Biomedical subjects

Takaki Yoshikawa

Publications and source records attributed to Takaki Yoshikawa.

At least 19 recordsLinked to original sources

PubMed2006

Long-term outcome after hernia repair with the prolene hernia system.

PURPOSE: We evaluated the long-term outcome and symptoms after inguinal hernia repair using the Prolene Hernia System (PHS). METHODS: We reviewed the medical records of all patients who underwent PHS surgery at our hospital to assess the postoperative complications and recurrence rates. Late symptoms were evaluated by a standardized interview using a questionnaire. RESULTS: A total of 395 hernias in 367 patients were studied. Postoperative complications developed after 20 repairs (5.1%), including a severe mesh infection in one patient. Seven (1.8%) patients suffered recurrence. Of 395 cases, 363 (91.9%) responded to the interview. After a median follow-up interval of 19.3 months (range 1.0-55.8), moderate pain and moderate discomfort were reported by only 1.9% and 0.8% of patients, respectively. CONCLUSIONS: Prolene Hernia System surgery is a safe and feasible procedure with low rates of complication, recurrence, and late symptoms.

Adolescent↗

PubMed2006

Protein levels of tissue inhibitor of metalloproteinase-1 in tumor extracts as a marker for prognosis and recurrence in patients with gastric cancer.

BACKGROUND: Tissue inhibitor of metalloproteinase-1 (TIMP-1) correlates with tumor progression in patients with gastric cancer; however, the clinical significance of TIMP-1 as a marker for prognosis and recurrence has not been fully clarified. METHODS: TIMP-1 protein was measured by an enzyme-linked immunosorbent assay in tumor samples from 86 patients who had undergone surgical resection. An intratumoral TIMP-1 value of 10.0 ng/mg protein or more was defined as positive. Patients were followed up for more than 5 years prospectively. RESULTS: Thirty-one of the 86 patients (36.0%) were positive for TIMP-1. Kaplan-Meier curves for overall survival were significantly different between patients who were positive and those who were negative for TIMP-1. Univariate analysis of factors affecting overall survival showed that depth of tumor invasion; lymph node metastasis; peritoneal dissemination; lymphatic invasion; venous invasion; Lauren classification of histology; curability; and TIMP-1 were statistically significant. Stepwise multivariate analysis for overall survival demonstrated that depth of tumor invasion, nodal metastasis, peritoneal dissemination, and TIMP-1 remained independent prognostic factors. Kaplan-Meier curves for disease-free survival were significantly different between patients who were positive and those who were negative for TIMP-1. The incidence of recurrence was significantly higher in patients positive for TIMP-1 than in those who were negative for TIMP-1. The frequency at each site of recurrence was higher in patients positive for TIMP-1. CONCLUSION: These results suggested that the protein concentration of TIMP-1 in the tumor extracts was a useful marker for overall survival, disease-free survival, and disease recurrence in patients with gastric cancer. Thus, tumor TIMP-1 may serve to identify a high-risk group, for whom optimal surgical and medical treatment can be given.

Biomarkers, Tumor↗

PubMed2006

The efficacy of gastrectomy for large gastric cancer.

BACKGROUND: Large gastric cancer (LGC) is frequently associated with extended disease, and the role of surgical resection has been debated. We investigated the efficacy of surgical treatment for LGC. METHODS: The size of LGC was defined as 8 cm or greater. Four hundred and fifteen patients with LGC who underwent gastrectomy were included. The clinicopathological features, the status of the residual tumor, the incidence and patterns of relapse, and the survival were analyzed. RESULTS: Macroscopically, diffuse-type tumors were dominant (60%). The numbers of patients with tumors of T3 or greater, lymph node involvement, and peritoneal metastases were 356 (86%), 359 (87%), and 126 (30%), respectively. One hundred and eighty-eight patients (45%) underwent incomplete tumor resection (R2). The R2/R0 (no residual tumor) ratio was greater than 1 in patients with type 4 tumors and N1 or greater metastasis and in those with type 3 tumors and N2 or greater metastasis. In contrast, T2, type 2, and type 5 tumors were more likely to be completely resected. The 5-year survival for all 415 patients was 26%. The survival rates were inversely related to the tumor type, size, and lymph node metastasis. In the 216 patients with R0, the 5-year survivals of those with pN (International Union Against Cancer [UICC] classification) 0, 1, 2, and 3 were 66%, 56%, 36%, and 5%, respectively (P = 0.001). In 96 of these 216 patients (44%) the tumor recurred, and peritoneal metastasis was the most frequent mode of recurrence (48%). By Cox's proportional hazard model, the tumor size was an independent prognostic factor. CONCLUSION: The chance of achieving R0 resection for LGC is low, except for T2, type 2, or type 5 tumors. Primary resection should be avoided for other types of LGC.

