- and stage-matched analysis
- Author
-
Wataru Izumo, Toru Furukawa, Masakazu Yamamoto, Ryota Higuchi, Yutaro Matsunaga, Takehisa Yazawa, Masahiro Shiihara, and Shuichiro Uemura
- Subjects
Adult ,Male ,Pathology ,medicine.medical_specialty ,Adenocarcinoma ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,medicine ,Humans ,Mucinous carcinoma ,Neoplasm Invasiveness ,Stage (cooking) ,skin and connective tissue diseases ,Pathological ,Aged ,Neoplasm Staging ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Gastroenterology ,Middle Aged ,medicine.disease ,Invasive ductal carcinoma ,Adenocarcinoma, Mucinous ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Pancreas ,business ,Carcinoma, Pancreatic Ductal - Abstract
Objective: We compared the pathological features and stage-matched outcomes of patients with invasive intraductal papillary mucinous carcinoma (IPMC) and invasive ductal carcinoma (IDC) of ...
- Published
- 2019
13. Evaluation of the Significance of Lymphatic, Microvascular and Perineural Invasion in Patients With Pancreatic Neuroendocrine Neoplasms
- Author
-
WATARU IZUMO, RYOTA HIGUCHI, TORU FURUKAWA, TAKEHISA YAZAWA, SHUICHIRO UEMURA, YUTARO MATSUNAGA, MASAHIRO SHIIHARA, YUKIKO TAKAYAMA, JUNKO TAHARA, KYOKO SHIMIZU, KATSUTOSHI TOKUSHIGE, and MASAKAZU YAMAMOTO
- Subjects
Research Article - Abstract
Background: Some prognostic factors for pancreatic neuroendocrine neoplasms (PanNENs) have been reported; however, the significance of lymphatic, microvascular, and perineural invasion remains unclear. We aimed to clarify the role of these factors in PanNEN recurrence. Patients and Methods: We analyzed 138 patients who underwent curative pancreatectomy and were pathologically diagnosed with PanNEN. We evaluated the association between clinicopathological factors and the recurrence of PanNENs. Results: The numbers of patients with lymphatic, microvascular, and perineural invasion were 34 (25%), 43 (31%) and 17 (12%), respectively. Twenty-four patients (17%) had recurrences, and the 3, 5, and 10-year recurrence-free survival (RFS) rates were 88%, 84%, and 76%, respectively. The recurrence sites (with duplication) were mainly the liver (twenty-two patients), followed by the lymph nodes (seven patients), and bone (two patients). In multivariate analyses, grade 2-3 and the presence of microvascular invasion were significant risk factors for RFS (hazard ratio=7.5 and 7.9, respectively). When examining outcomes according to these factors, the 5-year RFS rates of patients with risk scores of 0, 1, and 2 were 100%, 91%, and 32%, respectively (p
- Published
- 2021
14. Diagnosis by 64-Row Multidetector Computed Tomography for Longitudinal Superficial Extension of Distal Cholangiocarcinoma
- Author
-
Masahiro Shiihara, Wataru Izumo, Shuichiro Uemura, Takehisa Yazawa, Masakazu Yamamoto, Ryota Higuchi, Satoru Morita, and Toru Furukawa
- Subjects
Male ,medicine.medical_specialty ,Cholangiocarcinoma ,03 medical and health sciences ,0302 clinical medicine ,Drainage tubes ,Multidetector Computed Tomography ,Multidetector computed tomography ,medicine ,Carcinoma ,Humans ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Middle Aged ,medicine.disease ,Biliary cancer ,Predictive value ,Bile Duct Neoplasms ,Dysplasia ,030220 oncology & carcinogenesis ,Female ,030211 gastroenterology & hepatology ,Surgery ,Radiology ,Thickening ,business - Abstract
Background This study aimed to demonstrate the diagnostic ability of 64-row multidetector computed tomography (64-row MDCT) for longitudinal superficial extension of distal cholangiocarcinoma (LSEDC). Methods Twenty-seven patients with distal cholangiocarcinoma (DC) underwent preoperative 64-row MDCT without drainage tubes. LSEDC was diagnosed using curved planar reconstruction images reconstructed from 64-row MDCT, which were compared with pathologic findings. Results LSEDC was observed in 13 patients (48%). Ten patients (37%) had enhancing nonthickened bile ducts extending continuously from the main tumor (type 1). These coincided with pathologic findings of high-grade dysplasia (HGD) in 90.0% of cases; that is, a positive predictive value (9/10). Fourteen patients (52%) had only wall thickening of the main tumor with or without enhancement (type 2). Four patients with HGD in this group were difficult to diagnose. Three patients (11%) had enhancing nonthickened bile ducts not in continuity with the main tumor (type 3). This finding revealed an inflammatory change instead of a carcinoma in the pathologic findings. The sensitivity and specificity of detecting HGD were 75% and 93% on the liver side, 33% and 100% on the duodenal side, respectively. Four patients (67%) with HGD on the liver side were overdiagnosed, and one patient (17%) was underdiagnosed. Most of the patients overdiagnosed on the liver side (3/4 or 75%) had drainage tubes inserted before the MDCT. Conclusions For DC patients without drainage tubes, the 64-row MDCT technique may be useful for diagnosing HGD depicted as LSEDC on the liver side but not as useful on the duodenal side.
- Published
- 2019
15. Drain Lipase Levels and Decreased Rate of Drain Amylase Levels as Independent Predictors of Pancreatic Fistula with Nomogram After Pancreaticoduodenectomy
- Author
-
Masahiro Shiihara, Jiro Shimazaki, Masakazu Yamamoto, Shuji Suzuki, Wataru Izumo, Mitsugi Shimoda, Yukio Oshiro, and Kiyotaka Nishida
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Pancreaticoduodenectomy ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Postoperative Complications ,Risk Factors ,Internal medicine ,Medicine ,Humans ,Retrospective Studies ,Univariate analysis ,business.industry ,Hazard ratio ,Retrospective cohort study ,Lipase ,Nomogram ,medicine.disease ,Nomograms ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Amylases ,Drainage ,Surgery ,business ,Complication ,Abdominal surgery - Abstract
Pancreaticoduodenectomy (PD) has recently been improved due to its increased safety. However, postoperative pancreatic fistula (POPF) remains a lethal complication of PD. Identifying novel clinicophysiological risk factors for POPF during the early post-PD period would help improve patient morbidity and mortality. Therefore, this retrospective study aimed to evaluate possible risk factors during the early postoperative period after pancreaticoduodenectomy (PD). Data from 349 patients who underwent PD between 2007 and 2012 were examined retrospectively. All patients were classified into 2 groups: group A, patients without fistulae or biochemical leaks (288 patients), and group B, those with grade B or C POPF (61 patients). Data on various clinicophysiological parameters, including serum and drain laboratory data, were collected. Univariate and multivariate analyses were performed to evaluate POPF predictors. A predictive nomogram was established for these results. Univariate analysis showed that various serum and drain-related factors, such as white blood cell count, C-reactive protein levels, drain amylase (DAMY) levels, and drain lipase (DLIP) levels, were possible POPF risk factors. Multivariate analysis confirmed that postoperative day (POD) 1 DLIP levels (hazard ratio, 15.393; p = 0.037) and decreased rate (POD3/1) of DAMY levels (hazard ratio, 4.415; p = 0.028) were independent risk factors. Further, POD1 DLIP levels and decreased rate of DAMY levels were significantly lower in group A than in group B. The accuracy of nomogram was 0.810. POD1 DLIP levels (> 245 U/mL) and decreased rate of DAMY levels (> 0.44) were POPF risk factors, making them possible biomarkers for POPF.
- Published
- 2021
16. Negative prognostic outcomes of percutaneous transhepatic biliary drainage in distal cholangiocarcinoma: a retrospective analysis using propensity score matching
- Author
-
Ryota Higuchi, Toru Furukawa, Shuichiro Uemura, Takehiro Ota, Wataru Izumo, Takehisa Yazawa, Yutaro Matsunaga, and Masakazu Yamamoto
- Subjects
0301 basic medicine ,Peritoneal metastasis ,medicine.medical_specialty ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Hematology ,General Medicine ,Confidence interval ,Surgery ,03 medical and health sciences ,030104 developmental biology ,0302 clinical medicine ,Oncology ,Surgical oncology ,030220 oncology & carcinogenesis ,Propensity score matching ,Medicine ,Percutaneous transhepatic biliary drainage ,business ,Survival rate - Abstract
The efficacy of different types of preoperative biliary drainage for cholangiocarcinoma has been debated over the past two decades. Controversy concerning the use of percutaneous transhepatic biliary drainage (PTBD) versus endoscopic biliary drainage (EBD) still exists. This study aimed to compare the long-term outcomes between PTBD and EBD in patients with distal cholangiocarcinoma. Data of patients diagnosed with distal cholangiocarcinoma who underwent preoperative PTBD or EBD from January 1999 to December 2017 were analyzed retrospectively. Post-surgical outcomes, including the incidence of post-operative complications, peritoneal metastasis, disease-free survival, and overall survival, were analyzed. Survival analyses were also performed after propensity score matching in the PTBD and EBD groups. The incidence of post-operative complications was similar in both groups. The 5-year estimated cumulative incidences for peritoneal metastasis were 14.7% and 7.2% in the PTBD and EBD groups, respectively (p = 0.192). The 5-year disease-free survival rates were 23.7% and 47.3% in the PTBD and EBD groups, respectively (p = 0.015). In the multi-variate analysis for overall survival, PTBD was an independent poor prognostic factor. The 5-year overall survival rates were 35.9% and 56.3% in the PTBD and EBD groups, respectively (hazard ratio 1.85, confidence interval 1.05–3.26, p = 0.035). The results after propensity score matching indicated a poorer prognosis in the PTBD group, with a 5-year survival rate of 35.9% in the PTBD group vs 56.0% in the EBD group (p = 0.044). PTBD should be considered as a negative prognostic factor in distal cholangiocarcinoma patients.
