Seiji Ishiguro

Effect of alcohol consumption, cigarette smoking and flushing response on esophageal cancer risk: A population-based cohort study (JPHC study)

We examined the effect of alcohol consumption, cigarette smoking and flushing response on esophageal squamous cell carcinoma (ESCC) in a large-scale population-based cohort study. 44,970 middle-aged and older Japanese men were followed. A total of 215 cases of ESCC were newly diagnosed. Alcohol consumption and cigarette smoking are strongly associated with the incidence of ESCC. Heavy alcohol consumption increased the risk of ESCC especially among heavy smokers with the flushing response (HR = 3.41, 95% CI = 2.10-5.51). Strong effect modification was detected in heavy smokers. Our results suggest that heavy alcohol consumption together with heavy smoking may increase the risk of ESCC particularly in individuals with the flushing response.

Pelvic exenteration for clinical T4 rectal cancer: Oncologic outcome in 93 patients at a single institution over a 30-year period

BACKGROUND Patients with stage T4 rectal cancer are known to have poor survival and often require pelvic exenteration (PE). We describe the oncologic outcome of PE for patients with clinical T4 rectal cancer over a 30-year period. METHODS Data for 93 patients with primary rectal cancer who underwent PE between 1975 and 2005 were reviewed retrospectively. RESULTS Curative resection was performed in 91 patients (97.9%). Estimated 5-year overall survival (OS) and 5-year recurrence-free survival (RFS) rates were 52% and 46%, respectively. Irradiation was administered in 18 patients (19.4%). Local recurrence was observed in 7 patients, of whom 6 had lymph node (LN) involvement. Estimated local recurrence rate at 2 years was 8.6% (2.0% in node-negative and 16.4% in node-positive patients). Multivariate analysis demonstrated that lateral pelvic LN involvement (P = .03), a carcinoembryonic antigen level of >10 ng/dL (P = .04), and lymphovascular invasion (P = .04) were significantly associated with decreased OS. Only lateral pelvic LN involvement was significantly associated with decreased RFS (P = .01). CONCLUSION For patients with clinical T4 rectal cancer, PE can provide an opportunity for long-term survival and good local control. Patients with lateral pelvic LN involvement should be offered adjuvant treatment pre- or postoperatively to improve prognosis after PE.

Intersphincteric resection for very low rectal adenocarcinoma: univariate and multivariate analyses of risk factors for recurrence.

BackgroundThe aim of this study was to analyze the risk factors for local and distant recurrence after intersphincteric resection (ISR) for very low rectal adenocarcinoma.MethodsOne hundred twenty consecutive patients with T1–T3 rectal cancers located 1–5 (median 3) cm from the anal verge underwent ISR. Univariate and multivariate analyses of prospectively recorded clinicopathologic parameters were performed.ResultsFifty patients had disease categorized as stage I, 21 as stage II, 46 as stage III, and 3 as stage IV on the basis of International Union Against Cancer tumor, node, metastasis staging system. Median follow-up time was 3.5 years. The 3-year rates of local and distant recurrence were 6% and 13%, respectively. Univariate analysis of the risk factors for local recurrence revealed pathologic T, pathologic stage, focal dedifferentiation, microscopic resection margins, and preoperative serum CA 19-9 level to be statistically significant. Multivariate analysis showed resection margin, focal dedifferentiation, and serum CA 19-9 level to be independently significant. Univariate analysis of the risk factors for distant recurrence indicated tumor location, combined resection, tumor annularity, pathologic N, lateral pelvic lymph node metastasis, pathologic stage, histologic grade, lymphovascular invasion, perineural invasion, and adjuvant chemotherapy to be significant. Multivariate analysis identified pathologic N, histologic grade, and tumor location to be independently significant.ConclusionProfiles of risk factors for local and distant recurrences after ISR are different. With local recurrence, the resection margin, focal dedifferentiation, and serum CA 19-9 level are important. For distant recurrence, the lymph node status, histologic grade, and tumor location need to be taken into account.

Abdominal sacral resection for posterior pelvic recurrence of rectal carcinoma: analyses of prognostic factors and recurrence patterns.

