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Publication
Featured researches published by Toshihiro Saito.
Scandinavian Journal of Gastroenterology | 2004
Takashi Yokota; Shuichi Ishiyama; Toshihiro Saito; Shin Teshima; Y. Narushima; Katsuyuki Murata; Kazutsugu Iwamoto; R. Yashima; Hidemi Yamauchi; S. Kikuchi
Background: In Japan, the standard treatment policy for all potentially curable patients with gastric cancer is radical resection including extensive lymphadenectomy. This treatment strategy has been used for both early and advanced gastric cancers, and substantial increases in survival time have been reported. In advanced gastric cancer, lymphatic spread is reported to be one of the most relevant prognostic factors for gastric cancer resected for cure. The purpose of this study was to determine the factors affecting lymph node involvement and to establish guidelines for the extent of lymph node dissection most appropriate for the treatment of gastric cancer. Methods: The clinicopathological features of 926 patients with gastric cancer were reviewed. Information on the clinicopathological features was obtained from the database of gastric cancer at the Department of Gastroenterological Surgery, Sendai National Hospital. Univariate and multivariate analyses of data for patients with gastric cancer tumors were performed to evaluate the prognostic significance of clinicopathological features. The independent risk factors influencing lymph node metastasis were determined by multiple logistic regression analysis. Results: The following clinicopathologic factors were found to be correlated with prognosis of gastric cancer: (1) macroscopic type, (2) depth of invasion, (3) cancer‐stromal relationship, (4) histological growth pattern, (5) lymph node involvement, (6) lymphatic invasion, (7) vascular invasion and (8) tumor site. However, a multivariate analysis revealed that macroscopic type, depth of invasion, lymph node involvement and tumor site are independent risk factors for the prognosis of gastric cancer patients. Among these factors, the prognosis of patients with gastric cancer was most strongly influenced by lymph node involvement (odds ratio, 4.632). According to a multiple logistic regression model, depth of cancer invasion and lymphatic invasion was significantly correlated with lymph node metastases. Conclusions: Lymph node involvement has the strongest influence on the prognosis of gastric cancer. Among the clinicopathological factors, depth of invasion and microscopically lymphatic invasion are important factors in predicting lymph node metastases. Thus, the ability to perform gastrectomy with dissection of lymph nodes is a basic requirement for gastric cancer surgeons.
Lancet Oncology | 2003
Takashi Yokota; Shuichi Ishiyama; Toshihiro Saito; Shin Teshima; Masataka Shimotsuma; Hidemi Yamauchi
Surgical practice for gastric cancer in Japan is based on the Gastric Cancer Treatment Guidelines issued in 2001 by the Japanese Gastric Cancer Association. These recommendations list options for treatment of each stage of cancer, with clear distinctions between interventions recommended for routine use and those that should be confined to trial settings until further evidence for their curative potential becomes available. In this review, we discuss standard surgery, local resection, segmental resection, and pylorus-preserving gastrectomy (PPG) as examples of limited resection and describe in detail the indications for limited lymph-node dissection in cases of early-stage gastric cancer. At present, evidence does not support the conclusion that limited surgery is effective for local resection or for improving quality of life. Thus, use of limited surgery should be considered an experimental approach both in Japan and the West. We conclude that surgeons who are familiar with the criteria for selecting surgical procedures should decide on a case-by-case basis which technique is most appropriate. Choices should be made with consideration of the stage of the cancer, invasiveness of the surgical procedure, and the patients history. For all procedures, the patient must give informed consent and the surgeons must accurately assess the success of the operation after surgery.
Digestive Endoscopy | 2002
Masahiro Iwabuchi; Nobuo Hiwatashi; Tatsuhiko Suzuki; Shin Teshima; Toshihiro Saito; Hiroyoshi Suzuki; Yoshimasa Mori; Junichi Ishibashi; Nobuyuki Chida; Keiichi Tadokoro
We present a rare case of multiple colonic metastases from advanced gastric cancer presenting colon depressed‐type multiple early cancer (IIc)‐like configuration. The case was a 74‐year‐old man who presented with a symptom of abdominal fullness. Colonoscopy and barium enema study revealed multiple IIc‐like lesions, which were shown histologically to be metastatic deposits of signet ring cell carcinoma. He had synchronous gastric cancer, which histologically demonstrated moderate to poorly differentiated adenocarcinoma with signet ring cell differentiation. In addition, he had concomitant multiple small bowel metastatic lesions. This appears to be the first published report of multiple IIc‐like colonic metastatic lesions from a gastric cancer.