Gastrectomy↗

PubMed2005

[Treatment strategy for primary gastric cancer with peritoneal dissemination].

Curative resection is considered to be a standard therapy for gastric cancer with localized peritoneal metastases. For tumors with diffuse dissemination, chemotherapy may play a major role, however, the benefits of reduction surgery and standard chemotherapy have not yet been clarified. Median survival time after reduction surgery was reported to be 4-13 months for patients diagnosed by surgery and/or CT and 5-6 months for chemotherapy for those diagnosed by CT alone. Reduction surgery has a high risk, with a morbidity of 12-44% and a mortality of 3-14%. Palliative surgery should be indicated for stenosis or bleeding due to primary tumors. 5-FU, MTX-5-FU, TS-1, paclitaxel, and their combination are candidates for practice and clinical trials. It is important to evaluate the severity of peritoneal dissemination by diagnostic laparoscopy or laparotomy for decision making.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2005

[Two cases of advanced gastric cancer, successfully treated with TS-1/CDDP combination chemotherapy--case report].

We reported 2 cases with advanced gastric cancer, successfully treated with TS-1 and CDDP. Case 1 had Type 3 gastric cancer with left supra-clavicular (Virchow) and para-aortic lymph node metastases. Those distant node metastases completely disappeared after two courses of neoadjuvant chemotherapy (NAC) consisting of TS-1/ CDDP, and radical surgery for cure was conducted. The second case had Type 3 carcinoma with peritoneal dissemination. The primary lesion significantly decreased after four courses of the combination chemotherapy. The patient has been alive for 1 year and a half after 14 courses of TS-1/CDDP with stable disease. Significance of TS-1/CDDP in far advanced gastric cancer was discussed.

Adenocarcinoma↗

PubMed2004

Clinical diagnosis of metastatic gastric tumors: clinicopathologic findings and prognosis of nine patients in a single cancer center.

The clinical features of metastatic gastric tumors (MGTs) have not been well documented. We present a clinical series of nine patients with MGTs. Among 2579 patients with gastric tumors seen between 1992 and 2001, we studied 9 (0.3%) patients with MGT according to a prospective database. The MGTs were diagnosed based on findings in the surgical or endoscopic specimen, and patients with malignant lymphoma or direct invasion from adjacent organs were excluded from the study. MGTs were detected simultaneously with the primary tumors in three and afterward in six patients at 14 to 74 months. The primary tumors included one each of squamous cell carcinoma of the esophagus, signet-ring cell carcinoma of the breast, large-cell or small-cell carcinoma of the lung, renal cell carcinoma, hepatocellular carcinoma, squamous cell or epidermoid carcinoma of the uterus, and melanoma. Multiple organ metastases were present simultaneously in six patients. Although six patients underwent gastrectomy, macroscopic eradication of gastric metastatic disease was accomplished in only four, in whom a UICC R0 resection was possible in only two. Five patients were treated by chemotherapy with no apparent survival benefit. A median survival after MGT diagnosis was 170 days (range 16-892 days) for all cases, 384 days for those who underwent gastrectomy (n = 6), and 27 days for those without active treatment (n = 3) (p = 0.002). The cause of death was multiple organ metastases in most cases. Because multiple metastases are common, the prognosis of MGT is poor even after curative resection. MGT is likely to be a preterminal event, and surgical resection may be useful only for palliation.

Aged↗

PubMed2004

Can surgical diagnosis of "early" gastric cancer and lymph node metastasis be accurate?

