Biomedical subjects

Yosuke Adachi

Publications and source records attributed to Yosuke Adachi.

28 records · Page 2Linked to original sources

PubMed2000

Gastric cancer with extragastric lymph node metastasis: multivariate prognostic study.

BACKGROUND: Although many authors have investigated the prognostic factors of gastric cancer, there are few comprehensive studies on the prognosis of patients with extensive lymph node metastasis. The aim of this study was to clarify the prognostic factors of gastric cancer with extragastric lymph node metastasis, using multivariate analysis.METHODS: The study population consisted of 121 patients who had undergone radical gastrectomy and extended lymph node dissection (D2, D3) for gastric cancer with extragastric lymph node metastasis. We examined 18 clinicopathologic factors, including the type of gastrectomy, tumor size, depth of wall invasion, status of lymph node metastasis, and stage of disease. Survival rates were analyzed by the Kaplan-Meier and Mantel-Cox methods, and multivariate analysis was done using the Cox proportional hazards model.RESULTS: The overall 5-year survival rate was 32%, and the 5-year survival rate after curative gastrectomy was 37%. Overall survival rate was associated with the type of gastrectomy, stage of disease, operative curability, tumor size, depth of wall invasion, and anatomical distribution of positive nodes, whereas the survival rate after curative gastrectomy was correlated with the type of gastrectomy, stage of disease, tumor size, gross type, and depth of wall invasion. Independent prognostic factors were operative curability and depth of wall invasion, and survival after curative gastrectomy was influenced only by the depth of wall invasion (mucosa and submucosa [T1], muscularis and subserosa [T2] vs serosa [T3]).CONCLUSION: In patients with gastric cancer with extragastric lymph node metastasis, independent prognostic factors after gastrectomy were operative curability and depth of wall invasion. Long-term survival can be achieved when the patients have no serosal invasion (T1, T2) and are treated by curative gastrectomy.

Journal Article↗

PubMed1999

Surgical results of proximal gastrectomy for early-stage gastric cancer: jejunal interposition and gastric tube reconstruction.

BACKGROUND: The frequency of tumors in the upper one-third of the stomach has been increasing. The standard operation for proximal gastric cancer has been total or proximal gastrectomy. The aim of this study was to present the pathologic and surgical results of 30 patients with early-stage proximal gastric cancer managed by proximal gastrectomy.METHODS: A consecutive series of 30 patients who underwent proximal gastrectomy for early-stage proximal gastric cancer was studied. Sixteen patients underwent jejunal interposition, while 14 underwent gastric tube reconstruction, which consisted of a direct anastomosis between the esophagus and the remnant of the tube-like stomach.RESULTS: Twenty patients (67%) had no abdominal symptoms and the lesions were detected by screening gastric fiberscopy. The tumors were mostly located along the lesser curvature (73%), were grossly depressed type (IIc) (70%), and histologically well differentiated type (63%). The depth of wall invasion was the mucosa in 12 patients, submucosa in 15, and muscularis propria in 3; lymph node metastasis was absent in 28 patients (93%). When compared with patients with jejunal interposition, patients with gastric tube reconstruction had a shorter operation time (327 vs 165 min), less blood loss (508 vs 151 g), and shorter hospital stay after operation (31 vs 17 days). Endoscopy and 24-h pH monitoring showed no evidence of reflux esophagitis, except in 1 patient with gastric tube reconstruction, and no patient died of recurrence.CONCLUSIONS: Early-stage proximal gastric cancer can be successfully treated by proximal gastrectomy. Since gastric tube reconstruction is a simple, easy, and safe procedure, proximal gastrectomy followed by gastric tube reconstruction is recommended for patients with early-stage proximal gastric cancer.

Journal Article↗

PubMed1999

Gastric cancer presenting with obstructive jaundice.

Gastric cancer is rarely associated with obstructive jaundice, which is associated with poor survival. We describe five patients with gastric cancer who presented with jaundice. Two patients had primary gastric cancer and three had recurrent disease. The patients were treated by operation, chemotherapy, and percutaneous transhepatic biliary drainage (PTBD) according to the stage of the cancers. Although these treatments often fail to prolong survival, chemotherapy and PTBD can improve patient's quality of life.

Journal Article↗

PubMed1999

Laparoscopy in the management of scirrhous gastric cancer.