BackgroundLocal recurrence of rectal cancer presents challenging problems. Although abdominal sacral resection (ASR) provides pain control, survival prolongation, and possibly cure, reported morbidity and mortality are still high, and survival is still low. Thus, appropriate patient selection and adjuvant therapy based on prognostic factors and recurrence patterns are necessary. The purpose of this study was to evaluate the results of ASR for posterior pelvic recurrence of rectal carcinoma and to analyze prognostic factors and recurrence patterns.MethodsForty-four patients underwent ASR for curative intent in 40 and palliative intent in 4 cases. All but one could be followed up completely. Multivariate analyses of factors influencing survival and positive surgical margins were conducted.ResultsMorbidity and mortality were 61% and 2%, respectively. Overall 5-year survival was 34%. The Cox regression model revealed a positive resection margin (hazard ratio, 10 [95% confidence interval, 3.8–28]), a local disease–free interval of <12 months (4.2 [1.8–9.8]), and pain radiating to the buttock or further (4.2 [1.6–11]) to be independently associated with poor survival. The logistic regression model showed that macroscopic multiple expanding or diffuse infiltrating growths were independently associated with a positive margin (7.5 [1.4–40]). Of the patients with recurrence, 56% had failures confined locally or to the lung.ConclusionsASR is beneficial to selected patients in terms of survival. To select patients, evaluation of the resection margin, the local disease–free interval, pain extent, and macroscopic growth pattern is important. To improve survival, adjuvant treatment should be aimed at local and lung recurrences.

Second Hepatectomy for Recurrent Colorectal Liver Metastasis: Analysis of Preoperative Prognostic Factors

BackgroundSecond hepatectomy is a potentially curative treatment for patients with hepatic recurrence of colorectal cancer. However, there is still no consensus about the patient selection criteria for second hepatectomy under these circumstances, and the factors affecting prognosis after second hepatectomy remain uncertain.MethodsClinicopathologic data for 111 consecutive patients with colorectal liver metastasis who underwent second hepatectomy at a single institution between 1985 and 2004, and for whom complete clinicopathologic reports were available, were subjected to univariate and multivariate analyses.ResultsThe morbidity and mortality rates were 14% and 0%, respectively, and the overall 5-year survival rate was 41%. Multivariate analysis revealed that synchronous resection for the first liver metastasis (hazard ratio, 1.8), more than three tumors at the second hepatectomy (1.9), and histopathological involvement of the hepatic vein and/or portal vein by the first liver metastasis (1.7) were independently associated with poor survival. We used these three risk factors to devise a preoperative model for predicting survival. The 5-year survival rates of patients without any risk factors, and with one, two, or three risk factors, were 62%, 38%, 19%, and 0%, respectively.ConclusionsSecond hepatectomy is beneficial for patients without any risk factors. Before second hepatectomy, chemotherapy should be considered for patients with any of these risk factors, especially with two or three factors, in the adjuvant or neoadjuvant setting to prolong survival. These results need to be confirmed and validated in another data set or future prospective trial according to the scoring scheme we outline.

Double layer formation caused by contact between different temperature plasmas

The formation of an electrical potential difference between hot and cold plasmas is studied by means of a particle simulation. It is found that a double layer structure is formed on the hot‐plasma side of the contact surface between the cold and hot plasmas. The potential difference is given approximately by φDL∼Teh/2e, where Teh and e are the hot‐electron temperature and the electronic charge, respectively. The double layer is accompanied by a negative potential dip on the low potential side (cold plasma) of the double layer, the depth of which is φdip∼2Tec/e, where Tec is the cold‐electron temperature. Interestingly, however, the positive potential difference and the negative potential dip are created independently.

Serum aminotransferase level and the risk of hepatocellular carcinoma: a population-based cohort study in Japan.