- Published
- 2020
17. Evaluation of the significance of adjuvant chemotherapy in patients with stage ⅠA pancreatic ductal adenocarcinoma
- Author
-
Ryota Higuchi, Masahiro Shiihara, Masakazu Yamamoto, Toru Furukawa, Takehisa Yazawa, Yutaro Matsunaga, Wataru Izumo, and Shuichiro Uemura
- Subjects
Oncology ,Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Pancreatic ductal adenocarcinoma ,Adjuvant chemotherapy ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Antineoplastic Agents ,Deoxycytidine ,Disease-Free Survival ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Internal medicine ,Pancreatic cancer ,Antineoplastic Combined Chemotherapy Protocols ,medicine ,Humans ,In patient ,Stage (cooking) ,Aged ,Neoplasm Staging ,Retrospective Studies ,Tegafur ,Aged, 80 and over ,Hepatology ,business.industry ,Standard treatment ,Gastroenterology ,Middle Aged ,medicine.disease ,Gemcitabine ,digestive system diseases ,Pancreatic Neoplasms ,Drug Combinations ,Oxonic Acid ,Treatment Outcome ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,business ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
Although adjuvant chemotherapy is considered a standard treatment for resected pancreatic ductal adenocarcinoma (PDAC), its utility in stage ⅠA patients is unclear. We aimed to investigate the recurrence rate, surgical outcome, prognostic factors, effectiveness of adjuvant chemotherapy, and determination of groups in whom adjuvant chemotherapy is effective in patients with stage ⅠA PDAC.We retrospectively analyzed 73 patients who underwent pancreatectomy and were pathologically diagnosed with stage ⅠA PDAC between 2000 and 2018. We evaluated the relation between clinicopathological factors, recurrence rates, and outcomes such as the recurrence-free and disease-specific survival rates (RFS and DSS, respectively).The 5-year RFS and DSS rates were 52% and 58%, respectively. In multivariate analysis, a platelet-to-lymphocyte ratio (PLR) ≥ 170, prognostic nutrition index (PNI) 47.5, and pathological grade 2 or 3 constituted risk factors for a shorter DSS (hazard ratios: 4.7, 4.6, and 4.1, respectively). Patients with 0-1 of these risk factors (low-risk group; n = 47) had significantly higher 5-year DSS rates than those with 2-3 risk factors (high-risk group; n = 26) (80% vs. 23%; P 0.001). Patients in the low-risk group showed similar 5-year RFS rates regardless of whether they received or not adjuvant chemotherapy (75% vs 70%, respectively; P = 0.49). Contrarily, high-risk patients who underwent adjuvant chemotherapy had higher 5-year RFS rates than those who did not receive adjuvant chemotherapy (32% vs 0%; P = 0.045).In stage IA PDAC, adjuvant chemotherapy seems to be effective only in a subgroup of high-risk patients.
- Published
- 2020
18. Evaluation of the validity of pancreatectomy for very elderly patients with pancreatic ductal adenocarcinoma
- Author
-
Masahiro Shiihara, Wataru Izumo, Ryota Higuchi, Shuichiro Uemura, Takehisa Yazawa, Yutaro Matsunaga, Toru Furukawa, and Masakazu Yamamoto
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,030230 surgery ,Adenocarcinoma ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Internal medicine ,Medicine ,Humans ,Risk factor ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Hazard ratio ,Odds ratio ,Vascular surgery ,medicine.disease ,Prognosis ,Pancreatic Neoplasms ,Survival Rate ,Cardiothoracic surgery ,030220 oncology & carcinogenesis ,Surgery ,Neoplasm Recurrence, Local ,business ,Abdominal surgery ,Carcinoma, Pancreatic Ductal - Abstract
The role of pancreatectomy for very elderly patients with pancreatic adenocarcinoma is controversial. This study aimed to clarify the validity of pancreatic resection in octogenarian patients with pancreatic ductal adenocarcinoma. We compared 31 patients aged ≥ 80 years and 548 patients aged < 80 years who underwent pancreatectomy for pancreatic ductal adenocarcinoma and evaluated the relationship between age, clinicopathological factors, recurrence, and outcomes. Postoperative mortality, morbidity, and completion of adjuvant chemotherapy rates did not differ between groups. There were no significant differences in median recurrence–free survival, disease-specific survival, and overall survival between groups (1.0, 2.3, and 2.2 years in patients ≥ 80 years and 1.2, 2.8, and 2.7 years in patients < 80 years; P = 0.67, 0.47, and 0.46, respectively). The median time from recurrence to death of octogenarian patients was significantly shorter than that of younger patients (0.6 vs. 1.1 years, P = 0.0070). In multivariate analysis, age ≥ 80 years (hazard ratio, 1.5), resection of other organs (hazard ratio, 1.8), pathological grade 2/3 (hazard ratio, 1.6), and failure to implement of treatment after recurrence (hazard ratio, 3.6) were independent risk factors for a short time from recurrence to death. Furthermore, age ≥ 80 years (odds ratio, 0.32) was an independent risk factor for the implementation of treatment after recurrence. Pancreatectomy for octogenarians may be acceptable, but median survival time from recurrence to death was shorter due to lower rates of implementation of treatment after recurrence in octogenarian patients.
- Published
- 2020
19. Resectional surgery in gallbladder cancer with jaundice-how to improve the outcome?
- Author
-
Rahul K, Chaudhary, Ryota, Higuchi, Takehisa, Yazawa, Shuichirou, Uemura, Wataru, Izumo, Yutaro, Matsunaga, Erika, Nagano, Yasuto, Sato, Takehiro, Ota, Toru, Furukawa, and Masakazu, Yamamoto
- Subjects
Survival Rate ,Treatment Outcome ,Bile Duct Neoplasms ,Drainage ,Humans ,Jaundice ,Gallbladder Neoplasms ,Neoplasm Recurrence, Local ,Retrospective Studies - Abstract
To evaluate the surgical outcomes of patients with gallbladder cancer (GBC) with jaundice due to as-yet unelucidated prognostic factors.A total of 348 GBC patients underwent resection at our institute between 1985 and 2016. Of these, 67 had jaundice (serum total bilirubin ≥ 2 mg/dL). Preoperative biliary drainage was performed, with portal vein embolization as required. All patients underwent radical surgery. We retrospectively evaluated the outcomes, performed multivariate analysis for overall survival, and compared our findings to those reported in the literature.The 5-year survival rate of M0 (no distant metastasis) GBC patients with jaundice, who underwent resectional surgery, was 21.9%, versus 68.3% in those without jaundice (p0.05). Since 2000, surgical mortality in GBC patients with jaundice has decreased from 12 to 6.8%. Patients with jaundice had more advanced disease and underwent major hepatectomies and vascular resections; however, preoperative jaundice alone was not a prognostic factor. Multivariate analysis of jaundiced patients revealed that percutaneous biliary drainage (PTBD) (vis-à-vis endoscopic drainage [EBD], hazard ratio [HR] 2.82), postoperative morbidity (Clavien-Dindo classification ≥ 3, HR 2.31), and distant metastasis (HR 1.85) were predictors of poor long-term survival. The 5-year survival and peritoneal recurrence rates in M0 patients with jaundice were 16% and 44%, respectively, for patients with PTBD and 39% (p0.05) and 13% (p = 0.07) for those with EBD.M0 GBC patients with jaundice should undergo surgery if R0 resection is possible. Preoperative EBD may be superior to PTBD in M0 GBC patients with jaundice, although further studies are needed.
