Kentaro Kawasaki

Family history of cancer in Japanese gastric cancer patients

The aim of this study was to evaluate the family history of cancer in Japanese gastric cancer patients and to investigate the clinicopathological features of gastric cancer patients with and without a family history of cancer. Four hundred and forty gastric cancer patients were enrolled in this study. The family history (first- and second-degree relatives) was investigated. The 440 patients were divided into three groups: (1) patients with a family history of gastric cancer; (2) patients with a family history of other cancers; and (3) patients without a family history of cancer. Two hundred and four patients (46.4%) reported a family history of cancer. Gastric cancer was the most frequent, with 98 patients having a total of 123 reports of gastric cancer in the family; colorectal cancer was the second most frequent and lung cancer was the third most frequent. The average ages of the group with a family history of gastric cancer and the group with a family history of other cancers were significantly lower than that of the patients without a family history of cancer. Other clinicopathological factors examined showed no significant difference between the groups. Japanese gastric cancer showed aggregation within second-degree relatives. The average age of the patients in the group with a family history of gastric cancer was the only significant factor that differed between gastric cancer patients with and without a family history of cancer.

Multidetector computed tomography for preoperative identification of left gastric vein location in patients with gastric cancer

BackgroundThe area near the left gastric vein (LGV) is a challenging site at which to perform dissection of the lymph nodes during gastrectomy. Therefore, knowledge of the precise location of the LGV is important. The objective of this study was to examine the usefulness of multidetector computed tomography (MDCT) for the identification of the LGV.MethodsEighty-one patients with gastric cancer underwent MDCT, which was performed with contrast media in 76 patients and without contrast media in 5 patients. A 5-mm thin slice of the frontal image was reconstructed. These images were examined preoperatively to detect the location of the LGV. Upon gastrectomy, the LGV was identified and its location compared to that determined by MDCT.ResultsThe LGV was identified by MDCT in 76 of the 81 patients (93.8%). The LGV was subsequently located during the operation in all 81 patients. The LGV was located dorsal to the common hepatic artery in 40 patients (49.4%), ventral to the common hepatic artery in 18 patients (22.2%), ventral to the splenic artery in 17 patients (21.0%), dorsal to the splenic artery in 2 patients (2.5%) and in other positions in 4 patients (4.9%). In all patients, the location of the LGV detected using MDCT was consistent with that identified during gastrectomy. In the 4 patients with relatively unusual locations of the LGV, these 4 LGV variants were identified preoperatively by MDCT.ConclusionMDCT was useful for identifying the location of the LGV prior to gastrectomy.

Experimental evaluation of the mechanical strength of stapling techniques.

BackgroundThe single stapling technique (SST) and the double stapling technique (DST) are common anastomoses for rectal cancer. Although many mechanical devices have been developed, the best choice remains unclear. In this study we examined the strength of anastomoses by determining their bursting pressures using an animal model.MethodsThe intestines of pigs were used. In experiment 1, we compared the bursting pressures for Endo GIA™ 60 blue, Endo GIA™ 60 green, and GIA™ 60 blue. In experiment 2, the bursting pressures of a buttressed cutting site and a nonbuttressed cutting site were measured. In experiment 3, the SST, DST, and DST with buttress using PCEEA™ were performed and the bursting pressures and points of these anastomoses were examined.ResultsThe bursting pressure of Endo GIA 60 blue (80.3 ± 10.5 mmHg) was significantly higher than that of Endo GIA 60 green (37.3 ± 4.2 mmHg) and GIA 60 blue (31.7 ± 5.8 mmHg) (p < 0.01). When a cut end was buttressed, the bursting pressure (149.6 ± 37.6 mmHg) was significantly higher than that of the nonbuttressed end (75.3 ± 25.1 mmHg) (p < 0.01). The bursting pressure among SST, DST, and DST with buttress was not significantly different. Only one bursting point was the crossing point of the PCEEA and Endo GIA and the bursting pressure of this point was much lower than that of the others.ConclusionEndo GIA was most suitable for DST. The SST, DST, and DST with buttress had almost the same strength. The crossing point of PCEEA and Endo GIA may be a dangerous point for DST.

