Itsuro Fujita

Postoperative changes in body composition after gastrectomy

Nutritional status is one of the most important clinical determinants of outcome after gastrectomy. The aim of this study was to compare changes in the body composition of patients undergoing laparoscopyassisted gastrectomy (LAG), distal gastrectomy (DG), or total gastrectomy (TG). Total body protein and fat mass were measured by performing a multifrequency bioelectrical impedance analysis using an inBody II machine (Biospace, Tokyo, Japan) in 108 patients (72 men, 36 women) who had undergone LAG (n = 24), DG (n = 39), or TG (n = 45). Changes between the preoperative data and results obtained on postoperative day 14 and 6 months after surgery were then evaluated. The mean preoperative body weight of the subjects was 57.6 +- 10.7 kg, the mean body mass index was 22.5 +- 3.4 kg/m2, and the mean fat % was 24% +- 7%. In the immediate postoperative period (14 days), the body weight loss in the LAG group was significantly lower than in the DG and TG groups (2.5 +- 0.9 kg vs. 3.5 +- 1.8 kg and 4.0 +- 1.9 kg, respectively; P +- 0.0001). The body composition studies demonstrated a loss of total body protein rather than fat mass. Six months after surgery, body weight was not significantly different from preoperative values in the LAG and DG groups (-1.2 +- 3.8 kg and -1.8 +- 4.7 kg, respectively), but had decreased by 8.9 +- 4.9 kg in the TG group (P = 0.0003). A body composition analysis revealed a loss of fat mass in the DG and TG groups. The patients who underwent gastrectomy lost body protein mass during the early postoperative period. The type and extent of surgery has an effect on long-term body mass and composition. Bioelectric impedance analysis can be used to assess body composition and may be useful for nutritional assessment in patients who have undergone gastrectomy.

Correlation between epidermal growth factor receptor concentration and the growth of human gastric cancer xenografts in nude mice

SummarySeven human gastric cancer xenografts with different concentrations of EGF receptor were established in nude mice. The expression of EGF receptor in the tumors was demonstrated by Western blotting with anti-EGF receptor antibody, binding assay with125I-EGF and immunohistochemistry with anti-EGF receptor antibody. Western blotting revealed EGF receptor doublet bands at molecular masses of 150 KDa and 170 KDa in all of the samples. The concentration of125I-EGF binding activity in the tumors ranged from 36.0 to 11,000 fmol/mg protein, with a mean of 345 fmol/mg protein. EGF receptor was also demonstrated immunohistochemically on the apical border of the glands and the cell membrane of the tumor cells. There seemed to be a close correlation between the concentration of125I-EGF binding activity and the doubling time of these tumors in nude mice (γ= -0.68). However, no definite correlation was observed between EGF ligand binding and histological features of intestinal type or diffuse type. The expression of EGF receptor appears to facilitate the growth of human gastric cancer xenografts in nude mice.

Correlation of c-erbB-2 with invasion and metastasis in human gastric cancer

Recently, metastatic tumors of human gastric .)cancer have been reported to show a high incidence of c-erbB-2 amplification ] . This study was designed to examine the correlation of expression of c-erbB-2 protein in primary site with nodal involvement in resected human gastric cancer. C-erbB-2 was stained immunohistochemically with formalin-fixed and paraffin embedded specimens of 203 gastric cancers using anti-c-erbB-2 polyclonal antibody (Triton Bioscience Inc.) by the method of Hsu et al.. A cell line of gastric cancer, MKN-7, was used as a positive control. Twenty six of the 203 (12.8%) specimens showed positive reactiQn. Immunohistochemical staining was confined mainly to the cell membrane. The expression of c-erbB-2 correlated with the depth of invasion, histologic type and amount of stromal tissue. Six of 89 (6.7%) early cancers and 20 of 114 (17.5%) advanced cancers showed positive reaction (P< 0.05). Twelve of 2a (50%) papillary adenocarcinomas (pap), 8 of 83 (9.6%) tubular adenocarinomas (tub), 4 of 68 (5.9%) poorly differentiated adenocarinomas (por), 2 of 26 (7.7%) signetring cell carcinomas (sig), and no cases of mucinous adenocarcinoma are positive for c-erbB-2. The positive incidence in pap was found to be significantly higher than in other types (P<0.OI). Four of 46 (8.7%) scirrhous types and 16 of 68 (23.5%) non-scirrhous types showed a positive reaction (P<0.05). The p

Significance of Helicobacter Pylori in Gastrocarcinogenesis: Special Reference to Tissue IgA Antibody in Chronic Gastritis and Intestinal Metaplasia

sitivity in metastatic lymph nodes was found more frequently than in primary sites (Table) iirespective of the presence or absence of c-erbB-2 in primary sites. Thirty four of 38 (89.5%) metastatic nodes in pap, 37 of 60 (61.7%) in tub, 3~ of 96 (35.4%) in por and 3 of 20 (15%) in sig showed a positive reaction (Table). The positive incidence in metastatic lymph nodes was significantly higher in pap and tub than in others. Results suggest that expression of c-erbB-2 is related to invasion and lymph node metastasis of gastric cancer, especially in differentiated adenocacinoma.