Aminotransferase level is presumed to be a marker of hepatic inflammation, but uncertainty remains whether elevated aminotransferase levels are associated with an increased risk of hepatocellular carcinoma (HCC). We evaluated the incidence of HCC by aminotransferase level in 19 812 middle-aged and older individuals with and without hepatitis virus infection from a large-scale population-based cohort study (JPHC Study cohort II) in Japan. Hepatitis virus infection was identified at baseline in 1236 participants, namely 737 (3.7%) with hepatitis C virus, 479 (2.4%) with hepatitis B virus, and 20 (0.1%) with both. By the end of follow-up, a total of 109 newly arising HCC cases were diagnosed (71 men, 38 women), of which 87 (79.8%) had evidence of viral etiology. Alanine aminotransferase (ALT) was concentration-dependently associated with an increased risk of HCC in both virus-positive and virus-negative participants. Compared with virus-negative participants with ALT levels of less than 30 IU/l, a significant increase in the risk of HCC was observed in virus-negative participants with an ALT level greater than 30 IU/l, and in virus-positive participants with an ALT less than 30 IU/l, 30–69 IU/l, and ≥70 IU/l [Hazard ratio (95% confidence interval): 9.4 (3.9–22.3), 15.2 (6.1–37.6), 180.5 (89.4–364.2), 454.2 (221.5–931.2), respectively; P for trend <0.001]. In conclusion, our findings suggest that elevated ALT levels are strongly associated with the incidence of HCC regardless of hepatitis virus positivity. This finding indicates that ALT level is a good independent determinant of the need for intervention. Clinical application of these findings may help decrease HCC-associated mortality in hepatitis virus-endemic regions.

Wound infection after a laparoscopic resection for colorectal cancer.

PurposeThe aim of this study was to investigate whether the wound infection (WI) rate in laparoscopic surgery (LS) for colorectal cancer is lower than that in open surgery (OS), and to evaluate the influence of perioperative intravenous antibiotic prophylaxis on the development of WI in LS.MethodsWe performed a meta-analysis study comparing the WI rate in patients who underwent either OS or LS in randomized controlled trials (RCTs), with a relatively large number of registered patients. Moreover, a subgroup analysis of recently reported RCTs from Japan was performed, and 290 consecutive patients who underwent LS for colorectal cancer at our institution were evaluated for the influence of perioperative intravenous antibiotic prophylaxis on the development of WI.ResultsThe WI rate of the LS group was significantly lower than that of the OS group in a meta-analysis; however, no positive effect of the intra-and postoperative antibiotic prophylaxis on the development of WI was demonstrated.ConclusionsLaparoscopic surgery for colorectal cancer is considered a surgical technique that has a lower incidence of WI in comparison to OS. Well-designed prospective, randomized controlled trials should therefore be conducted to evaluate whether intraoperative repeated dosing or postoperative repeated dosing is effective in reducing WI in LS.

Wound infection after elective laparoscopic surgery for colorectal carcinoma

BackgroundThe aim of this study was to evaluate various clinical parameters that would influence the occurrence of wound infection (WI) in elective laparoscopic surgery (LS) for colorectal carcinoma.MethodsThe study included 290 patients who underwent LS between June 2001 and December 2005. WI was diagnosed within 30 days of the operation, and both superficial and deep incision surgical site infection were evaluated together.ResultsEighteen (6.2%) were diagnosed with WI. Of the infected patients, nine (50%) had WI at the extraction site, six (33%) at the port site of the drainage tube, and three (17%) at the supraumbilical incision. Following bivariate analysis, the variables of stoma creation, intraoperative hypotension, and length of operation were selected for multivariate analysis as their P values were <0.2, the predominant cutoff, and stoma creation and intraoperative hypotension were independently predictive of developing WI. Regarding the duration of postoperative hospital stay, there was no significant difference between patients with or without WI.ConclusionsStoma creation and intraoperative hypotension were independent risk factors for WI. The results obtained in this study should be considered in an effort to prevent WI in LS for colorectal carcinoma, although these risk factors need further evaluation.

Impact of viral load of hepatitis C on the incidence of hepatocellular carcinoma: A population-based cohort study (JPHC Study).

Impact of viral load of HCV on the incidence of hepatocellular carcinoma was investigated using a population-based cohort consisting of 20,794 Japanese. A total of 114 newly arising cases of hepatocellular carcinoma were diagnosed during follow-up. Compared to the hepatitis virus-negative group, the hazard ratio (HR) of developing hepatocellular carcinoma was 35.8-fold higher in HCV monoinfection (95% confidence interval [CI], 20.7-62.7). A titer-dependent increase in risk was not identified. The risk was 3.86-fold higher (CI; 1.73-8.62) for genotype 1 than genotype 2. Our findings suggest that HCV viremia strongly influences the occurrence of hepatocellular carcinoma without titer-dependence.