BACKGROUND: Scirrhous gastric cancer frequently shows extensive tumor spread, and gastrectomy for cure of the disease is not possible in the presence of peritoneal dissemination, which is often overlooked by conventional computed tomography. The aim of this study was to evaluate our experience of 16 patients who underwent laparoscopy in the management of scirrhous gastric cancer, and to examine whether peritoneal dissemination could be diagnosed accurately by laparoscopy.METHODS: All patients had nonobstructed, nonbleeding scirrhous gastric cancer and had no evidence of metastatic disease by ultrasonography and computed tomography. Laparoscopy was performed under general anesthesia with CO(2) pneumoperitoneum. A Hasson trocar and two manipulating forceps were inserted, and the surfaces of the peritoneum, omentum, stomach, spleen, pancreas, liver, and diaphragm were examined.RESULTS: The mean time for laparoscopy was 20 min. Peritoneal dissemination was disclosed in 4 patients (25%), and systemic and intraperitoneal chemotherapy was done without laparotomy. In 12 patients, subsequent gastrectomy with a curative intent was successfully performed. Pathology revealed that the tumor diffusely invaded the whole thickness of the gastric wall; the mean size of resected tumors was 12 cm, and the mean number of positive nodes was 17. Nine patients died of the disease with a mean survival period of 10 months, and 7 patients were alive without recurrence during a mean follow-up period of 11 months.CONCLUSIONS: Laparoscopy is useful for the evaluation of peritoneal spreads of advanced gastric cancer, can avoid unnecessary laparotomy because of peritoneal dissemination, and is important for the choice of treatments in patients with scirrhous gastric cancer.

Journal Article↗

PubMed1998

Long-term survival after perforation of advanced gastric cancer: Case report and review of the literature.

Although the standard operation for early cancer of gastric cardia is proximal gastrectomy followed by jejunal interposition, we recently reported a simple and useful technique for proximal gastrectomy with gastric tube reconstruction. The operative procedures included resection of the proximal two-thirds of the stomach, followed by anastomosis between the esophagus and gastric tube, using a circular stapler (Proximate ILS 25; Ethicon, Cincinnati, OH, USA). The gastric tube was about 20 cm long and 4 cm wide. The patient a 76-year-old man had no reflux symptoms such as heartburn, retrosternal pain, and regurgitation. Endoscopy showed no evidence of reflux esophagitis, including mucosal redness, erosion, and ulceration. Ambulatory 24-h pH monitoring indicated that the pH of the lower esophagus was between 6 and 8 when the patient was upright and between 5 and 7 when he was in the supine position. There were nine reflux episodes during the day, and no reflux episode while he was asleep. The duration of each reflux episode was less than 1 min, and the total reflux time was 1 min in the 12-h day (0.1%). These data indicate that reconstruction by gastric tube may prevent esophageal reflux in patients who have undergone proximal gastrectomy for early cancer of the gastric cardia.

Journal Article↗

PubMed1998

Gastric tube reconstruction prevented esophageal reflux after proximal gastrectomy.

Journal Article↗

PubMedDate not supplied

Gastric remnant cancer compared with primary proximal gastric cancer.

BACKGROUND/AIMS: Recently, detections of early-stage gastric remnant cancer and small proximal gastric cancer are increasing. The aim of this study was to compare pathologic and prognostic data of gastric remnant cancer with those of primary proximal gastric cancer including upper gastric cancer based on a recent 15-year experience at a single institute in Japan. METHODOLOGY: Among 698 patients who underwent gastrectomy for cancer between 1984 and 1998, 15 (2.1%) were patients with gastric remnant cancer. During the same period, 139 patients underwent primary gastrectomy for proximal gastric cancer which included 71 with upper gastric cancer confined to the upper one-third of the stomach. Clinicopathologic findings of gastric remnant cancer were compared with those of proximal gastric cancer. RESULTS: Of 15 gastric remnant cancers, 8 (53%) were stage I tumors. Although gastric remnant cancer and proximal gastric cancer was not different in several clinicopathologic factors, gastric remnant cancer and upper gastric cancer confined to the upper one-third of the stomach was different with regard to the frequency of tumor size > or = 4 cm (60% vs. 32%, p < 0.05), poorly differentiated type (67% vs. 38%, p < 0.05), serosal invasion (40% vs. 11%, p < 0.01), lymph node metastasis (47% vs. 20%, p < 0.05), stage III or IV disease (47% vs. 10%, p < 0.01), and noncurative gastrectomy (20% vs. 1%, p < 0.01). The 5-year survival rate of gastric remnant cancer (69%) was higher than that of proximal gastric cancer (57%) and lower than that of upper gastric cancer (81%), although the differences were not statistically significant. CONCLUSIONS: In our recent series, a half of gastric remnant cancers are stage I tumors. Although gastric remnant cancers are similar to proximal gastric cancers, they are more advanced and their surgical results are less satisfactory when compared with upper gastric cancers confined to the upper one-third of the stomach.