Upsala Journal of Medical Sciences | 1999
Takashi Yokota; Yasou Kunii; Shin Teshima; Yasuo Yamada; Toshihiro Saito; Michinori Takahashi; Shu Kikuchi; Hidemi Yamauchi
BACKGROUND We evaluated the influence of several clinicopathologic variables on 5-year survival of patients with gastric cancer associated with esophageal or duodenal invasion, and determined the significance of resection line involvement. PATIENTS AND METHODS A review of the database for gastric adenocarcinoma at Sendai National Hospital between January 1985 and December 1995 identified 923 patients who underwent gastric cancer resection. Of these patients, 37 were reported to have tumour infiltration of the esophagus or duodenum on histological examination of the resected specimens. Univariate and multivariate analyses of patients with esophageal or duodenal invasion were performed to evaluate the prognostic significance of clinicopathologic features. Then the patients were divided into two groups based on the results of microscopic examination: a tumour wedge-positive group for resection margins of less than 5 mm in width and a tumour wedge-negative group for resection margins of more than 5 mm in width. There were 8 patients in the narrow (margin-positive) group and 29 patients in the wide margin (margin-negative) group, respectively. RESULTS Univariate analysis revealed that the significant prognostic factors were nodal involvement (p=0.0004) and gross type (p=0.0031). Multivariate analysis of the esophagus or duodenum-invaded cancer cases, however, revealed that only nodal involvement was a significant prognostic factor. There were statistical correlations between these groups (margin-positive and margin-negative groups) and the Borrmann type of tumour and tumour size. The survival rate was worse in patients with tumour line involvement. CONCLUSIONS Multivariate analysis revealed that the prognosis of patients with esophageal or duodenal invasion was affected only by nodal involvement independently. The risk of surgical margin involvement was high in cases of a large Borrmann type-4 tumour and infiltrative carcinoma.
Upsala Journal of Medical Sciences | 1999
Takashi Yokota; Yasuo Kunii; Toshihiro Saito; Shin Teshima; Yasuo Yamada; Michinori Takahashi; Shu Kikuchi; Hidemi Yamauchi
Data of 58 cases of poorly differentiated, solid-type adenocarcinoma of the stomach treated at our hospital between 1985 and 1995 were reviewed and compared to data of 146 cases of non-solid-type carcinoma in order to determine whether there are distinguishable clinicopathological features between these two types of carcinoma. Significant differences were observed with respect to tumor size, stage, macroscopic appearance, depth of invasion, histologic growth pattern, lymph node metastasis, microscopical lymphatic invasion and vascular permeation. Patients in the solid-type cancer group tended to have smaller tumors; the disease was in the early stage in 48% of the patients, and total gastrectomy was performed in only 20 of the 58 patients. Nodal involvement, lymphatic invasion and vascular permeation were also less common in patients with solid-type cancer. The overall survival rate of patients with solid-type carcinoma was higher than that of patients with non-solid-type carcinoma, though no significant differences were observed when corrected for stage. Our results suggest that poorly differentiated solid-type carcinoma of the stomach should be regarded as a distinct type of adenocarcinoma that has a good prognosis. The significant prognostic factors for this type of gastric cancer are lymphatic invasion and tumor location.
Upsala Journal of Medical Sciences | 2002
Shin Teshima; Kenji Kakizaki; Toshihiro Saito; Takashi Yokota; Hidemi Yamauchi
Clinicopathological characteristics, stromal volume (Vvf), nuclear DNA content and cell protein were retrospectively analyzed in order to scrutinize the risk factors of hepatic metastasis from carcinoma of the stomach. We conducted a clinicopathological study of 327 patients with gastric cancer, including 34 patients with liver metastasis (synchronous, 22; metachronous, 12) and 294 patients without liver metastasis. Univariate analysis revealed significant inter-group differences in tumor size (p<0.001), depth of invasion (p<0.001), lymph node metastasis (p<0.001), vascular involvement (p<0.001), lymphatic involvement (p<0.001), peritoneal dissemination (p<0.05), Vvf (p<0.01) and DNA content (p<0.01). Vvf and DNA content were estimated in the liver metastasis group (n=20) and in the group of patients with stage III-IVa carcinoma but without liver metastasis (n=11). In multivariate analysis, only Vvf and DNA content showed significant correlations with liver metastasis (p<0.01). A comparison of Vvf and expression of the amount of interstitial connective tissue showed that there as a significant correlation between them. Our results indicate that gastric cancer with low Vvf and high DNA content carries a high risk of hepatic metastasis. Therefore, mean DNA content and Vvf are useful indices for predicting liver metastasis from gastric carcinoma.
Tohoku Journal of Experimental Medicine | 1998
Takashi Yokota; Yasuo Kunii; Shin Teshima; Yasuo Yamada; Toshihiro Saito; Shu Kikuchi; Hidemi Yamauchi
Anticancer Research | 2002
Takashi Yokota; Shuichi Ishiyama; Toshihiro Saito; Shin Teshima; Yasuo Yamada; Kazutsugu Iwamoto; Michinori Takahashi; Katsuyuki Murata; Hidemi Yamauchi
International Surgery | 2000
Takashi Yokota; Yasuo Kunii; Shin Teshima; Yasuo Yamada; Toshihiro Saito; Michinori Takahashi; Shu Kikuchi; Hidemi Yamauchi
International Surgery | 1998
Takashi Yokota; Toshihiro Saito; Shin Teshima; Shu Kikuchi; Yasuo Kunii; Hidemi Yamauchi
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National Institute of Advanced Industrial Science and Technology
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