BACKGROUND: The objective of this study was to evaluate the accuracy of the intraoperative assessment of early gastric cancer (EGC) and lymph node status. METHODS: A total of 280 patients underwent gastrectomy for primary gastric cancer at the Department of Surgery, Yokohama City Kowan Hospital, from 1994 to 2002. Of these 280 patients, 140 were diagnosed as having EGC during surgery (sT1), while the rest were diagnosed with advanced disease (sT2-T4). Of the former 140 patients, 136 patients, who underwent curative resection with D1 or D2 lymphadenectomy, were further investigated for the assessment of lymph node status. RESULTS: The sensitivity, specificity, and accuracy of the surgical diagnosis of EGC were 96.4% (135 of 140), 90.0% (126 of 140), and 93.2% (261 of 280), respectively, while these values for the assessment of lymph node metastases were 55.6% (5 of 9), 94.5% (120 of 127), and 91.9% (125 of 136), respectively. In a further analysis in which patients with tumors of macroscopically depressed type and undifferentiated histology were excluded, all patients staged as sT1sN0 had no lymph node metastases pathologically. CONCLUSION: Although the depth of tumor invasion can be correctly assessed intraoperatively, it is difficult to be precise regarding the presence of nodal metastases. One practical solution to this problem might be to employ limited surgery for those patients with macroscopically elevated and histologically differentiated tumors.

False Positive Reactions↗

PubMed2004

Expression of survivin mRNA associates with apoptosis, proliferation and histologically aggressive features in hepatocellular carcinoma.

The clinical impact of survivin on human cancer pathogenesis and prognosis has been investigated. To clarify the clinical effect of survivin on tumor behavior and prognosis of patients with hepatocellular carcinoma (HCC), the expression of survivin mRNA in 40 samples of HCC tissue and matched-adjacent liver tissue, as well as 7 healthy hepatic tissue samples were measured by a real-time reverse transcription polymerase chain reaction. The expressed level of survivin mRNA (log copies/microg total RNA) in healthy liver tissue was 1.95+/-0.44, in morbid liver tissue adjacent to the tumors was 4.79+/-0.96, and in HCC tissue was 5.87+/-0.73 (values are mean +/- SD and P<0.001). The amount of survivin mRNA in HCC tissues correlated negatively with the apoptotic indices (r=-0.573 and P<0.001) and correlated positively with the proliferation indices (r=0.433 and P=0.005). Expression of survivin was significantly related with histologic grade (P=0.011) and pathological tumor stage (P=0.017). Patients with HCC tumors that had a large amount of survivin mRNA (> or = mean) had lower survival rate (P=0.030), but multivariate analysis showed only Ki-67 labeling index, histologic grade, and pathologic T stage to be the independent prognosticators. These findings indicate that survivin is associated with reduced tumor cell apoptosis, increased tumor cell proliferation, and histologically aggressive tumor features, and may play an important role in tumor progression of HCC. However, further examination is needed to clarify its predictive significance for HCC patients.

Aged↗

PubMed2003

Clinical and pathological study of gastric cancer with ovarian metastasis.

BACKGROUND: The aim of this study was to determine the treatment strategy for ovarian metastases from gastric cancer, by a retrospective study of the treatment results. METHODS: We reviewed the records of patients with ovarian metastases from primary gastric cancer. Ovarian metastases were found in 24 of 897 female patients with gastric cancer. Of these, 21 patients with histologically proven disease were studied. RESULTS: Ovarian metastasis was detected before the primary gastric cancer in 1 patient, simultaneously in 6, and after in 14. Ovarian tumors were detected by computed tomography (CT) in a majority of patients (95%), while uterine tumors were detected in only 29%. Metastasis to the uterus was histologically examined in 14 tumors and confirmed in 11 tumors. All patients with positive endometrial cytology had uterine metastases. Total abdominal hysterectomy was performed with bilateral salpingo-oophorectomy in 12 patients and with unilateral resection in 2. In these 14 patients, 5 were curatively operated. In the clinical course, all patients developed multiple metastases, and patients suffered peritoneal dissemination. None survived for longer than 3 years. The median survival time after ovarian metastases (MST) was 10.3 months for all patients; 3.6 months in patients in their sixties, and 12.5 months in those in their fifties. Survival was significantly longer in patients who underwent curative resection (MST, 30.4 months) compared with those who had noncurative resection (MST, 10.3 months). CONCLUSION: The prognosis for ovarian metastasis of gastric cancer was poor without curative resection. Because of frequent microscopic metastases to the uterus, total hysterectomy with bilateral oophorectomy is recommended if curative resection is possible.

Adenocarcinoma↗

PubMed2003

[A case of small cell carcinoma of the stomach].

