Toshiro Wakatsuki

Prophylactic therapy for peritoneal recurrence of gastric cancer by continuous hyperthermic peritoneal perfusion with mitomycin C

Continuous hyperthermic peritoneal perfusion (CHPP) with a solution that contains mitomycin C (CHPP‐M) has been clinically introduced as a prophylactic treatment for peritoneal recurrence of gastric cancer with serosal invasion. Two studies, each with a treated and a control group, were performed. In the historical control study the postoperative 3‐year survival rate of patients (73.7%) in the treated group (n = 38) was significantly higher than the survival rate (52.7%) of those in the control group (n = 55) (P < 0.04). In the random control study the survival rate (83%) of patients in the treated group (n = 26) was also higher than that (67.3%) of those in the control group (n = 21) in the 30 months that followed gastric surgery. However, there was no significant difference. In the historical control study with respect to the postoperative complications, anastomotic leak was observed in 8.5% of patients who were given CHPP‐M and 12.8% patients who did not have CHPP‐M. In the random control study anastomotic leak was observed in 3.1% of patients who had CHPP‐M and 7.1% of patients who did not have CHPP‐M. The incidence of adhesive ileus in patients having CHPP‐M did not increase in historical or random control groups. Postoperative prolonged intestinal paresis or chemical peritonitis were not induced by CHPP‐M. These results indicate that CHPP‐M is a simple, safe, and readily available prophylactic therapy for peritoneal recurrence that may follow gastric cancer surgery.

Carcinoembryonic Antigen in Gastric Cancer Patients

Carcinoembryonic antigen (CEA) levels were determined in 252 gastric cancer patients. In patients with resectable cancer, the preoperative CEA values and CEA positivity rates were 2.4 +/- 1.5 ng/ml and 7.7% for stage I, 24.9 +/- 72.0 ng/ml and 10.0% for stage II, 21.6 +/- 84.1 ng/ml and 17.9% for stage III, and 6.3 +/- 8.4 ng/ml and 27.1% for stage IV cancers, respectively. In patients with nonresectable cancers, the CEA value was 83.0 +/- 235.5 ng/ml, the CEA positivity rate was 47.8%. Overall, of 252 patients with primary gastric cancer, 47(18.7%) were positive for CEA. In patients with cancer recurrence, the CEA value averaged 41.8 +/- 101.8 ng/ml, the positivity rate was 63%. This rate increased as the cancer stage increased; it was highest in gastric cancer patients with liver metastasis. In 4 of 13 patients with recurrence, an elevation in CEA was observed about 4.8 months before the clinical detection of cancer recurrence. Our results suggest that in gastric cancer patients, the preoperative and periodic postoperative assay of CEA levels has predictive value in determining cancer stage, progression and recurrence.

Topoisomerase I expression in tumors as a biological marker for CPT-11 chemosensitivity in patients with colorectal cancer.

Irinotecan (CPT-11) is used as a first- and second-line chemotherapy for advanced or recurrent colorectal cancer (CRC). However, only 20%–30% of patients show an objective response to CPT-11 and the drug has severe toxicities, such as delayed-onset diarrhea, neutropenia, nausea, and vomiting. It is important to select patients who will demonstrate sensitivity to CPT-11 treatment to avoid unnecessary drug toxicities and to introduce anticancer treatment benefits to CRC patients. DNA topoisomerase I (Topo I) is essential for vital cellular processes such as DNA replication, transcription, translation, recombination, and repair. This article reviews the possibility of assessing Topo I protein expression in tumors as a biological marker for CPT-11 treatment in CRC.

Length of Stay and Cost for Surgical Site Infection after Abdominal and Cardiac Surgery in Japanese Hospitals: Multi-Center Surveillance

PURPOSE This study evaluated the influence of surgical site infections (SSIs) after abdominal or cardiac surgery on the post-operative duration of hospitalization and cost. METHODS A retrospective 1:1 matched case-control study of length of stay and healthcare expenditures for patients who were discharged from nine hospitals, between April 1, 2006 and March 31, 2008, after undergoing abdominal or cardiac surgery and who did and did not have a SSI. RESULTS Information was obtained from 246 pairs of patients who had undergone abdominal surgery and 27 pairs of patients who had undergone cardiac surgery. Overall, the mean post-operative hospitalization was 20.7 days longer and the mean post-operative healthcare expenditure was