- Published
- 2020
20. Evaluation of allowable pancreatic resection rate depending on preoperative risk factors for new-onset diabetes mellitus after distal pancreatectomy
- Author
-
Wataru Izumo, Ryota Higuchi, Masahiro Shiihara, Takehisa Yazawa, Masakazu Yamamoto, and Shuichiro Uemura
- Subjects
Adult ,Blood Glucose ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Kaplan-Meier Estimate ,Gastroenterology ,Pancreaticoduodenectomy ,Impaired glucose tolerance ,Diabetes Complications ,03 medical and health sciences ,Young Adult ,0302 clinical medicine ,Insulin resistance ,Pancreatectomy ,Risk Factors ,Internal medicine ,medicine ,Diabetes Mellitus ,Humans ,Risk factor ,Pancreas ,Aged ,Retrospective Studies ,Aged, 80 and over ,Glycated Hemoglobin ,Hepatology ,business.industry ,Incidence (epidemiology) ,Incidence ,Odds ratio ,Glucose Tolerance Test ,Middle Aged ,medicine.disease ,Impaired fasting glucose ,Survival Analysis ,Pancreatic Neoplasms ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Preoperative Period ,030211 gastroenterology & hepatology ,Female ,Insulin Resistance ,business ,Follow-Up Studies - Abstract
Although more patients have long-term survival after pancreatectomy, the details of pancreatogenic diabetes mellitus (DM) are still unclear. We aimed to investigate the incidence of new-onset DM (NODM) after distal pancreatectomy (DP) and to clarify the risk factors, including allowable pancreatic resection rate (PR), for NODM.The incidence, onset time, and risk factors for NODM were retrospectively evaluated in 150 patients who underwent DP without preoperative DM and with5 years of postoperative follow-up between 2005 and 2015.The incidence rate of NODM was 39%, and 60% of this incidence was noted within 6 months postoperatively. In the multivariate analysis, hemoglobin A1c ≥ 5.8% (odds ratio [OR] 7.6), impaired glucose tolerance and/or impaired fasting glucose (OR 4.2), homeostasis model assessment of insulin resistance ≥1.4 (OR 5.5), and insulinogenic index0.7 (OR 3.9) were the preoperative risk factors for NODM. Based on these four preoperative risk factors of NODM, we made the new scoring system to predict the NODM after DP. The NODM incidence was 0%, 8%, 48%, 60%, and 86% in patients with risk scores 0 (n = 25), 1 (n = 36), 2 (n = 33), 3 (n = 35), and 4 (n = 21), respectively. PRs ≥42.1% and ≥30.9% were allowable in the preoperative risk-score 0-1 and 2-4 groups. In the former group, the NODM incidence for PR ≥ 42.1% and42.1% was significantly different (20% vs 0%, P 0.05). In the latter group, the NODM incidence for PR ≥ 30.9% vs30.9% was significantly different (75% vs 23%, P 0.05).We clarified the preoperative risk factors and allowable PR for NODM and recommended the use of a risk scoring system for predicting NODM preoperatively.
- Published
- 2020
21. Importance of each high-risk stigmata and worrisome features as a predictor of high-grade dysplasia in intraductal papillary mucinous neoplasms of the pancreas
- Author
-
Masakazu Yamamoto, Toru Furukawa, Wataru Izumo, Ryota Higuchi, Shuichiro Uemura, Takehisa Yazawa, and Masahiro Shiihara
- Subjects
Adult ,Male ,medicine.medical_specialty ,Multivariate analysis ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,education ,Gastroenterology ,Risk Assessment ,Young Adult ,Predictive Value of Tests ,Risk Factors ,Internal medicine ,medicine ,Odds Ratio ,Humans ,Cyst ,Aged ,Retrospective Studies ,Aged, 80 and over ,Hepatology ,Intraductal papillary mucinous neoplasm ,business.industry ,Incidence (epidemiology) ,Incidence ,Odds ratio ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Pancreatitis ,Dysplasia ,Pancreatectomy ,Female ,business ,Carcinoma, Pancreatic Ductal - Abstract
Background High-risk stigmata (HRS) and ‘worrisome features’ (WFs) are defined as predictive factors for malignancies of intraductal papillary mucinous neoplasms (IPMNs). We performed this study to determine the importance and odds ratio (OR) of each HRS and WFs as predictors for high-grade dysplasia (HGD). Methods We analyzed 295 patients who underwent pancreatectomy for branch duct and mixed-type IPMN, and evaluated the association between HRS and WFs (as defined by the ‘2017 Fukuoka Consensus Guidelines’) and HGD. Results The proportions of patients with low-grade dysplasia (LGD), HGD, and invasive carcinoma were 47%, 28%, and 25%, respectively. Multivariate analysis comparing patients with LGD and HGD using all HRS and WFs revealed that an enhancing mural nodule ≥5 mm (OR: 4.1), pancreatitis (OR: 2.2), and thickened/enhancing cyst walls (OR: 2.2) were independent predictive factors for HGD. Based on the OR (the former factor is two points and the latter two factors are each one point), the incidence of HGD in patients with none (n = 43), one (n = 82), two (n = 25), three (n = 52), and four (n = 19) of these predictive factors were 9%, 26%, 52%, 62%, and 63%, respectively. Assuming a score of one or higher as a surgical indication, the sensitivity, specificity, positive predict value, and negative predict value of HGD were 95, 38, 44, and 91%. Conclusions Our derived scoring system using more important factors in HRS and WFs may be useful for predicting HGD and determining surgical indications of IPMN.
- Published
- 2020
22. Propensity score-matched analysis of internal stent vs external stent for pancreatojejunostomy during pancreaticoduodenectomy: Japanese-Korean cooperative project
- Author
-
Wataru Izumo, Sun Whe Kim, Hongbeom Kim, Ki Byung Song, Sohei Satoi, Masakazu Yamamoto, Toshio Shimokawa, Sang-Jae Park, Song Cheol Kim, Seiko Hirono, Seong Ho Choi, Jin-Young Jang, Hiroki Yamaue, Joo Seop Kim, Sae Byeol Choi, Michiaki Unno, Joon Seong Park, Hee Chul Yu, Masayuki Sho, Tae Ho Hong, Dong Sup Yoon, Manabu Kawai, Takumi Fukumoto, Young Joon Ahn, Jin Seok Heo, Katsuhiko Uesaka, Tsutomu Fujii, Ryosuke Amano, Masafumi Nakamura, and Ryo Ashida
- Subjects
Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,medicine.medical_treatment ,Pancreaticoduodenectomy ,Cohort Studies ,03 medical and health sciences ,Pancreatic Fistula ,0302 clinical medicine ,Postoperative Complications ,Japan ,Pancreaticojejunostomy ,Republic of Korea ,medicine ,Clinical endpoint ,Humans ,In patient ,Propensity Score ,Aged ,Aged, 80 and over ,Hepatology ,business.industry ,Incidence (epidemiology) ,Incidence ,Gastroenterology ,Pancreatic Ducts ,Stent ,Middle Aged ,equipment and supplies ,medicine.disease ,Surgery ,Clinical trial ,Treatment Outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Propensity score matching ,030211 gastroenterology & hepatology ,Female ,Stents ,business - Abstract
Several studies comparing internal and external stents have been conducted with the aim of reducing pancreatic fistula after PD. There is still no consensus, however, on the appropriate use of pancreatic stents for prevention of pancreatic fistula. This multicenter large cohort study aims to evaluate whether internal or external pancreatic stents are more effective in reduction of clinically relevant pancreatic fistula after pancreaticoduodenectomy (PD).We reviewed 3149 patients (internal stent n = 1,311, external stent n = 1838) who underwent PD at 20 institutions in Japan and Korea between 2007 and 2013. Propensity score matched analysis was used to minimize bias from nonrandomized treatment assignment. The primary endpoint was the incidence of clinically relevant pancreatic fistula. This study was registered on the UMIN Clinical Trials Registry (UMIN000032402).After propensity score matched analysis, clinically relevant pancreatic fistula occurred in more patients in the external stents group (280 patients, 28.7%) than in patients in the internal stents group (126 patients, 12.9%) (OR 2.713 [95% CI, 2.139-3.455]; P 0.001). In subset analysis of a high-risk group with soft pancreas and no dilatation of the pancreatic duct, clinically relevant pancreatic fistula occurred in 90 patients (18.8%) in internal stents group and 183 patients (35.4%) in external stents group. External stents were significantly associated with increased risk for clinically relevant pancreatic fistula (OR 2.366 [95% CI, 1.753-3.209]; P 0.001).Propensity score matched analysis showed that, regarding clinically relevant pancreatic fistula after PD, internal stents are safer than external stents for pancreaticojejunostomy.