Thoracoscopic long myotomy in the prone position to treat rapid esophageal contractions with normal latency.

Epidemiological reports have indicated that infection with Helicobacter pylori in the stomach induces chronic gastritis and is closely correlated with intestinal metaplasia and gastric cancer. In this study, we investigated H.pylori infection by detection of tissue IgA antibody (Ab) against H.pylori in the mucosae of patients with chronic gastritis, intestinal metaplasia and gastric cancer. Tissue IgA Ab was assayed by ELISA and expressed semi-quantitatively as an index (sample O.D./cut-off O.D.;1.2< positive; <0.8, negative). The results showed that 1) indices of tissue IgA Ab against H.pylori were correlated with the severity of chronic gastritis/ intestinal metaplasia, and 2) tissue IgA Ab against H.pylori was negative in cancerous tissue, in contrast high positivity in the surrounding mucosa. These results show that H.pylori infection is closely correlated with precursory lesions of gastric cancer such as chronic gastritis and intestinal metaplasia.

Mediastinoscopy-assisted Transhiatal Esophagectomy for Esophageal Cancer: A Single-Institutional Cohort Study.

A 56-year-old woman with an 8-year history of dysphagia and chest pain received a diagnosis of diffuse esophageal spasm by esophageal high-resolution manometry (HRM). Approximately 2 years of medical therapy was ineffective, and the patients symptoms were worsening. Therefore, surgery was considered to be the most optimal treatment for this patient. The right thoracoscopic approach was selected because a long myotomy from the distal to proximal level of the esophagus was needed based on the HRM findings. The operation was performed in the prone position with establishment of pneumothorax. The total length of the myotomy was 16 cm, and the operation was finished within 2 hours. After the operation, the symptoms were considerably improved and no contractions were detected by HRM. The HRM findings before the operation were classified as rapid contractions with normal latency based on the 2012 Chicago classification of esophageal motility. Treatment for patients with rapid esophageal contractions with normal latency has not been previously described; however, treatment for diffuse esophageal spasm was considered to be pertinent to this patient. In conclusion, right thoracoscopic esophageal long myotomy in the prone position with establishment of pneumothorax may be useful when a proximal-level esophagomyotomy is required based on preoperative mapping by HRM.

Abstract 3623: Clinical significance of serum tumor markers in patients with esophageal cancer

We compared the therapeutic outcomes of mediastinoscopy-assisted transhiatal esophagectomy (MATHE) with transthoracic esophagectomy (TTE), and with video-assisted thoracoscopic esophagectomy (VATS-E) for the treatment of esophageal cancer. Twenty patients underwent MATHE in our institute from 2001 to 2005 were enrolled. We evaluated the therapeutic outcomes, including perioperative complications and long-term prognosis after surgery, and compared these with 15 patients who underwent TTE during the same time period and 15 who underwent VATS-E at a later date. MATHE was performed safely and the long-term prognosis were satisfactory compared with TTE. However, the number of dissected mediastinal lymph nodes, total blood loss, and sophistication of the procedure were inferior to VATS-E. MATHE represents a less invasive surgical procedure. However, in light of the risk of leaving lymph node metastasis around the tracheal bifurcation in patients with tumor invasion beyond the muscularis mucosa, MATHE should only be adopted in a minority of patients.

