Papers - NANASHIMA Atsushi
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Clinical Value of Serum p53 Antibody in the Diagnosis and Prognosis of Colorectal Cancer. Reviewed
Kunizaki M, Sawai T, Takeshita H, Tominaga T, Hidaka S, To K, Miyazaki T, Hamamoto R, Nanashima A, Nagayasu T
Anticancer research 36 ( 8 ) 4171 - 4175 2016.8
Language：English Publishing type：Research paper (scientific journal)
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Nanashima A., Izumino H., Sumida Y., Tominaga T., Wakata K., Hidaka S., Tsuchiya T., Nagayasu T.
Anticancer Research 36 ( 8 ) 3899 - 3903 2016.8
Language：English Publishing type：Research paper (scientific journal) Publisher：Anticancer Research
Background/Aim: Oxidative stress is defined as an imbalance between the pro-oxidant and antioxidant potential of cells leading to intracellular DNA damage. To clarify the oxidative stress response as a tumor marker, we investigated measurement of urinary 8-hydroxydeoxyguanosine (8-OHdG) levels in hepatobiliary diseases. Materials and Methods: Relationships between urinary 8-OHdG levels and clinicopathological factors were analyzed in 101 patients, including 84 with hepatobiliary malignancies, and 18 healthy volunteers. Co-existing biliary inflammation was detected in 8 patients. Results: Urinary 8-OHdG levels did not correlate with any clinical or liver functional parameters. The existence of inflammation and any tumor-related factor did not correlate with urinary 8-OHdG levels either. Urinary 8-OHdG levels were significantly higher in patients with benign and malignant diseases than in healthy volunteers (p<0.05), but not significantly different between benign and malignant diseases. Among patients with intrahepatic cholangiocarcinoma and gallbladder carcinoma, urinary 8-OHdG levels tended to be higher in patients with lymph node metastasis-positive than in those with lymph node-negative disease (p=0.057). Conclusion: The clinical significance of oxidative DNA damage and increases in its urinary metabolites in patients with hepatobiliary malignancies or inflammatory diseases remain unknown. Further studies are necessary to clarify the relationship between node metastasis and oxidative stress as a prognostic marker.
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Beppu T., Okabe H., Okuda K., Eguchi S., Kitahara K., Taniai N., Ueno S., Shirabe K., Ohta M., Kondo K., Nanashima A., Noritomi T., Okamoto K., Kikuchi K., Baba H., Fujioka H.
Journal of the American College of Surgeons 222 ( 6 ) 1138 - 1148.e2 2016.6
Language：English Publishing type：Research paper (scientific journal) Publisher：Journal of the American College of Surgeons
© 2016 by the American College of Surgeons. Published by Elsevier Inc. All rights reserved.Background Portal vein embolization (PVE) is useful to expand the indications of major hepatectomy; however, its oncologic effects are not fully understood. This study aimed to confirm the efficacy of preoperative PVE for hepatocellular carcinoma patients. Study Design Between 2000 and 2012, five hundred and ten patients with hepatocellular carcinoma undergoing right-side hemihepatectomy were enrolled (PVE group, n = 162 and non-PVE group, n = 348). To equalize background factors, one-to-one propensity case-matched analysis and multivariate analysis were performed. Short- and long-term outcomes were evaluated. Results Propensity score-matched patients, 148 in each group, were selected. The percentage of resected liver volume on admission was significantly greater in the PVE group (60.5% vs 48.3%; p < 0.001), but decreased considerably after PVE, from 60.5% to 50.3% (p < 0.001). The 5-year cumulative recurrence-free survival (36.4% vs 35.3%) and overall survival (58.6% vs 52.8%) rates were comparable. Extrahepatic recurrences were less common in the PVE group (18.1% vs 38.8%; p = 0.004). Independent prognostic factors for recurrence-free survival were morbidity (hazard ratio [HR] = 1.56), multiple tumors (HR = 1.97), red cell concentrate administration (HR = 1.57), older age (HR = 2.09), and massive portal invasion (HR = 2.33); and those for overall survival were morbidity (HR = 2.37), multiple tumors (HR = 1.71), and massive hepatic venous invasion (HR = 3.49). Conclusions Even though hepatocellular carcinoma patients who underwent preoperative PVE and right-side hemihepatectomy had a significantly larger resected liver volume on admission, they have a comparable long-term prognosis as patients with up front hepatectomy. In addition, PVE might decrease extrahepatic recurrences.