- Published
- 2020
23. Comparison of Clinicopathological Features of Biliary Neuroendocrine Carcinoma with Adenocarcinoma
- Author
-
Masakazu Yamamoto, Ryota Higuchi, Wataru Izumo, Masahiro Shiihara, Toru Furukawa, Takehisa Yazawa, and Shuichiro Uemura
- Subjects
Adult ,Male ,medicine.medical_specialty ,Kaplan-Meier Estimate ,Gastroenterology ,Metastasis ,Cholangiocarcinoma ,Bile Ducts, Extrahepatic ,Internal medicine ,Medicine ,Humans ,Neuroendocrine carcinoma ,Risk factor ,Pathological ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Bile duct ,Hazard ratio ,Cancer ,Middle Aged ,medicine.disease ,Prognosis ,digestive system diseases ,Carcinoma, Neuroendocrine ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Adenocarcinoma ,Surgery ,Female ,business - Abstract
Objective: This study aimed to demonstrate the clinical features and postoperative outcomes of extrahepatic bile duct (EHBD) neuroendocrine carcinoma (NEC) and compared with those of adenocarcinoma. Methods: We retrospectively analyzed patients with EHBD cancer operated in our institution between 1995 and 2015. Results: Of 475 patients, 468 had adenocarcinoma, while 7 had NEC/mixed adenoneuroendocrine carcinoma (MANEC) in this study. There were no notable preoperative and pathological features in patients with NEC/MANEC. However, patients with NEC/MANEC had a higher recurrence rate (51.8 vs. 100%, p = 0.016), poorer relapse-free survival (RFS) time (the median RFS time: 35 vs. 12 months, p = 0.006), and poorer overall survival (OS) time (the median OS time: 60 vs. 19 months, p = 0.078) than those with adenocarcinoma. Furthermore, patients with NEC/MANEC had higher rates of liver metastasis (11.9 vs. 85.7%, p < 0.001) than those with adenocarcinoma. In multivariable regression analysis, pathological type with NEC/MANEC was a risk factor for poorer RFS (p = 0.022, hazard ratio: 6.09). Conclusions: Patients with NEC/MANEC have high malignant potential and poor outcomes. It is necessary to develop an effective approach and postoperative adjuvant treatment for patients with NEC/MANEC.
- Published
- 2020
24. A Comparison of the Pathological Types of Undifferentiated Carcinoma of the Pancreas
- Author
-
Ryota Higuchi, Wataru Izumo, Toru Furukawa, Masahiro Shiihara, and Masakazu Yamamoto
- Subjects
Adult ,Male ,medicine.medical_specialty ,Endocrinology, Diabetes and Metabolism ,Lymph node metastasis ,Kaplan-Meier Estimate ,Gastroenterology ,Giant Cells ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Endocrinology ,Text mining ,Internal medicine ,Internal Medicine ,Carcinoma ,medicine ,Humans ,Pathological ,Pancreas ,Aged ,Aged, 80 and over ,Hepatology ,business.industry ,Middle Aged ,medicine.disease ,Prognosis ,Pancreatic Neoplasms ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,Undifferentiated carcinoma ,business ,Spindle cell carcinoma - Abstract
OBJECTIVES This study aimed to identify the detailed clinicopathological features of undifferentiated carcinoma of the pancreas (UCP). METHODS We investigated clinical, imaging features and the prognoses of 261 patients; 8 were our patients, and the remainder were identified by searching English-language articles in PubMed. RESULTS We classified patients with UCP into 3 types based on pathological findings: osteoclast-like giant cell-associated carcinoma, pleomorphic cell carcinoma (PLC), and spindle cell carcinoma. There were no remarkable differences in clinical, radiological features between these 3 types. However, PLCs were significantly more likely to be unresectable than were the other 2 types (P < 0.001). Patients with osteoclast-like giant cell-associated carcinoma achieved the best overall survival (OS) rates (P < 0.001), whereas those with spindle cell carcinoma had significantly longer OS rates than did those with PLC (P = 0.004). These OS patterns were maintained when considering only those patients who underwent resection. Patients with PLC had both lower curative resection and high lymph node metastasis rates (P = 0.029, P = 0.023). Patients who underwent resection had more favorable prognoses than did those who did not. CONCLUSIONS Surgery is the first choice for resectable UCP. Pleomorphic cell carcinoma is particularly malignant; postoperative treatment should be introduced immediately.
- Published
- 2020
25. Surgical Outcomes for Perihilar Cholangiocarcinoma with Vascular Invasion
- Author
-
Shuichiro Uemura, Hiroto Egawa, Kosuke Kiyohara, Takehiro Ota, Wataru Izumo, Takehisa Yazawa, Toru Furukawa, Masakazu Yamamoto, and Ryota Higuchi
- Subjects
Male ,medicine.medical_specialty ,030230 surgery ,Gastroenterology ,Vascular invasion ,03 medical and health sciences ,Hepatic Artery ,Postoperative Complications ,0302 clinical medicine ,Carcinoembryonic antigen ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Neoplasm Invasiveness ,Neoplasm Metastasis ,Perihilar Cholangiocarcinoma ,Aged ,Proportional Hazards Models ,Retrospective Studies ,biology ,Portal Vein ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Perioperative ,Odds ratio ,Treatment Outcome ,medicine.anatomical_structure ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,biology.protein ,Female ,Surgery ,business ,Klatskin Tumor ,Artery - Abstract
To investigate short- and long-term surgical outcomes for patients with perihilar cholangiocarcinoma and vascular invasion. Data from 249 patients who underwent perihilar cholangiocarcinoma surgery between 2000 and 2016 were retrospectively analyzed. Patient evaluations included short-term surgical outcomes following vascular resection and long-term outcomes in cases with histopathological vascular invasion. Mortality was 3.6% overall; 16% for hepatic artery resections, 5.4% for portal vein resections, and 1.7% in the absence of vascular resection (p = 0.029). No between-group differences were observed in the incidence of Clavien–Dindo grade ≥ 3 complications. The factors related to perioperative mortality were hepatic artery resection (odds ratio [OR] = 25.5), right trisectionectomy (OR = 13.0), and central bisectionectomy (OR = 13.8). Multivariate analysis for overall survival identified several prognostic factors: carcinoembryonic antigen level ≥ 5 ng/mL (hazard ratio [HR] = 1.68), poor differentiation (HR = 2.39), distant metastasis (HR = 1.97), and R1 invasive resection (HR = 2.13). Five-year overall survival for patients with portal vein invasion and M0R0/1cis was 35.6%, significantly worse than the 53.4% for patients with no portal vein invasion and M0R/1cis but better than the 0% for patients with portal vein invasion and M1 or R1. Those with hepatic arterial invasion and M0R0/1cis were 24.7%, significantly worse than the 53.4% for patients with no hepatic arterial invasion and M0R0/1cis but significantly better than the 0% for patients with hepatic arterial invasion and M1 or R1. Short-term outcomes for patients with perihilar cholangiocarcinoma and undergoing vascular resection were poor compared to those without vascular resection. Long-term survival in R0M0 disease was more favorable; aggressive surgery is recommended.
- Published
- 2018
26. Level of total bilirubin in the bile of the future remnant liver of patients with obstructive jaundice undergoing hepatectomy predicts postoperative liver failure
- Author
-
Ryota Higuchi, Wataru Izumo, Masakazu Yamamoto, Takehito Otsubo, Takehisa Yazawa, and Shuichiro Uemura
- Subjects
medicine.medical_specialty ,Bilirubin ,medicine.medical_treatment ,Gastroenterology ,Remnant liver ,chemistry.chemical_compound ,Postoperative Complications ,Internal medicine ,Medicine ,Bile ,Hepatectomy ,Humans ,Risk factor ,Retrospective Studies ,Hepatology ,Receiver operating characteristic ,business.industry ,Bile duct ,Liver failure ,Jaundice ,Jaundice, Obstructive ,medicine.anatomical_structure ,chemistry ,Surgery ,medicine.symptom ,business ,Liver Failure - Abstract
Background/purpose We investigated whether the daily level of total bilirubin in the bile (LTB) excreted from the future remnant liver (FRL) can predict post-hepatectomy liver failure (PHLF) in patients with obstructive jaundice undergoing hepatectomy. Methods Seventy-four patients who underwent biliary drainage and collection of bile juice from the FRL before undergoing right hepatectomy or right/left trisectionectomy with bile duct resection were included. The LTB from the FRL (mg/day) was calculated as the volume of the bile (dL) per day multiplied by the density of total bilirubin in the bile (mg/dL). We compared patients' characteristics with or without PHLF, which was defined as the total serum bilirubin level remaining >10 mg/dL after postoperative day 10. Then, pre- and intraoperative factors related to PHLF were examined. Results PHLF was observed in six patients. LTB was significantly lower in the PHLF group. The LTB cut-off value for predicting PHLF, as determined using the receiver operating characteristic curve, was 56 mg/day. On multivariate analysis, LTB was found to be an independent risk factor for PHLF (p=0.01, OR 35.88). Conclusions LTB may be a potential functional assessment in jaundiced patients before right hepatectomy and right/left trisectionectomy.