A new pouch reconstruction method after total gastrectomy (pouch-double tract method) improved the postoperative quality of life of patients with gastric cancer

8,791 higher in the SSI group than for the SSI-free group. Among the patients who had undergone abdominal surgery, development of SSI extended the average hospitalization by 17.6 days and increased the average healthcare expenditure by

Negative correlation between cholecystectomy and the subsequent development of large bowel carcinoma in a low-risk Japanese population

6,624. Among the patients who had undergone cardiac surgery, SSI extended the post-operative hospitalization by an average of 48.9 days and increased the post-operative healthcare expenditure by an average of

Corrigendum to “Antimicrobial susceptibility of common pathogens isolated from postoperative intra-abdominal infections in Japan” [J Infect Chemother 24 (2018) 330–340]

28,534. CONCLUSIONS Under the current healthcare system in Japan, the development of SSI after abdominal surgery necessitates extension of hospitalization two-fold and increases the post-operative healthcare expenditure 2.5-fold. Development of SSI after cardiac surgery necessitates extension of hospitalization fourfold and increases the healthcare expenditure six-fold.

PRIMARY CANCER OF THE SMALL INTESTINE ARISEN IN THE ELEVATED INTESTINE AFTER TOTAL GASTRECTOMY

PurposeMany reconstruction methods after total gastrectomy (TG) lead patients to dumping syndrome, reflux esophagitis, and poor postoperative quality of life (QOL). To improve patients’ postoperative QOL after TG, we introduce a new reconstruction method named “pouch-double tract” (PDT).MethodsA prospective randomized study was performed between 2005 and 2007 in 29 patients who were diagnosed as stage I or II gastric cancers preoperatively. Patients were followed until the end of 2009. Conventional Roux-en-Y reconstruction (RY) was performed in 15 patients, and PDT was used in 14 patients. Postoperative patients’ nutritional assessments and patients’ QOL were compared between the groups.ResultsPDT did not increase morbidity or mortality compared with RY. Patients in the PDT group did not complain of dumping and showed better postoperative food intake. Body weight recovered better in PDT than in RY.ConclusionPDT is safe and associated with better nutritional status compared with the RY.

Impact of surgical site infection after colorectal surgery on hospital stay and medical expenditure in Japan

The incidence of previous cholecystectomy in a series of 541 patients with colorectal cancer and 1832 patients with stomach cancer was studied. Five patients (0.92 percent) with colorectal cancer and eight (0.44 percent) with stomach cancer had undergone previous cholecystectomy. To avoid biases in the two groups of patients, 416 pairs of patients, comparable in sex, age, and time of admission for cancer treatment, were matched from each group to compare the number of patients who had undergone previous cholecystectomy. Within these matched pairs, three patients with colorectal cancer and two with stomach cancer had histories of cholecystectomy. Hence, no substantial difference was noted between the two groups. In a follow-up study of 461 patients who had undergone cholecystectomy for gallstones, large bowel carcinoma and stomach carcinoma developed in one and six patients, respectively, during an observation period of four to 36 years. The ratio of patients with large bowel cancer to those with stomach cancer observed in this survey was almost equal to the value estimated for the population of Tottori Prefecture, where the majority of the patients reside.The incidence of larg bowel carcinoma is not increased among cholecystectomized patients in a low-risk Japanese population.

Relationship between expression of apoptosis-related proteins and the efficacy of postoperative chemotherapy in patients with T3 gastric cancer.

Yoshio Takesue a, w, , Shinya Kusachi a, , Hiroshige Mikamo a, , Junko Sato , Akira Watanabe , Hiroshi Kiyota , Satoshi Iwata , Mitsuo Kaku , Hideaki Hanaki , Yoshinobu Sumiyama c, , Yuko Kitagawa c, , Kazuhiko Nakajima , Takashi Ueda , Motoi Uchino , Toru Mizuguchi , Yoshiyasu Ambo , Masafumi Konosu , Keiichiro Ishibashi , Akihisa Matsuda , Kazuo Hase , Yasushi Harihara , Koji Okabayashi , Shiko Seki , Takuo Hara , Koshi Matsui , Yoichi Matsuo , Minako Kobayashi , Shoji Kubo , Kazuhisa Uchiyama , Junzo Shimizu , Ryohei Kawabata , Hiroki Ohge , Shinji Akagi , Masaaki Oka , Toshiro Wakatsuki , Katsunori Suzuki , Kohji Okamoto , Katsunori Yanagihara ae