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Development and clinical usefulness of the liver hanging maneuver in various anatomical hepatectomy procedures. Reviewed
Nanashima A, Nagayasu T
Surgery today 46 ( 4 ) 398 - 404 2016.4
Language：English Publishing type：Research paper (scientific journal)
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Nanashima A., Sumida Y., Murakami G., Sawai T., Nagayasu T.
Acta Medica Nagasakiensia 60 ( 3 ) 109 - 117 2016.4
Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All rights reserved.Background: Intermittent occlusion of hepatic inflow, so-called Pringle’s maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated with hepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
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Tominaga T., Takeshita H., Takagi K., Kunizaki M., To K., Abo T., Hidaka S., Nanashima A., Nanashima A., Nagayasu T., Sawai T., Sawai T.
International Journal of Colorectal Disease 31 ( 2 ) 217 - 225 2016.2
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Colorectal Disease
© 2015, Springer-Verlag Berlin Heidelberg.Purpose: The aim of this study was to clarify whether a surgical-specific risk scoring system estimating the physiologic ability and surgical stress (E-PASS) score was useful for prediction of postoperative morbidity and mortality. Methods: The E-PASS score consists of the preoperative risk score (PRS), surgical stress score (SSS), and the comprehensive risk score (CRS). Conventional scoring systems [colorectal physiologic and operative severity score for the enumeration of mortality (CR-POSSUM) and the prognostic nutritional index (PNI)] were also examined. We retrospectively compared these scores in patients with or without postoperative complications. We assessed the relationship between these scores, clinicopathological features and postoperative mortality. Results: Postoperative complications developed in 78 patients (33 %). American Society of Anesthesiologists score, performance status, PNI score, PRS, SSS, and CRS were significantly higher in patients with postoperative complications than in those without postoperative complications (p < 0.05). The area under the receiver operating characteristic curve (AUC) was highest for E-PASS [E-PASS (PRS, 0.74; SSS, 0.62; CRS, 0.78), PNI (0.62), CR-POSSUM (PS, 0.57; OSS, 0.52)]. Multivariate logistic analysis identified CRS ≥ 0.2 as a significant determinant of postoperative complications (p < 0.01; hazard ratio, 4.84). Overall survival was significantly better in the CRS < 0.2 group than in the CRS > 0.2 group (p < 0.01). Conclusions: The E-PASS score system was a useful predictor of postoperative complications and mortality, especially in patients with advanced age.
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Intraoperative Diagnosis of Lymph Node Metastasis in Non-small-cell Lung Cancer by a Semi-dry Bot-blot Method. Reviewed
Tomoshige, K., Tsuchiya, T., Otsubo, R., Oikawa, M., Yamasaki, N., Matsumoto, K., Miyazaki, T., Hayashi, T., Kinoshita, N., Nanashima, A. and Nagayasu, T.:
European journal of Cardio-Thoracic Surgery. 49 ( 2 ) 617 - 622 2016.2
Language：English Publishing type：Research paper (scientific journal)
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Intraoperative diagnosis of lymph node metastasis in non-small-cell lung cancer by a semi-dry dot-blot method. Reviewed
Tomoshige K, Tsuchiya T, Otsubo R, Oikawa M, Yamasaki N, Matsumoto K, Miyazaki T, Hayashi T, Kinoshita N, Nanashima A, Nagayasu T
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery 49 ( 2 ) 617 - 22 2016.2
Language：English Publishing type：Research paper (scientific journal)
DOI： 10.1093/ejcts/ezv118
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肉眼的に明らかな腫瘤性病変を認めなかった陰窩腺由来肛門管癌のPagetoid spreadの1例． Reviewed
土屋和代, 春山幸洋, 石﨑秀信, 南史朗, 柴田直哉, 池田拓人, 七島篤志：
日本大腸肛門病学会雑誌 69 ( 1 ) 20 - 26 2016.1
Language：Japanese Publishing type：Research paper (scientific journal)
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Down-Regulation of Nogo-B Expression as a Newly Identified Feature of Intrahepatic Cholangiocarcinoma. Reviewed
Nanashima, A., Hatachi, G., Tominaga, T., Murakami, G., Takagi, K., Arai, J., Wada, H., Nagayasu, T. and Shimada, Y.：
The Tohoku Journal of Experimental Medicine 238 ( 1 ) 9 - 16 2016.1
Language：English Publishing type：Research paper (scientific journal)
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Inamura Y., Honma K., Kimura D., Miyakoda M., Kimura K., Fukudome K., Nanashima A., Nagayasu T., Yui K.