Differential expression of SHP2, a protein-tyrosine phosphatase with SRC homology-2 domains, in various types of renal tumour

Abstract SHP2, a widely distributed protein-tyrosine phosphatase with src homology-2 (SH2) domains, is highly expressed in the brain and may play a role in synaptic communications or cellular proliferation. In this study, we examined SHP2 protein expression in 110 renal cell tumours of various histological subtypes, including clear, granular, papillary, chromophobe, collecting duct, and sarcomatoid-type renal cell carcinoma (RCC), and oncocytoma. SHP2 was expressed predominantly in normal distal tubules and collecting ducts, and positivity in various types of renal tumours was as follows: clear cell RCC, 0% (0/77 cases); granular, 7.7% (1/13); papillary, 50% (3/6); sarcomatoid, 0% (0/1); chromophobe, 85.7% (6/7); collecting duct carcinoma, 0% (0/2); oncocytoma, 100% (4/4). Clear and granular-type RCCs showed a very low but positive expression of SHP2. Chromophobe RCC and oncocytoma showed the highest rates and strongest intensities of SHP2 protein on immunostaining. SHP2 may serve as a powerful marker in detecting rare tumours. Estimates of its expression may be useful in histological diagnosis.

Expression of urokinase-type plasminogen activator receptor and plasminogen activator inhibitor-1 in gastric cancer

In gastric cancer, the urokinase‐type plasminogen activator (uPA) system plays important roles in invasion and metastasis, processes which entail proteolysis and adhesion. Both the urokinasetype plasminogen activator receptor (uPAR) and the plasminogen activator inhibitor‐1 (PAI‐1) are thought to be important factors in this system. To clarify the relationship between these two factors and gastric cancer invasiveness, we evaluated the expression of uPAR and PAI‐1 in 91 cases of gastric cancer by immunohistochemistry and in situ hybridization. Urokinase‐type plasminogen activator receptor‐mRNA, PAI‐1‐mRNA, uPAR and PAI‐1 protein were diffusely distributed in the cytoplasm of the cancer cells and concentrated at invasive foci. Urokinase‐type plasminogen activator receptor protein expression correlated with lymphatic, venous invasion (P<.01) and lymph node metastasis (P<0.05); uPAR‐mRNA expression correlated with lymphatic, venous invasion and lymph node metastasis (P<0.05). Plasminogen activator inhibitor‐1 protein expression correlated with lymphatic, venous invasion, lymph node metastasis and depth of invasion (P<0.01); PAI‐1‐mRNA expression was linked to lymphatic, venous invasion (P<0.01), lymph node metastasis and depth of invasion (P<0.05). This suggests that the proteolytic activity of uPAR and the cellular motility of PAI‐1 in gastric cancer cells may determine penetration of lymphatic and blood vessels, whereby lymph node metastasis may be promoted and that the promotion of cellular motility by PAI‐1 may influence the depth of cancer invasion.

Clinicopathological features of esophageal cancer simultaneously associated with gastric cancer

Background and Objectives: We usually use the stomach for esophageal substitution in the surgical treatment of esophageal cancer, although it is often associated with gastric cancer. In order to improve the likelihood of safe and curative surgery of esophageal cancer, we investigated the clinicopathological characteristics of synchronous esophageal and gastric cancer.