- Published
- 2019
27. Total Pancreatectomy for a Pancreatic Neuroendocrine Tumor with Agenesis of the Pancreatic Body and Tail
- Author
-
Wataru Izumo, Toru Teduka, Hideo Katsuragawa, and Kazuomi Suzuki
- Subjects
Pancreatic body ,medicine.medical_specialty ,Pancreatic neuroendocrine tumor ,business.industry ,Total pancreatectomy ,medicine.disease ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Internal medicine ,Agenesis ,medicine ,030211 gastroenterology & hepatology ,business - Published
- 2018
28. Correction to: Negative prognostic outcomes of percutaneous transhepatic biliary drainage in distal cholangiocarcinoma: a retrospective analysis using propensity score matching
- Author
-
Yutaro Matsunaga, Ryota Higuchi, Takehisa Yazawa, Shuichiro Uemura, Wataru Izumo, Takehiro Ota, Toru Furukawa, and Masakazu Yamamoto
- Subjects
Oncology ,Surgery ,Hematology ,General Medicine - Published
- 2021
29. ENBD is Associated with Decreased Tumor Dissemination Compared to PTBD in Perihilar Cholangiocarcinoma
- Author
-
Masakazu Yamamoto, Wataru Izumo, Ryota Higuchi, Toru Furukawa, Takehisa Yazawa, Shuichiro Uemura, and Rohan Jagat Chaudhary
- Subjects
Male ,medicine.medical_specialty ,Percutaneous ,medicine.medical_treatment ,030230 surgery ,Bile duct cancer ,Resection ,03 medical and health sciences ,0302 clinical medicine ,Risk Factors ,Preoperative Care ,medicine ,Humans ,Endoscopy, Digestive System ,Perihilar Cholangiocarcinoma ,Risk factor ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Hazard ratio ,Gastroenterology ,medicine.disease ,Survival Rate ,Bile Duct Neoplasms ,030220 oncology & carcinogenesis ,Drainage ,Female ,Surgery ,Radiology ,Hepatectomy ,business ,Klatskin Tumor - Abstract
Little is known regarding the risk of tumor dissemination when percutaneous biliary drainage is used before surgical resection of perihilar cholangiocarcinoma (PHC). We aimed to compare the incidence of tumor dissemination after preoperative endoscopic nasobiliary drainage (ENBD) with that after percutaneous transhepatic biliary drainage (PTBD) for PHC. Data from 208 consecutive patients who underwent PHC resection between 2000 and 2013 were retrospectively analyzed. The influence of drainage type on incidence of tumor dissemination was examined. Seventy-six patients underwent ENBD (37%), 87 underwent PTBD (42%), and 45 underwent surgery without preoperative biliary drainage (WD, 22%). The respective 2- and 5-year estimated cumulative incidences of tumor dissemination in the ENBD group (11.8/14.6%) were lower than in the PTBD group (28.8/35.9%, p = 0.003) and equivalent to that in the WD group (11.2/15.9%, p = NS). PTBD (hazard ratio [HR] vs. ENBD, 2.80) was an independent risk factor for postoperative tumor dissemination in the multivariate analysis. The 2- and 5-year disease-specific survival rates were higher in the ENBD group (67.6/47.3%) than in the PTBD group (56.6/27.8%, p = 0.032) and equivalent to that in the WD group (64.9/53.8%, p = NS). However, drainage type was not an independent risk factor in multivariate analysis of disease-specific survival. For patients with PHC, the associated risk of postoperative tumor dissemination in the ENBD group was lower than in the PTBD group and equivalent to that in the WD group. Thus, ENBD is the ideal procedure for preoperative biliary drainage.
- Published
- 2017
30. A long-term recurrence-free survival of a patient with the mixed adeno-neuroendocrine bile duct carcinoma: A case report and review of the literature
- Author
-
Wataru Izumo, Masahiro Shiihara, Yutaro Matsunaga, Ryota Higuchi, Shuichiro Uemura, Takehisa Yazawa, Masakazu Yamamoto, and Toru Furukawa
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Case Report ,NEN, neuroendocrine neoplasm ,Neuroendocrine tumors ,Bile Duct Carcinoma ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,Biopsy ,medicine ,Carcinoma ,MANEC, mixed adeno-neuroendocrine carcinoma ,Mixed adeno-neuroendocrine carcinoma ,NETs, neuroendocrine tumors ,medicine.diagnostic_test ,business.industry ,Bile duct ,MANEC ,medicine.disease ,Pancreaticoduodenectomy ,Distal Bile Duct Carcinoma ,CT, computed tomography ,NEC, neuroendocrine carcinoma ,Long term survival ,medicine.anatomical_structure ,ERC, endoscopic retrograde cholangiography ,030220 oncology & carcinogenesis ,Adenocarcinoma ,030211 gastroenterology & hepatology ,Surgery ,business ,MRI, magnetic resonance imaging - Abstract
Highlights • Mixed adeno-neuroendocrine carcinoma arising primarily in the bile duct is very rare neoplasm. • The patient with mixed adeno-neuroendocrine carcinoma in the bile duct indicates a poor prognosis. • On imaging studies, a hypervascular tumor is suspicious of mixed adeno-neuroendocrine carcinoma. • Curative resection is the only way to obtain the long-term prognosis, even if these patients have lymph node metastasis., Introduction Neuroendocrine tumors arising primarily in the bile duct are rare. And among these tumors, mixed adeno-neuroendocrine carcinoma (MANEC) is quite uncommon. We report a patient with MANEC who achieved long-term recurrence-free survival. And our case report includes analysis previous case reports. Presentation of case A 66-year-old man underwent investigation for persistent anorexia and fatigue. Laboratory tests showed that the values of hepatobiliary enzymes were increased. On CT, a 10 mm × 8 mm hypervascular tumor was observed in the distal bile duct and the proximal bile duct was markedly dilated. Endoscopic retrograde cholangiography (ERC) also showed a stenosis with a long diameter of 10 mm. Examination of a biopsy specimen obtained from the narrow site of the bile duct at the time of ERC revealed tubular adenocarcinoma. Therefore, pylorus-preserving pancreaticoduodenectomy was performed under a preoperative diagnosis of distal bile duct carcinoma. Postoperative pathologic examination revealed alveolar structures and a mixture of moderately differentiated adenocarcinoma with synaptophysin-positive and chromogranin-A-positive neuroendocrine carcinoma. Therefore, the final diagnosis was MANEC, pT3, pN1, M0, pStage II B (TNM classification of the UICC). Curative resection was achieved and there has been no recurrence after 30 months. Discussion In the previous reports, only five patients (14.7%) survived for 24 months or longer. Median survival was longer (14 months) in the curative resection group and shorter (6 months) in the non-curative resection group. Conclusion Curative resection is essential to achieve long-term survival in patients with bile duct MANEC, even if these patients have lymph node metastasis.
- Published
- 2017
31. ASO Author Reflections: Prognostic Factors for Surgically Resected Intraductal Papillary Neoplasm of Bile Duct
- Author
-
Wataru Izumo, Masakazu Yamamoto, Yutaro Matsunaga, Ryota Higuchi, Masahiro Shiihara, Toru Furukawa, Takehiro Ota, Shuichiro Uemura, and Takehisa Yazawa
- Subjects
medicine.medical_specialty ,Bile duct ,business.industry ,Prognosis ,Bile Ducts, Intrahepatic ,medicine.anatomical_structure ,Bile Duct Neoplasms ,Oncology ,Surgical oncology ,medicine ,Humans ,Surgery ,Bile Ducts ,Radiology ,business ,Intraductal Papillary Neoplasm - Published
- 2020
32. Evaluation of preoperative risk factors for postpancreatectomy hemorrhage
- Author
-
Shuichiro Uemura, Takehisa Yazawa, Masahiro Shiihara, Wataru Izumo, Ryota Higuchi, and Masakazu Yamamoto
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,030230 surgery ,Gastroenterology ,Cohort Studies ,Hospitals, University ,0302 clinical medicine ,Japan ,Preoperative ,Pancreatoduodenectomy ,Mortality rate ,Incidence (epidemiology) ,Middle Aged ,Treatment Outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,Pancreatectomy ,Post-pancreatectomy hemorrhage ,Female ,Original Article ,Adult ,medicine.medical_specialty ,Postoperative Hemorrhage ,Risk Assessment ,Pancreaticoduodenectomy ,03 medical and health sciences ,Pancreatic Fistula ,Predictive Value of Tests ,Internal medicine ,Preoperative Care ,Carcinoma ,medicine ,Humans ,Neoplasm Invasiveness ,Risk factor ,Aged ,Neoplasm Staging ,Retrospective Studies ,Analysis of Variance ,business.industry ,Odds ratio ,medicine.disease ,Survival Analysis ,Pancreatic Neoplasms ,Logistic Models ,Multivariate Analysis ,Surgery ,business ,Body mass index ,Follow-Up Studies - Abstract
Purpose To investigate the risk factors for post-pancreatectomy hemorrhage (PPH). Methods The incidence, outcome, and risk factors for PPH were evaluated in 1169 patients who underwent pancreatectomy. Results The incidence and mortality rates of PPH were 3% and 11% in all pancreatectomies, 4% and 11% in pancreatoduodenectomy, 1% and 20% in distal pancreatectomy, and 3% and 0% in total pancreatectomy, respectively. Male sex [odds ratio (OR) 2.32], body mass index (BMI) ≥ 25 kg/m2 (OR 3.70), absence of diabetes mellitus (DM; HbA1c ≤ 6.2%; OR 3.62), and pancreatoduodenectomy (OR 3.06) were risk factors for PPH after all pancreatectomies. The PPH incidence was 0%, 1%, 2%, 6%, and 20% in patients with risk scores of 0 (n = 65), 1 (n = 325), 2 (n = 455), 3 (n = 299), and 4 (n = 25), respectively. The differences between risk-score groups 0–2 (2%) and 3–4 (7%) were significant (P P = 0.28). The incidence of POPF post-pancreatoduodenectomy was 20%. BMI ≥ 25 kg/m2 (OR 3.17), serum albumin Conclusion Our study clarified the preoperative risk factors for PPH and recommends using a risk scoring system that includes “absence of DM” for predicting PPH.