Acta Medica Nagasakiensia 60 ( 2 ) 77 - 84 2016.1
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
© 2016, Nagasaki University School of Medicine. All Rights Reserved. The toll-like receptor 4 (TLR4)-mediated immune response is considered as one of the triggers of acute respiratory distress syndrome. The agonistic monoclonal antibody UT12 specific for the TLR4/MD2 complex induces immune activation in a manner distinct from lipopolysaccharide (LPS). In order to compare the effects of this differential TLR4 signaling activation, we examined immune cell recruitment to the lung following intratracheal inoculation with UT12 and LPS in mice. The increase in pulmonary neutrophils was much higher after LPS treatment compared with UT12 treatment, while CD11bhiCD11＋cells increased to similar levels following both treatments. These changes were MyD88-dependent and TRIF-independent. These differential effects on immune cell recruitment to the lung suggest distinct underlying mechanisms in response to TLR4 stimulation. These findings further indicate that TLR signaling can lead to different outcomes depending on the ligand and activation pathway, which may relate to the complex pathogenesis of inflammatory lung diseases.
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A Case of Adenosquamous Carcinoma of the Distal Extrahepatic Bile Duct Reviewed
KANEMARU Mikio, NANASHIMA Atsushi, SANO Koichiro, SUETA Hideto, UCHIYAMA Shuichiro, MAGATA Hisato, TANAKA Hiroyuki
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 77 ( 3 ) 625 - 630 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Surgical Association
Adenosquamous carcinoma of the extrahepatic biliary tract is a relatively rare disease, and in general, has a poor prognosis. A 73-year-old man with jaundice was referred to our hospital for further examination and possible surgery. Contrast-enhanced abdominal CT showed dilatation of the intra and extrahepatic bile ducts and a contrast-enhancing tumor about 15 mm in diameter in the distal extrahepatic bile duct. ERCP showed the tumor in the distal extrahepatic bile duct and a biopsy revealed the diagnosis of adenosquamous carcinoma of the bile duct, as the tumor contained a mixture of both adenocarcinoma and squamous cell carcinoma components. Subtotal stomach-preserving pancreaticoduodenectomy was performed. Histopathology of the resected specimen confirmed the diagnosis of adenosquamous carcinoma of the bile duct based on the presence of both adenocarcinoma and squamous cell carcinoma components in the tumor. Metastases to the liver were identified 3 months after the surgery and the patient died of acute respiratory failure complicating aspiration pneumonia 6 months after the surgery.
DOI： 10.3919/jjsa.77.625
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Current status and experiences of photodynamic therapy for cholangiocarcinoma worldwide from a surgeon's standpoint Invited Reviewed
Nanashima Atsushi, Sumida Yorihisa, Nagayasu Takeshi, Isomoto Hajime
Tando 30 ( 4 ) 699 - 708 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Biliary Association
Complete surgical resection is only a curable treatment for cholangiocarcinoma. However, postoperative incurable results of remnant cancer at the bile duct or unresectable case and postoperative tumor recurrence are often observed. Although systemic chemotherapy or brachytherapy are selected, evidence of efficacy for local control was not indicated in these modality. While, treatment efficacy and safety by photodynamic therapy (PDT) for unresectable cholangiocarcinoma has been reported since 1988. Since the highly evidence-based clinical trials was reported, PDT was admitted as a useful local control modality to release biliary stricture or prolong survival period clarified worldwide. Although PDT was not developed in Japan, neoadjuvant or chemotherapy-combined PDT or use of new photosensitizer has been recently progressed. As a surgeon's standpoint who professionally experienced PD in Japan, actual managements, current clinical and research status of PDT for cholangiocarcinoma worldwide and the future aspect was summarized and described.