Developmental expression of the tight junction protein, occludin, in the gastrointestinal tract of the chick embryo

Abstract The developmental expression of occludin was studied biochemically in whole chick embryos to determine when intercellular tight junctions develop. Occludin mRNA was first detected after 3 days of incubation by the reverse transcriptase-polymerase chain reaction. On northern blot analysis, although occludin mRNA was not discernible in 3-day-old embryos, weak but clear expression was noted on day 4 of incubation and increased dramatically in 5-day-old embryos. Occludin was not detectable on days 3 or 4 of incubation by western blot analysis, and was first detected in 5-day-old embryos. In addition, the expression of occludin was examined immunohistochemically in the gastrointestinal tract of 3- to 21-day-old embryos. Immunoreactivity for occludin was not expressed on day 3 of incubation. On day 4 of incubation, weak immunoreactivity was demonstrated in the gastrointestinal tract, and gradually became stronger with development. By day 11 of incubation, a positive immunoreaction was obtained only on the apical surfaces of the epithelial cells, i.e., at the junctional complexes, while weak immunoreactivity was diffusely distributed throughout the epithelial cells. The possible roles of occludin in the developing gastrointestinal tract are discussed.

Comparing the short-term outcomes of laparoscopic distal gastrectomy with D1+ and D2 lymph node dissection for gastric cancer

Laparoscopic distal gastrectomy (LDG) with D1+ lymph node dissection (LND) for early gastric cancer has been widely accepted. However, LDG with D2 LND for advanced gastric cancer remains in limited use. The aim of this retrospective study was to clarify the safety of LDG with D2 LND for gastric cancer.

Standardized laparoscopy-assisted distal gastrectomy with a novel surgical technique for lifting the liver.

BACKGROUND/AIMS It is very important to achieve a sufficient field and space in laparoscopic assisted distal gastrectomy (LADG) for a less-experienced surgeon. In this study, the usefulness of a novel surgical technique to lift the liver was evaluated in LADG. METHODOLOGY Fifty-four patients who underwent standardized LADG for gastric cancer using the novel technique of lifting the liver were retrospectively evaluated based on video records. Patient characteristics, the time required to lift the liver and for gastrectomy, total operation time, blood loss and complications were analyzed. RESULTS The mean time necessary to lift the liver using this novel technique was 240.1±86.1 seconds and that for gastrectomy was 167.6±50.4 minutes. Blood loss was 72.5±59.6mL. The morbidity rate was 4/54 (7.4%). CONCLUSIONS Standardized LADG using this novel technique is feasible and possible in a period of time.

Experimental Evaluation of the Mechanical Strength of the Stapling Techniques: Experimental Study on Animal Model

The creation of a gastrointestinal tract anastomosis is a fundamental and important surgical procedure. The mean incidence of clinically apparent leakage after gastrointestinal tract anastomosis ranges from 2.1% to 14.9%. Although many techniques for successfully producing such anastomoses have been described, the goal of these techniques to be technically feasible and safe. In the 1960s, Steichen and Ravitch introduced stapling instruments. During the subsequent years, automatic stapling instruments have continued to be refined, and many automatic anastomotic techniques have been applied to gastrointestinal surgery. In addition, various instruments and techniques for stapling intestinal anastomoses have been applied to colorectal surgery. Functional end-to-end anastomosis (FETEA), stapled end-to-end anastomosis (ETEA), and stapled side-to-end anastomosis (STEA) are the most common techniques. Moreover, there are two types of stapled ETEA, the single stapling technique (SST) and the double stapling technique (DST). Although these methods have been shown to be reliable and safe, anastomosis leakage remains a major problem. Major leakages affect the long-term quality of life (QOL) of patients. In addition, leakage can cause significant morbidity. Studies have reported that the frequency of leakage ranges from 2.9 to 23%, and that the shorter the distance from the anal verge to the anastomosis the greater the risk of leakage. As mentioned above, automatic stapling instruments have been refined over the years, and many automatic anastomotic techniques have been applied to colorectal surgery; however, the optimal instrument and method remain unclear. Since the mechanical strength of an anastomosis is an important factor affecting leakage during the initial postoperative phase, experimental evaluation of this factor would be useful for clarifying these issues. In this chapter, we examined the pressure required to induce failure (bursting pressure) in various kinds of stapled anastomosis and investigated which stapling technique is most suitable.