We report a case of small cell carcinoma of the stomach in a 60-year-old man. The patient was found to have a gastric tumor by routine upper gastrointestinal endoscopy for chronic gastrititis, and was admitted to the hospital. The patient underwent a curative distal gastrectomy with D2 lymph node dissection following a diagnosis of early gastric cancer at the posterior wall of the antrum, in June 2001. Surgical findings were T1, N1, P0, H0, M0, stage I b. The final pathological diagnosis was small cell carcinoma of the stomach with severe lymphatic and vascular invasion (INF alpha, sm, ly3 v2, n1 (+)). In a review of 47 cases seen in the Japanese literature, only 5 patients had early gastric cancer. Lymph node metastasis was observed in 95.0% of all cases, and liver metastasis in 41.0%. Four of the 5 patients with early gastric cancer (80.0%) had lymph node metastases. The prognosis was reported to be extremely poor because small cell carcinoma frequently metastasizes to lymph nodes and/or the liver even in an early stage. The chemotherapy selected by many hospitals is mainly CDDP, but the use of chemotherapeutic drugs varied from hospital to hospital and no effective chemotherapy for the disease has been established as yet.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2002

Is D2 lymph node dissection necessary for early gastric cancer?

BACKGROUND: The objective of this study was to clarify a survival benefit of D2 lymphadenectomy in patients with early gastric carcinoma (GC). METHODS: A retrospective study was conducted to examine the incidence of metastasis to level 2 lymph nodes, the causes of postoperative death, and the mode of recurrence in 1041 patients who had early GC and underwent D2 lymphadenectomy with curative intent. RESULTS: Postoperative mortality occurred in 129 (12.4%) of 1041 patients, 6 patients (.6%) died of surgical complications, 108 (10.2%) died of diseases other than cancer, and 16 (1.5%) died of recurrence. Hematogenous metastasis was the major mode of recurrence (56.3% of recurrences). The incidence of metastasis to level 2 nodes was 2.5% (26 of 1041 patients, 18 of whom were alive). Thus, the estimated survival benefit of radical lymphadenectomy for patients with early GC was calculated to be 1.7% (18 of 1041 patients). CONCLUSIONS: D2 lymphadenectomy in patients with early GC had little survival benefit because (1) metastasis to level 2 nodes was rare, (2) most causes of death were not related to the tumor, and (3) more than half the recurrences were hematogenous. Use of radical lymphadenectomy for early GC should be limited.

Carcinoma↗

PubMed2002

Unusual survival for more than 2 years with peritoneal metastases of gastric cancer.

We report a patient with peritoneal metastases who was successfully treated with a novel oral fluoropyrimidine anticancer drug, TS-1, as first-line chemotherapy. The patient was a 72-year-old man who had undergone curative resection for type 4 gastric cancer with peritoneal dissemination that was located only at the greater omentum. Final findings were P1, T4, N1, and stage IV. Eighteen months after the gastrectomy, his cancer recurred with peritoneal metastases; these were diagnosed by the presence of multiple stenoses of the colon, an abdominal mass, and elevated levels of the serum tumor markers, carcinoembryonic antigen (CEA) and carbohydrate antigen (CA)19-9. He was treated with 100 mg/day of TS-1, given orally, for 28 days, followed by 14 days' rest, as one course. Two courses of the treatment resulted in a marked reduction of the abdominal tumor, without severe toxicity. After 3 courses, barium enema revealed dramatic improvement in the stenoses. Laparoscopy after 11 courses showed neither peritoneal dissemination, nor ascites, and peritoneal lavage cytology was negative. The serum tumor markers were reduced to almost normal levels. Two years after the onset of the peritoneal metastases, the patient is alive without any sign of progressive disease. Our report is the first to demonstrate the advantages of TS-1 as chemotherapy for the treatment of peritoneal metastasis of gastric cancer.

Aged↗

PubMed2002

Solitary metastasis to the left axillary lymph node after curative gastrectomy in gastric cancer.

Regional lymph node metastasis in advanced gastric cancer is common, whereas axillary lymph node metastasis (ALNM) is rare. We experienced a patient with a solitary ALNM in gastric cancer. A 48-year-old woman underwent curative distal gastrectomy for advanced gastric cancer (P0H0T3N3M0CY0, stage IV). Twenty-one months after the surgery, she complained of an asymptomatic left axillary tumor. Mammography and computed tomography (CT) scans showed the presence of tumors in neither breast nor lung. Fine-needle aspiration of the axillary tumor demonstrated poorly differentiated adenocarcinoma cells, which coincided with the cells of the resected gastric carcinoma. We diagnosed ALNM from gastric cancer and operated on the patient with radical left axillary lymph node dissection. One year after the reoperation, she has had no recurrence. We conclude that gastric cancer can metastasize to unusual sites. A re-radical resection is recommended if curative resection is feasible.