- Published
- 2019
33. Impact of transient hepatic attenuation differences on computed tomography scans in the diagnosis of acute gangrenous cholecystitis
- Author
-
Toshiya Sugishita, Wataru Izumo, Takehisa Yazawa, Shuichiro Uemura, Satoru Morita, Ryota Higuchi, and Masakazu Yamamoto
- Subjects
Adult ,Male ,Databases, Factual ,medicine.medical_treatment ,Cholecystitis, Acute ,Contrast Media ,Computed tomography ,Independent predictor ,Risk Assessment ,Sensitivity and Specificity ,Severity of Illness Index ,Cohort Studies ,Gangrene ,Hospitals, University ,03 medical and health sciences ,0302 clinical medicine ,Sex Factors ,Japan ,medicine ,Acute cholecystitis ,Humans ,Cholecystectomy ,Aged ,Retrospective Studies ,Hepatology ,medicine.diagnostic_test ,business.industry ,Age Factors ,Middle Aged ,medicine.disease ,Prognosis ,stomatognathic diseases ,Treatment Outcome ,Acute gangrenous cholecystitis ,ROC Curve ,030220 oncology & carcinogenesis ,Multivariate Analysis ,Cholecystitis ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Nuclear medicine ,Tomography, X-Ray Computed ,Arterial phase - Abstract
Background We examined the utility of transient hepatic attenuation differences (THADs) detected in the arterial phase of computed tomography for the diagnosis of acute gangrenous cholecystitis (AGC). Methods We examined 83 consecutive patients who underwent cholecystectomy within 72 h of undergoing three-phase dynamic computed tomography scans for acute cholecystitis between 2009 and 2018 (histopathological examination later confirmed 42 with AGC, 41 without). The THAD volume (cm3 ) was calculated by multiplying the total area of the enhancing lesions (traced on axial images) by the thickness of the scan (0.5-cm slices). We evaluated the sensitivity and specificity of the THAD volume and other computed tomography findings of AGC. Results The THAD volume was significantly larger in the AGC group than in the non-gangrenous acute cholecystitis group (P 78 cm3 to be an independent predictor of AGC. Conclusions Acute gangrenous cholecystitis can be diagnosed using THAD volume, resulting in improved treatment and fewer serious complications.
- Published
- 2019
34. Evaluation of the Site and Frequency of Lymph Node Metastasis with Non-Functioning Pancreatic Neuroendocrine Tumor
- Author
-
Wataru Izumo, Takehisa Yazawa, Toru Furukawa, Masahiro Shiihara, Ryota Higuchi, Shuichiro Uemura, and Masakazu Yamamoto
- Subjects
Adult ,Male ,medicine.medical_specialty ,medicine.medical_treatment ,Neuroendocrine tumors ,Splenic artery ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,medicine.artery ,Internal medicine ,Medicine ,Humans ,Superior mesenteric artery ,Lymph node ,Aged ,Retrospective Studies ,business.industry ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Pancreatic Neoplasms ,Dissection ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Pancreatectomy ,030211 gastroenterology & hepatology ,Surgery ,Female ,business ,Artery - Abstract
Backgrounds: The optimal lymph node dissection range in patients with non-functioning pancreatic neuroendocrine tumors is not yet clear. In this study, we investigated the site and frequency of lymph node metastasis and the significance of lymph node dissection in patients with non-functioning pancreatic neuroendocrine tumors. Methods: This retrospective study analyzed 74 patients who underwent a curative pancreatectomy for non-functioning pancreatic neuroendocrine tumors between 2000 and 2016. The site and frequency of lymph node metastasis and clinicopathological factors were evaluated. Results: The rate of synchronous lymph node metastasis was 17.6%, with 11.1 and 29.4% for tumors with diameters of 10–19 mm and ≥20 mm, respectively. Lymph node metastasis was not observed for tumors with a diameter Conclusions: This study clarified the site and frequency of lymph node metastasis and the optimal range of lymph node dissection in patients with non-functioning pancreatic neuroendocrine tumors.
- Published
- 2019
35. Evaluation of preoperative prognostic factors in patients with resectable pancreatic ductal adenocarcinoma
- Author
-
Masakazu Yamamoto, Takehisa Yazawa, Ryota Higuchi, Masahiro Shiihara, Wataru Izumo, Toru Furukawa, and Shuichirou Uemura
- Subjects
Adult ,Male ,medicine.medical_specialty ,Pancreatic ductal adenocarcinoma ,endocrine system diseases ,CA-19-9 Antigen ,Kaplan-Meier Estimate ,Gastroenterology ,Risk Assessment ,03 medical and health sciences ,0302 clinical medicine ,Pancreatectomy ,Japan ,Risk Factors ,Internal medicine ,Carcinoma ,medicine ,Humans ,In patient ,Pancreatic carcinoma ,Risk factor ,Aged ,Proportional Hazards Models ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Standard treatment ,Middle Aged ,medicine.disease ,Prognosis ,Combined Modality Therapy ,digestive system diseases ,Pancreatic Neoplasms ,Survival Rate ,Chemotherapy, Adjuvant ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Multivariate Analysis ,030211 gastroenterology & hepatology ,Female ,Neoplasm Recurrence, Local ,business ,Carcinoma, Pancreatic Ductal - Abstract
Objective: Upfront surgery is the standard treatment for resectable pancreatic ductal adenocarcinomas (R-PDACs); however, these tumors often recur. We investigated the factors governing recurrence and prognosis in patients with R-PDAC. Methods: We analyzed 359 patients who underwent upfront surgery for R-PDAC between 2000 and 2016, and evaluated the relationship between clinicopathological factors and recurrence/outcomes. Results: The rate of recurrence was 74% while the median time to recurrence was 1.2 years. On multivariate analysis, carbohydrate antigen 19-9 (CA19-9) >37 U/mL (hazard ratio [HR]: 2.02), tumor size >2.6 cm (HR: 1.50), pathological grade 3 (HR: 2.58), lymph node metastasis (LNM; HR: 1.65), residual tumor (HR: 1.47) and forgoing adjuvant chemotherapy (HR: 1.31) were risk factors for a shorter recurrence-free survival; the median survival time (MST) was 2.8 years. On multivariate analysis, CA19-9 > 37 U/mL (HR: 1.99), tumor size >2.6 cm (HR: 1.43), pathological grade 3 (HR: 2.93), pathological portal vein invasion (HR: 1.48), LNM (HR: 1.79) and forgoing adjuvant chemotherapy (HR: 1.39) were risk factors for shorter disease-specific survival intervals. When examining outcomes according to preoperatively measurable factors (CA19-9 > 37 U/mL and tumor size >2.6 cm), the median time to recurrence and MSTs of patients with none (n = 83), one (n = 112) and both (n = 164) risk factors were 3.2, 1.8 and 0.8 years; and 7.2, 4.0 and 1.7 years, respectively. Conclusions: CA19-9 > 37 U/mL and tumor size >2.6 cm were preoperative independent risk factors for early recurrence and poor outcomes in patients with R-PDAC. Therefore, preoperative treatment should be considered for such patients.
