Hiroto Koyama

Adjuvant Oral Uracil-Tegafur with Leucovorin for Colorectal Cancer Liver Metastases: A Randomized Controlled Trial

Background The high recurrence rate after surgery for colorectal cancer liver metastasis (CLM) remains a crucial problem. The aim of this trial was to evaluate the efficacy of adjuvant therapy with uracil-tegafur and leucovorin (UFT/LV). Methods In the multicenter, open-label, phase III trial, patients undergoing curative resection of CLM were randomly assigned in a 1:1 ratio to either the UFT/LV group or surgery alone group. The UFT/LV group orally received 5 cycles of adjuvant UFT/LV (UFT 300mg/m2 and LV 75mg/day for 28 days followed by a 7-day rest per cycle). The primary endpoint was recurrence-free survival (RFS). Secondary endpoints included overall survival (OS). Results Between February 2004 and December 2010, 180 patients (90 in each group) were enrolled into the study. Of these, 3 patients (2 in the UFT/LV group and 1 in the surgery alone group) were excluded from the efficacy analysis. Median follow-up was 4.76 (range, 0.15–9.84) years. The RFS rate at 3 years was higher in the UFT/LV group (38.6%, n = 88) than in the surgery alone group (32.3%, n = 89). The median RFS in the UFT/LV and surgery alone groups were 1.45 years and 0.70 years, respectively. UFT/LV significantly prolonged the RFS compared with surgery alone with the hazard ratio of 0.56 (95% confidence interval, 0.38–0.83; P = 0.003). The hazard ratio for death of the UFT/LV group against the surgery alone group was not significant (0.80; 95% confidence interval, 0.48–1.35; P = 0.409). Conclusion Adjuvant therapy with UFT/LV effectively prolongs RFS after hepatic resection for CLM and can be recommended as an alternative choice. Trial Registration UMIN Clinical Trials Registry C000000013

Advanced primary Hodgkin's disease of the spleen cured by surgical resection: report of a case.

We describe herein the case of a 61-year-old man who underwent successful resection of advanced primary Hodgkin’s disease of the spleen. On admission, computed tomography and ultrasonography showed a fist-sized, slightly enhanced mass, and angiography demonstrated a typical neoplastic tumor stain in the spleen. Exploratory laparotomy revealed a hard mass invading the splenic hilar lymph nodes, gastric upper body, transverse colon, pancreatic tail, and left lateral segment of the liver. The patient underwent splenectomy with combined resection of the surrounding organs invaded by the tumor, followed by postoperative chemotherapy. Histological examination showed many Reed-Sternberg cells, and the tumor was subsequently diagnosed as Hodgkin’s disease of the spleen. The patient is currently well without any signs of recurrence 4 years after surgery.

Experimental transcatheter hepatic subsegmentectomy using absolute ethanol in dogs

In this study, we evaluate the effect of an intraportal injection of absolute ethanol in the canine liver and discuss how to introduce it in clinical application. The intraportal injection of ten millitiers of ethanol using a balloon occlusion catheter created an evident and well-demarcated necrotic lesion in the right central lobe. Histological examination showed a typical coagulation necrosis with fibrous bands, which became thicker day by day. The weight of the necroses ranged from 5 to 55 grams with an average of 26.0±5.5 grams (mean±SE), which was approximately 20 to 40 per cent of the right central lobe. Complications resulting from the ethanol injection were minimal and although more studies need to be done to clearly establish its safety for cirrhotic patients with hepatoma, this technique may be an easier and less invasive substitute for operative hepatic subsegmentectomy.

Management of esophageal varices.

教室では, 昭和24年以来食道静脈瘤の治療として主に外科治療を施行してきた. 昭和39年まではシャント手術を行ったが, 肝性脳症が46%に発生したので昭和39年以後は, 直達手術を治療法として選択してきた. なお, 昭和54年以後, 肝機能不良例, 肝癌非切除例, 再発例, 手術拒否例に対しては内視鏡的硬化療法を行っている. 東大二外法の10年累積生存率は, 肝外門脈閉塞症, 93%, 特発性門脈圧亢進症81%, 肝硬変症のChild分類別では各々A: 55.3%, B: 38.9%, C: 16.2%であり, 経腹的食道離断術では, 4年累積生存率が90%であることから肝障害軽度例Child分類A, Bに対しては, 現在, 経腹的食道離断術を行っている.

New Vascular Occulusion Method with Lateral Laser Aming Probe

The primary disadvantage of the conventional forward aiming fiberprobe is the need to fire the laser parallel with, or close to the longitudinal axis of the gastrointestinal tract. How, cancers and ulcers appearing on the wall of the gastrointestinal tract can be treated through laser radiation delivered by the lateral-aiming fiberprobe. After several years of study, we have succeeded in developing a lateral-aiming probe which incorporates a truncated quartz fiber tip protected by a micro-cap. Effective treatment of all lesions in hollow organs has become possible endoscopically with the ability to freely rotate the probe. We have successfully treated gastric cancers, bleeding duodenal ulcers and esopageal strictures which could not be effectively treated with conventional laser probes.