Yoshihide Otani

A multicenter retrospective study of endoscopic resection for early gastric cancer.

BackgroundThe reported outcomes of endoscopic resection (ER) for early gastric cancer (EGC) remain limited to several single-institution studies.MethodsA multicenter retrospective study was conducted at 11 Japanese institutions concerning their results for ER, including conventional endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD).ResultsA total of 714 EGCs (EMR, 411; ESD, 303) in 655 consecutive patients were treated from January to December 2001. Technically, 511 of the 714 (71.6%) lesions were resected in one piece. The rate of one-piece resection with ESD (92.7%; 281/303) was significantly higher compared with that for EMR (56.0%; 230/411). Histologically, curative resection was found in 474 (66.3%) lesions. The rate of curative resection with ESD (73.6%; 223/303) was significantly higher compared with that for EMR (61.1%; 251/411). Blood transfusion because of bleeding was required in only 1 patient (0.1%) with EMR of 714 lesions. Perforation was found in 16 (2.2%). The incidence of perforation with ESD (3.6%; 11/303) was significantly higher than that with EMR (1.2%; 5/411). All complications were managed endoscopically, and there was no procedure-related mortality. The median follow-up period was 3.2 years (range, 0.5–5.0 years). In total, the 3-year cumulative residual-free/recurrence-free rate and the 3-year overall survival rate were 94.4% and 99.2%, respectively. The 3-year cumulative residual-free/recurrence-free rate in the ESD group (97.6%) was significantly higher than that in the EMR group (92.5%).ConclusionER leads to an excellent 3-year survival in clinical practice and could be a possible standard treatment for EGC. ESD has the advantage of achieving one-piece resection and reducing local residual or recurrent tumor.

Clinical practice guidelines for gastrointestinal stromal tumor (GIST) in Japan: English version

Diagnostic and treatment strategies for gastrointestinal stromal tumors (GISTs) have evolved greatly since the introduction of molecularly targeted therapies. Although several clinical practice guidelines are extant, such as those published by the National Comprehensive Cancer Network and the European Society of Medical Oncology, it is not clear as to whether these are appropriate for clinical practice in Japan. Therefore, clinical practice guidelines for the optimal diagnosis and treatment of GIST tailored for the Japanese situation have often been requested. For this reason, the Japanese Clinical Practice Guideline for GIST was proposed by the GIST Guideline Subcommittee, with the official approval of the Clinical Practice Guidelines Committee for Cancer of the Japan Society of Clinical Oncology (JSCO), and was published after assessment by the Guideline Evaluation Committee of JSCO. The GIST Guideline Subcommittee consists of members from JSCO, the Japanese Gastric Cancer Association (JGCA), and the Japanese Study Group on GIST, with the official approval of these organizations. The GIST Guideline Subcommittee is not influenced by any other organizations or third parties. Revision of the guideline may be done periodically, with the approval of the GIST Guideline Subcommittee, either every 3 years or when important new evidence that might alter the optimal diagnosis and treatment of GIST emerges. Here we present the English version of the Japanese Clinical Practice Guideline for GIST prepared by the GIST Guideline Subcommittee.

Lymphatic mapping and lymphatic endothelial cell isolation in colorectal cancer patients

Background:  Sentinel lymph node (SLN) biopsy has already been established as a common procedure with malignant lymphoma and breast cancer. In colorectal cancer, however, the application of the SLN theory remains uncommon and its clinical significance is also unclear. In addition, the characteristics of the lymphatic vessels that connect SLNs or the lymphatic endothelial cells have been unclear. Our purpose is to determine the feasibility and accuracy of SLN mapping by intraoperative subserosal dye injection and to develop a novel method for the isolation of anatomically defined lymphatic endothelial cells.

The Development of Acute Gastric Mucosal Lesions Following Burn Stress

The stomach has many physiological functions, such as acid and pepsin secretion, mucus production and motility, which are supposed to be regulated by gastric mucosal blood flow. Therefore, blood flow is an extremely important defensive factor for the gastric mucosa. The present study was designed to elucidate the role of mucosal blood flow in the development of acute gastric mucosal lesions (AGML) after burn stress. Gastric mucosal blood flow and microcirculatory disturbance were investigated. Also, we examined the influence of gastric mucosal blood flow on the alternation of acid and pepsin activity, energy metabolism and mucus production (Hexosamine content).

Mechanism of metastasis of gastric cancer, from the viewpoint of basement membrane degradative enzyme.

上皮性癌の転移過程では, まず癌原発巣部における癌細胞の基底膜層の通過, 間質内での浸潤, その後に遭遇する脈管基底膜層の通過と脈管内への侵入, さらには転移としての着床部位における脈管外への遊出の際の脈管基底膜層の通過などが考えられ, 転移におけるいわゆるseed and soilの際に癌細胞が基底膜を何回にも渡って通過しなければならない.基底膜は主にIV型コラーゲンから構成されており, IV型コラーゲン分解酵素 (IVase) によって特異的に分解される.そこで癌組織中のIV ase活性はその癌の生物学的悪性度を表す指標となる可能性の追求を, まず組織中IV ase活性測定法を確立し, それを胃癌症例に用いて行い, その可能性を証明した.さらにIV型コラーゲンの分解産物である尿中3-hydroxyprolineが進行胃癌症例で増加していることもわかった.

Complications and sequelae of vagotomy - Analysis of 5,607 cases collected from institutions belonging to the japanese research society of vagotomy.

第15回迷切研究会の際の主題:“迷切に伴う合併症と後遺症”に関するアンケート調査の集計報告をもとに, 迷走神経切離術の合併症と後遺症を検討した.集計症例数は5,607例でそのうち, 緊急手術例は420例 (7.5%) であった.術式別ではSV43.3%, SPV41.7%, TV15.0%であった.合併症, 後遺症の発生率は19.8%であった.緊急手術例でのその発生率は38.1%で, 待期手術例での17.9%に比べ高率であった.各合併症ごとの検討では, 縫合不全, 肺合併症, 肝機能障害などが緊急手術で発生が高率であった.手術直接死亡, 下痢はTVにおいて高率であった.早期ダンピング症候群, 胃内容停滞, 貧血の発生はSPVで低率であったが, 嚥下困難の発生はSPVで高率であった.