- Published
- 2019
- Full Text
- View/download PDF
36. Resectional Surgery in Gallbladder Cancer with Jaundice - How to Improve the Outcome?
- Author
-
Rahul K Chaudhary, Ryota Higuchi, Takehisa Yazawa, Schuichirou Uemura, Wataru Izumo, Yutaro Matsunaga, Erika Nagano, Takehiro Ota, Toru Furukawa, and Masakazu Yamamoto
- Published
- 2019
37. Surgical Outcomes of Perihilar Cholangiocarcinoma - Especially on Postoperative Portal Vein Thrombosis
- Author
-
Masakazu Yamamoto, Shuichirou Uemura, Takehisa Yazawa, Yutaro Matsunaga, M.T. Cao, Ryota Higuchi, and Wataru Izumo
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,Gastroenterology ,Medicine ,Radiology ,Perihilar Cholangiocarcinoma ,business ,medicine.disease ,Portal vein thrombosis - Published
- 2021
38. Granulocyte-colony stimulating factor-producing gallbladder carcinoma-include analysis all case reports: A case report
- Author
-
Kenji Furukawa, Masakazu Yamamoto, Wataru Izumo, Kenichirou Hataji, Tatsuya Furukawa, Toru Tezuka, Kyousuke Shigematsu, Akio Komatsu, and Hideo Katsuragawa
- Subjects
Oncology ,medicine.medical_specialty ,Poor prognosis ,business.industry ,Gallbladder ,Case Report ,medicine.disease ,Granulocyte-colony stimulating factor ,Granulocyte colony-stimulating factor ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Internal medicine ,Immunology ,Carcinoma ,medicine ,Surgery ,030212 general & internal medicine ,Long survival ,business ,Gallbladder carcinoma - Abstract
Highlights • G-CSF producing gallbladder carcinoma is rare and has a poor prognosis. • We report a long term survival of G-CSF producing gallbladder carcinoma. • We suggest multidisciplinary therapy prolong the survival of patients with G-CSF producing gallbladder carcinoma., Introduction It is extremely rare for gallbladder carcinoma to produce granulocyte-colony stimulating factor (G-CSF) and such tumors have a poor prognosis. Presentation of case A 67-year-old man was admitted with continuous fever. Laboratory tests showed a leukocyte count of 27,980/μL, serum C-reactive protein (CRP) of 9.2 mg/dL and serum G-CSF of 225 pg/mL. Imaging revealed an irregular gallbladder mass about 90 mm in diameter with peripheral enhancement that also involved the liver and transverse colon. G-CSF producing gallbladder carcinoma was diagnosed. We performed cholecystectomy, partial resection of segments 4 and 5 of the liver, partial resection of the transverse colon, and gastrostomy. Histopathological examination showed gallbladder carcinoma (pT3, pN0, M0, G2, and pStage IIIA by the UICC classification, version 7). On immunohistochemical staining, tumor cells were positive for G-CSF. The leukocyte count was normalized postoperatively and fever subsided immediately after surgery. Two months later, the leukocyte count rose to 56,820/μL and metastases to the liver and lymph nodes were detected by CT. Chemotherapy (gemcitabine plus cisplatin) was started and the leukocyte count was normalized after the first course. The patient has continued chemotherapy and has survived for 16 months postoperatively. Discussion G-CSF producing gallbladder carcinoma has a poor prognosis and most patients die within 12 months of starting therapy. It is rare for patients with recurrence to survive for 16 months after surgery, as in the present case. Conclusion Multidisciplinary therapy (surgery and chemotherapy) may prolong the survival of patients with G-CSF producing gallbladder carcinoma, especially those with recurrence.
- Published
- 2016
39. Original Scientific Reports: Clinicopathological Findings of Remnant Pancreatic Cancers in Survivors Following Curative Resections of Pancreatic Cancers
- Author
-
Kyoko Shimizu, Nana Oshima, Wataru Izumo, Toru Furukawa, Masakazu Yamamoto, and Shuji Suzuki
- Subjects
Adult ,Male ,Oncology ,medicine.medical_specialty ,Original Scientific Report ,endocrine system diseases ,030230 surgery ,03 medical and health sciences ,Pancreatectomy ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Pancreas ,Aged ,Retrospective Studies ,Ultrasonography ,business.industry ,Retrospective cohort study ,Middle Aged ,Prognosis ,Magnetic Resonance Imaging ,digestive system diseases ,humanities ,Pancreatic Neoplasms ,body regions ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Female ,Surgery ,Tomography, X-Ray Computed ,business ,Carcinoma, Pancreatic Ductal ,Follow-Up Studies - Abstract
Background This retrospective study aimed to evaluate clinicopathological findings of remnant pancreatic cancers in survivors of invasive ductal adenocarcinomas of the pancreas (PDAC). Methods A group of 23 patients out of 826 who had curative resections for PDAC between 1980 and 2011 was identified and treated for metachronous pancreatic cancer. Results The following tubular adenocarcinomas were found at the first surgery: 3 well differentiated, 17 moderately differentiated, 1 papillary, and 1 poorly differentiated. Treatments for the remnant pancreas consisted of remnant pancreatectomy in 12 patients, chemotherapy in 6, and the best supportive care in 5. The mean time to treatment was 74.2 months. The 12 patients who received remnant resections had 10 PDACs and 2 intraductal papillary mucinous carcinomas. The median survival time was 31.6 months, and 8 patients are still alive. Conclusions Long-term survivors after curative resection for pancreatic cancer should receive follow-up for remnant pancreatic cancer, and aggressive resection should be considered for more favorable prognosis of PDAC.
- Published
- 2015
40. Surgery in node-positive gallbladder cancer: The implication of an involved superior retro-pancreatic lymph node
- Author
-
Rahul K. Chaudhary, Takehisa Yazawa, Wataru Izumo, Kosuke Kiyohara, Toru Furukawa, Ryota Higuchi, Shuichiro Uemura, and Masakazu Yamamoto
- Subjects
Oncology ,Male ,medicine.medical_specialty ,Multivariate analysis ,Disease ,030230 surgery ,Disease-Free Survival ,Pancreaticoduodenectomy ,Pancreatic Lymph Node ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Abdomen ,medicine ,Humans ,Cholecystectomy ,Gallbladder cancer ,Lymph node ,Neoplasm Staging ,Retrospective Studies ,business.industry ,Cancer ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Survival Rate ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Lymphatic Metastasis ,Lymph Node Excision ,Surgery ,Female ,Gallbladder Neoplasms ,Lymph Nodes ,business ,Follow-Up Studies - Abstract
The treatment approach to node-positive gallbladder cancer has unresolved issues with regard to the management of patients with a positive superior retro-pancreatic (level 13a) node, which is the highest level of spread. The American Joint Committee on Cancer remains unclear on the status of the 13a node.This retrospective study consisted of 165 patients with node-positive gallbladder cancer without distant metastasis. Patients were reclassified according to the American Joint Committee on Cancer eighth edition classification. The survival of patients with positive level 13a node was compared with that of patients with N1 disease (T stage-wise) and those with para-aortic nodal disease. A multivariate analysis was performed for factors affecting survival.The 5-year survival of patients with positive level 13a with 1-3 nodes was similar to those with N1 disease (40.2% and 32.9%, respectively) and was better than those with more distant nodal spread (P.05). In univariate and multivariate analyses, intraoperative blood loss (hazard ratio [HR] 1.58), R1 resection (HR 1.87), and T4 disease (versus T2, HR 3.44) were poor prognosticators. Pancreaticoduodenectomy may be beneficial in T2 patients.A positive superior retro-pancreatic node does not worsen the prognosis in an otherwise N1 disease in T1/T2 gallbladder cancer. It behaves like a regional lymph node and should be treated as such.
- Published
- 2018
41. Is it significant for surgical treatment for gallbladder cancer with jaundice?
- Author
-
Masakaz Yamamoto, Ryota Higuchi, Wataru Izumo, Takehiro Ota, Erika Nagano, Takehisa Yazawa, Rahul K. Chaudhary, Toru Furukawa, and Shuichirou Uemura
- Subjects
medicine.medical_specialty ,Hepatology ,business.industry ,General surgery ,Gastroenterology ,medicine ,Gallbladder cancer ,Jaundice ,medicine.symptom ,medicine.disease ,Surgical treatment ,business - Published
- 2019
42. A case of long-survival insulinoma with multiple neuroendocline tumour type 1 controlled by multimodal therapy
- Author
-
Wataru Izumo, Toru Furukawa, Ryota Higuchi, Takehisa Yazawa, Masakazu Yamamoto, Shuichiro Uemura, and Masahiro Shiihara
- Subjects
endocrine system ,medicine.medical_specialty ,Everolimus ,endocrine system diseases ,business.industry ,medicine.medical_treatment ,Enucleation ,Octreotide ,Case Report ,030209 endocrinology & metabolism ,Multimodal therapy ,Neuroendocrine tumors ,medicine.disease ,Pancreaticoduodenectomy ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Medicine ,Surgery ,MEN1 ,Radiology ,business ,Insulinoma ,medicine.drug - Abstract
Insulinomas with multiple neuroendocrine tumour type 1 (MEN1) sometimes have metachronous or recurrent tumours. However, the treatment for these tumours is controversial, and published reports regarding multimodal therapy for insulinomas are limited. We report a 73-year-old woman with recurrent insulinoma with MEN1 successfully controlled by multimodal therapy. She had several complications, and poor performance status. Her hypoglycaemia did not improve after 6-month octreotide LAR; as such, she underwent enucleation of the pancreatic tumour. Within 7 years after the first operation, she underwent four succeeding surgeries for recurrent tumours. Her medications during follow-up were octreotide-LAR and Everolimus. Insulinoma can be managed through various treatment options. Medical treatment includes octreotide-LAR and Everolimus, while surgical approach includes enucleation and pancreaticoduodenectomy. Some tumours, particularly those that are MEN1, can recur repeatedly. Thus, several treatments are needed to control them. We highlight the importance of multimodal therapy, including repeated surgery, for the control of the disease.