Adenocarcinoma↗

PubMedDate not supplied

Quality of life after laparoscopic or open colonic resection for cancer.

BACKGROUND/AIMS: Although laparoscopic colectomy has been widely accepted, little is known about the subjective clinical results of this less invasive surgery. The aim of this study was to evaluate the quality of life of patients who had undergone laparoscopic or open colonic resection for cancer. METHODOLOGY: The study included 26 patients with laparoscopic colectomy and 87 with conventional open colectomy for cure of colon cancer. Body temperature, serum C-reactive protein and albumin levels, lymphocyte count, and weight loss during hospital stay were compared between the two groups. Quality of life was estimated by the 9-item questionnaire with scoring system of 1 (high), 2 (fair), and 3 (low). RESULTS: Laparoscopic colectomy was significantly different from open colectomy with regard to the body temperature (37.8 degrees C vs. 38.0 degrees C, p < 0.01) and C-reactive protein level (6.34 mg/dL vs. 11.15 mg/dL, p < 0.01) on postoperative day 1, albumin level (3.54 g/dL vs. 3.36 g/dL, p < 0.05) and lymphocyte count (1354/mm3 vs. 995/mm3, p < 0.01) on postoperative day 7, and weight loss on postoperative day 14 (3.95% vs. 5.45%, p < 0.01). Although all patients with laparoscopic colectomy were satisfied with their surgical results, total score of the quality-of-life questionnaire was not significantly different between the two groups (10.95 vs. 11.81). Both laparoscopic and open colonic resections were similarly accepted by the patients as a good operation that they would recommend to others (1.105 vs. 1.206). CONCLUSIONS: These results indicate that although laparoscopic colonic resection for cancer was less invasive than conventional open colectomy, both laparoscopic and open colonic resections were favorably accepted by the patients, and quality of life after operation was not significantly different between the two procedures.

Colectomy↗

PubMedDate not supplied

Surgical technique influences bowel function after low anterior resection and sigmoid colectomy.

BACKGROUND/AIMS: Since June 1996, we have changed surgical strategies to preserve the pelvic autonomic nerve and abandon high ligation of the inferior mesenteric artery. The aim of this study was to clarify the influence of this surgical technique on subjective bowel function of patients with low anterior resection and sigmoid colectomy for cancer. METHODOLOGY: Forty-eight patients who underwent low anterior resection or sigmoid colectomy for cancer during June 1996 and February 2000 replied to the questionnaire which consisted of eight categories of bowel symptoms. Subjective bowel function and operative data of these patients were compared with those obtained from 84 patients with low anterior resection or sigmoid colectomy during April 1984 and May 1996. RESULTS: When recent series were compared with previous series, the frequency of bowel movement at night (21% vs. 60%, p < 0.01) and patient's own judgment as fair or poor (0% vs. 29%, p < 0.01) was decreased in patients with low anterior resection; whereas the frequency of defecation > 2 per day (5% vs. 34%, p < 0.01), difficulty in emptying (32% vs. 71%, p < 0.01), and incomplete evacuation (32% vs. 66%, p < 0.05) was decreased in patients with sigmoid colectomy. Patient judged as poor bowel function was less frequent in the recent group after low anterior resection (25% vs. 71%, p < 0.01) and sigmoid colectomy (18% vs. 42%, p < 0.05) compared with the previous group. Operative data including volume of blood loss, frequency of transfusion, and length of resected specimen were also different between the two groups. CONCLUSIONS: Surgical technique had a significant impact on bowel function following low anterior resection and sigmoid colectomy for cancer. When high ligation of the inferior mesenteric artery is abandoned and the pelvic autonomic nerve is preserved by careful technique, postoperative bowel dysfunction in patients with rectosigmoid colon cancer can be minimized.

Colectomy↗

PubMedDate not supplied

Gastrointestinal stromal tumor with diffuse mesenteric metastases.

Although malignant gastrointestinal stromal tumors (GISTs) sometimes show peritoneal dissemination, diffuse metastasis to only the mesentery is rare. We describe the unusual case of GIST in a 69-year-old woman who showed multiple nodules restricted only to the mesentery except the surface of the small and large bowel, omentum, and abdominal wall. These small nodules were similar to those seen in leiomyomatosis peritonealis disseminata. Histological and immunohistochemical findings were consistent with GIST. This case of GIST shows an apparently unique and rare spreading pattern.

Aged↗