Adenocarcinoma↗

PubMed2002

Is there a role for nontraditional resection of early gastric cancer?

Current trends in the treatment of gastric cancer indicate the emergence of a more sophisticated approach, with tailored therapy applied to individual cases. Treatment includes a broader spectrum of therapeutic options (Fig. 3), including EMR, laparoscopic or laparoscopy-assisted surgery, modified radical surgery, and typical radical surgery with lymph node dissections. Precise characterization of the lesions, especially the depth of invasion in the gastric wall, its size, histology and whether there is ulceration, is the key to successful treatment of N0 mucosal cancer. Micrometastasis and metastasis at the molecular level are issues that require further investigation. Laparoscopic surgery may be more widely accepted. The limitations of nodal dissection based on the concept of a sentinel node should be carefully evaluated in future studies. [figure: see text] Many treatment options, ranging from minimally invasive surgery to D2 node dissection, are available to the surgical oncologist who is treating EGC. As more information is gathered, surgeons will be better able to select patients who are good candidates for minimal surgical procedures.

Gastrectomy↗

PubMed2002

[Benefit of screening for gastric cancer--a comparison of symptomatic and screened patients who underwent gastrectomy].

UNLABELLED: We compared the clinicopathological factors and treatment results with regard to symptoms and screening in patients who underwent gastrectomy for primary gastric cancer. PATIENTS: The subjects included 797 patients with asymptomatic gastric cancer (SCG) and 1090 patients with symptomatic cancer (SYG) who had undergone gastrectomy for gastric cancer from 1989 to 2000. RESULTS: The proportion of early gastric cancer, N0 cases, and curative cases in the SCG and SYG patients were 70% & 33%, 77% & 44%, and 98% & 80%, respectively (p = 0.000, for each). Five-year survival rates of the SCG and SYG patients were 87% and 63% (p = 0.000). CONCLUSION: Screening for gastric cancer in order to detect asymptomatic disease may contribute to patient survival.

Adult↗

PubMed2002

[Clinical and diagnostic significance of abdominal CT for peritoneal metastases in patients with primary gastric cancer].

The clinical and diagnostic significance of abdominal computed tomography (CT) was evaluated in 123 patients with primary gastric adenocarcinoma and disseminated peritoneal metastases. The peritoneal metastases were diagnosed by CT findings such as ascites (30.1%), wall thickness of the intestine (1.6%), increase in fat density of peritoneal fat tissue (4.9%), peritoneal nodules (2.4%), and hydronephrosis (4.9%). The overall diagnosis of peritoneal metastasis was 37.4%. The CT findings of peritoneal metastases were significantly correlated with anemia, poor performance status, distant metastases, P3, and resectability of the primary tumor. The survival of the patients with positive findings was significantly poor (150 days of median survival), compared with those without findings (230 days). The abdominal CT thus provides information for diagnosis of peritoneal metastases and on the prognosis in patients with primary gastric cancer.

Humans↗

PubMed2002

[Is sentinel lymph node navigation useful for laparoscopic gastrectomy].

The aim of this paper is to assess the usefulness of sentinel lymph node navigation for laparoscopic gastrectomy. The standard lymph node dissection for gastric cancer is a D2 dissection. D2 dissection and sentinel lymph node biopsy can be performed with laparoscopic gastrectomy as well as with open surgery. Sentinel lymph node navigation surgery for gastric cancer has not yet been established, but once a strong consensus is reached we will be able to perform the laparoscopic gastrectomy safely.

Gastrectomy↗

PubMed2002

[Recurrence of right breast cancer at the thoracic wall successfully treated with intra-arterial infusion of doxorubicin hydrochloride--a case report].

We report a recurrent case of breast cancer successfully treated with intra-arterial infusion of doxorubicin hydrochloride (ADM) combined with systemic CAF therapy. The patient, a 37-year-old woman, was diagnosed with a recurrence at the thoracic wall 55 months after curative resection for right breast cancer. She was treated with intra-arterial infusion chemotherapy of ADM, 30 mg, combined with systemic CAF therapy of cyclophosphamide, 100 mg from days 1 to 14, ADM, 30 mg on days 1 and 8, and 5-fluorouracil, 500 mg on days 1 and 8, as one course. Two courses of the treatment resulted in a complete response of the tumor. This result suggests that local and systemic chemotherapy could be effective for the treatment of local recurrence of breast cancer.

Adult↗