- Published
- 2017
43. The Evaluation of the Early and Late Postoperative Pancreatic Function and Nutritional Status: Central Pancreatectomy Versus Distal Pancreatectomy
- Author
-
Wataru Izumo
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Internal medicine ,Pancreatectomy ,Pancreatic function ,Medicine ,Nutritional status ,business ,Distal pancreatectomy ,Gastroenterology - Published
- 2017
44. High-grade dysplasia/carcinoma in situ of the bile duct margin in patients with surgically resected node-negative perihilar cholangiocarcinoma is associated with poor survival: a retrospective study
- Author
-
Takehisa Yazawa, Wataru Izumo, Ryota Higuchi, Masakazu Yamamoto, Shuichiro Uemura, and Toru Furukawa
- Subjects
Male ,medicine.medical_specialty ,education ,030230 surgery ,Gastroenterology ,Risk Assessment ,Disease-Free Survival ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Japan ,Internal medicine ,Cause of Death ,medicine ,Hepatectomy ,Humans ,Clinical significance ,Neoplasm Invasiveness ,Neoplasm Staging ,Proportional Hazards Models ,Retrospective Studies ,Analysis of Variance ,Hepatology ,business.industry ,Bile duct ,Carcinoma in situ ,Hazard ratio ,Margins of Excision ,Histology ,Retrospective cohort study ,medicine.disease ,Prognosis ,Survival Analysis ,Surgery ,medicine.anatomical_structure ,Treatment Outcome ,Bile Duct Neoplasms ,Dysplasia ,030220 oncology & carcinogenesis ,Cohort ,Multivariate Analysis ,Female ,Lymph Nodes ,Neoplasm Recurrence, Local ,business ,Carcinoma in Situ ,Klatskin Tumor - Abstract
The clinical relevance of a high-grade dysplasia/carcinoma in situ (HD/CIS)-positive bile duct margin in perihilar cholangiocarcinoma (PHC) is unclear. We evaluated the surgical outcomes of PHC patients with HD/CIS.Clinicopathological data of 163 consecutive patients who underwent resection of PHC between 2004 and 2013 were analyzed retrospectively.Postoperative states included curative resection (R0) with free margins in 113 patients, non-curative resection with HD/CIS (R1-HD/CIS) in 22 patients, and non-curative resection with any invasive carcinoma margin in 28 patients. Multivariate analyses in the entire cohort showed that lymph node metastasis (hazard ratio [HR] 1.91), distant metastasis (HR 3.87), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 2.06) were significant independent prognosticators. However, in node-negative and distant metastasis-negative PHC patients, histology (HR 2.97), R1-HD/CIS (vs. R0; HR 2.31), and non-curative resection with any invasive carcinoma margin (vs. R0; HR 5.33) were significant independent prognosticators. The 2- and 5-year disease-specific survival rates in node-negative and distant metastasis-negative PHC patients with R1-HD/CIS margins were lower compared with those in patients with R0 margins (2-year, 76.7% vs. 84.3%; 5-year, 37.5% vs. 69.3%; P = 0.026).R1-HD/CIS should be avoided in patients undergoing surgery for node-negative and distant metastasis-negative PHC.
- Published
- 2017
45. Esophageal metastasis of renal cancer 10 years after nephrectomy
- Author
-
Kosuke Narumiya, Masakazu Yamamoto, Kenji Kudo, Wataru Izumo, Masaho Ota, and Yushi Shirai
- Subjects
medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gastroenterology ,Alpha interferon ,Cancer ,Case Report ,medicine.disease ,Nephrectomy ,Surgery ,medicine.anatomical_structure ,Renal cancer ,Esophageal metastasis ,Esophagectomy ,Clear cell carcinoma ,medicine ,Thoracotomy ,Esophagus ,business ,Lymph node - Abstract
The patient was a 65-year-old man, who had undergone right nephrectomy for renal cancer in 2002. At that time, histopathological examination revealed clear cell carcinoma (pT3a, pN0, M0, and pStage III). Postoperatively, he received natural interferon alpha (6 million units 3 times a week) from November 2002 to February 2005, and showed no evidence of recurrence. However, he noticed dysphagia in March 2012. Endoscopy revealed a pedunculated polypoid tumor in the mid-esophagus and biopsies were taken showing a clear cell carcinoma. Contrast-enhanced thoracoabdominal CT scanning identified a pedunculated polypoid tumor in the mid-thoracic esophagus and enlargement of a lymph node adjacent to the right main bronchus. With a diagnosis of esophageal and lymph node metastases of renal cancer, the patient underwent esophagectomy with right thoracotomy with reconstruction by a posterior mediastinal stomach tube. Postoperative histopathological examination revealed clear cell carcinoma. Because esophageal metastasis of renal cancer is extremely rare, this case is reported here together with discussions of the relevant literature.
- Published
- 2014
46. ENBD is associated with decreased tumor dissemination compared to ptbd in perihilar cholangiocarcinoma
- Author
-
Toru Furukawa, Takehisa Yazawa, Wataru Izumo, Shuichirou Uemura, Masakazu Yamamoto, and Ryota Higuchi
- Subjects
03 medical and health sciences ,medicine.medical_specialty ,0302 clinical medicine ,Hepatology ,business.industry ,030220 oncology & carcinogenesis ,Gastroenterology ,Medicine ,030211 gastroenterology & hepatology ,Radiology ,Perihilar Cholangiocarcinoma ,business - Published
- 2018
47. Evaluation of the ULTRAPROTM HERNIA SYSTEM for Inguinal Hernia Repair
- Author
-
Masakazu Yamamoto, Kenji Furukawa, and Wataru Izumo
- Subjects
Inguinal hernia ,medicine.medical_specialty ,business.industry ,medicine ,Hernia ,medicine.disease ,business ,Surgery - Published
- 2012
48. Long-term survival with locally advanced panceatic body carcinoma and paraaortic lymph node metastasis treated by the combination of surgery, chemotherapy, and radiation
- Author
-
Wataru Izumo, Hideo Katsuragawa, Kieko Yamazaki, Kyousuke Shigematsu, Kenji Hurukawa, Tatsuya Hurukawa, and Akio Komatsu
- Subjects
Chemotherapy ,medicine.medical_specialty ,Paraaortic lymph nodes ,business.industry ,medicine.medical_treatment ,Long term survival ,Carcinoma ,medicine ,Locally advanced ,medicine.disease ,business ,Metastasis ,Surgery - Published
- 2012
49. [A case of advanced gastric cancer with tumor embolus in the portal vein and liver metastasis responding to S-1 plus cisplatin chemotherapy]
- Author
-
Wataru, Izumo, Kenji, Furukawa, Hideo, Katsuragawa, Akio, Komatsu, and Kyousuke, Shigematsu
- Subjects
Portal Vein ,Liver Neoplasms ,Neoplastic Cells, Circulating ,Neoadjuvant Therapy ,Drug Combinations ,Oxonic Acid ,Gastrectomy ,Stomach Neoplasms ,Antineoplastic Combined Chemotherapy Protocols ,Humans ,Female ,Cisplatin ,Aged ,Tegafur - Abstract
A 67-year-old woman presented with anemia. Computed tomography and upper gastrointestinal endoscopy revealed a primary gastric cancer with tumor embolus in the portal vein, liver metastasis, lymph node metastasis, and pancreatic involvement. Because curative surgery was deemed impossible, we started chemotherapy using S-1 (120 mg/m(2)/day for 3 weeks, followed by discontinuation for 2 weeks) plus cisplatin (80 mg/m(2)/day on days 1 and 8). After 4 courses of chemotherapy, the tumor embolus in the portal vein, liver metastasis, lymph node metastasis, and pancreatic involvement had resolved. Therefore, we performed distal gastrectomy. Histological examination revealed ypT1a, ly0, v0, ypN0 (0/49), ypCY0, ypStage IA, with a two-grade histological change in the main tumor after chemotherapy. Postoperatively, she underwent adjuvant chemotherapy with S-1 for 1 year (120 mg/m(2)/day for 4 weeks, followed by discontinuation for 2 weeks). At the 30-month follow-up after the adjuvant chemotherapy, she had no recurrence.
- Published
- 2014
50. The evaluation of the malignancy of the intraductal tubullopapillary neoplasm
- Author
-
Wataru, Izumo, primary, Higuchi, Ryota, additional, Yazawa, Takehisa, additional, Uemura, Syuichirou, additional, Matsunaga, Yutarou, additional, Doi, Manami, additional, Takayama, Keiko, additional, Shimizu, Kyoko, additional, Furukawa, Toru, additional, Tokushige, Katsutoshi, additional, and Yamamoto, Masakazu, additional
- Published
- 2016
- Full Text
- View/download PDF
Catalog
Discovery Service for Jio Institute Digital Library
For full access to our library's resources, please sign in.