Abstract 3187: Utility of serum p53 antibodies in patients with various types of malignant tumors

Proceedings: AACR 103rd Annual Meeting 2012‐‐ Mar 31‐Apr 4, 2012; Chicago, IL Background: Esophageal cancer is still a disease with a high degree of fatality despite resent advances in surgical techniques and various therapies. Several serum tumor markers have been applied to diagnose and to follow-up in patients with esophageal cancer in clinical practice in Japan. The aim of this study was to investigate the diagnostic and prognostic significance of various serum tumor markers in patients with esophageal cancer. Methods: Eighty one patients with esophageal cancer were recruited for this study. Serum level of tumor markers, squamous cell carcinoma antigen(SCC-Ag), p53 antibody(p53-Ab) carcinoembryonic antigen(CEA), and CYFRA 21-1, were measured in subjects before treatment. The results of these tumor markers were compared with the clinicopathological findings of the subjects. Results: The positive rates of SCC-Ag, p53-Ab, CEA and CYFRA 21-1 were 44%, 34%, 17%, and 16% patients with esophageal cancer, respectively. SCC-Ag and p53-Ab showed positive with a relatively high frequency in cases of early stage esophageal cancer or superficial invasion, while CEA and CYFRA 21-1 could rarely be detected in such cases. Positive for SCC-Ag was significantly higher in patients with tumor invading into or through the musclaris propria than the patients within the submucosal layer. Substantially, the positive rate of SCC-Ag was associated with an advanced stage of disease. Values of p53-Ab in serum virtually demonstrated gradual decrease after treatment, not rapid depletion. All negative cases for p53-Ab before treatment showed negative at any point of treatment or follow-up on a consistent basis. CYFRA 21-1 showed positive in cases with distant metastasis. Conclusion: Each tumor marker for esophageal cancer presented different features in a clinicopathological analysis. The use of several combination of serum tumor markers seems to be most important for the detection and follow-up for of esophageal cancer at present. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3623. doi:1538-7445.AM2012-3623

Abstract 1755: Utility of anti-p53 antibody in blood as a predictive marker for the detection of early recurrence in postoperative patients with esophageal carcinoma

Proceedings: AACR 102nd Annual Meeting 2011‐‐ Apr 2‐6, 2011; Orlando, FL Background: Circulating anti-p53 antibody(p53-Ab) in blood can be detected in various cancers. Serum p53-Ab has been applied as a tumor marker in clinical practice. We studied the clinical significance of p53-Ab in patients with esophageal, colorectal, and breast carcinoma. Methods: p53-Ab in serum was measured with Enzyme-linked immunosorvent assay (ELISA) before treatment in 51 patients with esophageal carcinoma, 54 patients with colorectal carcinoma, and 84 patients with breast carcinoma. clinical and pathological features of these cancers The association between clinicopathological factors of these cancers and the level of p53-Ab in serum was evaluated. Results: Twenty-one(41%) of 51 patients with esophageal cancer, 23 (42%) of 54 with colorectal cancer, and 26 (30%) of 84 with breast cancer were diagnosed as p53-Ab positive according to the Manufactures cut-off value. p53-Abs in serum were observed in all these cancer patients with earlier stage. Positive p53-Ab cases in esophageal, colorectal, and breast cancer in stage I were 33%, 25%, and 35%, respectively. There was no correlation between the positive cases and the age, sex, lymph node metastases, distant metastases, or tumor stage. Conclusion: This study showed that p53-Ab in serum was frequently detected in patients with esophageal, colorectal, and breast cancer. p53-Ab can be a promising tumor marker for the early detection of these cancers. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 3187. doi:10.1158/1538-7445.AM2011-3187

Clinical significance of a standardized clinical pathway in gastrectomy patients

Background: Circulating anti-p53 antibody(p53-Ab) in blood can be detected in various cancers. Serum p53-Ab has been applied as a tumor marker in detecting esophageal squamous cell carcinoma (ESCC). However, little is known about prognostic value for postoperative patients with ESCC. We evaluate the significance of preoperative serum p53-Ab as a potential marker of early recurrence after curative resection for ESCC. Methods: Anti-p53 antibodies in serum was measured with Enzyme-linked immunosorvent assay (ELISA) to analyze serum p53-Ab before treatment in 44 patients with ESCC. Squamous cell carcinoma antigen(SCC-Ag) and Carcinoembryonic antigen (CEA) as popular tumor markers for ESCC were measured simultaneously by immunoradiometric assay to compare with the p53-Ab results. Clinicopathological characteristics were also examined. Kaplan-Meier survival analyses were used to analyze the association with prognosis. Results: The recurrence-free rate was significantly higher in patients negative for p53-Ab in serum than those strongly positive for p53-Ab (p=0.0002). The patients positive for p53-Ab in serum were more likely to have early recurrence after curative resection than patients negative for p53-Ab (p=0.05). On the other hand there were no significant correlations between CEA, SCC-Ag positivity and early recurrence. Conclusions: This study suggests that p53-Ab in serum is a promising tumor marker to predict a risk of early recurrence after curative surgical resection for ESCC. Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 1755.