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Tsuchiya Kazuyo, Haruyama Yukihiro, Ishizaki Hidenobu, Minami Shiro, Shibata Naoya, Ikeda Takuto, Nanashima Atsushi
The Japanese journal of proctology 69 ( 1 ) 20 - 26 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：The Japan Society of Coloproctology
A 79-year-old woman with anal itching, bleeding and perianal skin eruption, suggestive of perianal Paget's disease, was presented. Although skin biopsy revealed pagetoid cells in the perianal skin lesion, no macroscopically remarkable tumor lesion was found in the anal canal or in the distal rectum during colonoscopy. Subsequent pathological examination revealed an invasive adenocarcinoma and proliferation of pagetoid cells into the epidermis. Upon immunohistochemical examination, the tumor cells and pagetoid cells were positively stained for cytokeratin 7, 20, and caudal type homeobox 2, however, gross cystic disease fluid protein-15 was negative. On the basis of these findings, the patient was diagnosed as anal canal cancer accompanied by pagetoid spread, and laparoscopic abdominoperineal resection combined with bilateral pelvic lymph node dissection was performed. From the pathological resected specimen, anal canal adenocarcinoma derived from crypt glands invading the internal sphincter muscle accompanied by pagetoid spread was eventually diagnosed. Relapse-free survival for 15 months after curable operation was obtained. It is necessary to keep in mind that anal canal adenocarcinoma without remarkably macroscopic tumor lesions may cause pagetoid spread.
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HAMADA Takeomi, IMAMURA Naoya, TSUCHIMOCHI Yuki, YANO Koichi, HIYOSHI Masahide, OHUCHIDA Jiro, FUJII Yoshiro, HARUYAMA Yukihiro, KATAOKA Hiroaki, NANASHIMA Atsushi
Suizo 31 ( 4 ) 662 - 669 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Pancreas Society
We report a case of local recurrence and liver metastases of solid pseudopapillary neoplasm (SPN) of the pancreas twenty-one years after primary pancreatectomy. The patient was a 61-year-old female who underwent a previous spleen preserving distal pancreatectomy for solid and cystic tumor in 1993. In 2014, liver tumors were detected by ultrasoud screening. Radiological findings revealed that a tumor was composed of solid and cystic portions concomitant with hemorrhage. We carried out a liver biopsy to diagnose SPN. A remnant distal pancreatectomy with splenectomy and limited resection of the all liver metastases was performed. The histological examination revealed a pattern of solid and pseudopapillary neoplasm, which showed similar histological findings to the primary tumor. Immunohistochemical stains are useful to diagnose SPN. Especially, the dot-like staining pattern of CD99, a characteristic finding typically found in SPN. SPN is potentially a low malignant pancreatic neoplasm indicating the better prognosis after complete tumor resection. However, a recurrence of tumor can be expected over a long-term course of 10-20 years. Therefore, life-long long-term follow-up should be necessary for all SPN patients who underwent surgical resection.
DOI： 10.2958/suizo.31.662
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A case of bile duct cancer, 43 years after cholangiojejunostomy for congenital biliary dilatation Reviewed
Tominaga Tetsuro, Nanashima Atsushi, Murakami Goushi, Tobinaga Shuichi, Abo Takafumi, Sumida Yorihisa, Kinoshita Naoe, Nagayasu Takeshi
Tando 30 ( 5 ) 876 - 882 2016
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japan Biliary Association
We recently encountered a patient who developed bile duct cancer of the porta hepatis, 43 years after cholangiojejunostomy for congenital biliary dilatation (CBD). This 59-year-old woman had undergone cholangiojejunostomy for CBD at 15 years old. She had remained asymptomatic and no long-term follow-up was performed. However, she developed epigastric pain, and was referred to our hospital after intrahepatic stones were diagnosed.Imaging showed an irregular stricture of the left hepatic duct and mucosal erythema and irregularity of the opening of the left hepatic duct and cholangiojejunostomy site. Biopsy revealed moderately differentiated adenocarcinoma. Resection of the left hepatic and caudate lobes and site of cholangiojejunostomy was performed. Histopathological examination showed a nodular, well-differentiated adenocarcinoma (T1bN0M0, stage I) in the bile duct.The patient has remained recurrence-free as of 2 years postoperatively. Cholangiojejunostomy for CBD is associated with high risk of cancer, and the prognosis is poor if cancer develops. Patients who have undergone cholangiojejunostomy for CBD may develop complications involving cancer of the residual bile ducts when conditions such as intrahepatic stones develop, and this possibility needs to be addressed through detailed examinations. Some patients, such as the present patient, have not received periodic surveillance after undergoing surgery for CBD during childhood.
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Nanashima Atsushi, Sumida Yorihisa, Murakami Goushi, Sawai Terumistu, Nagayasu Takeshi
Acta Medica Nagasakiensia 60 ( 3 ) 109 - 117 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：長崎大学医学部
Background: Intermittent occlusion of hepatic inflow, so-called Pringle's maneuver, is a useful technique to control intraoperative bleeding; however, it can lead to ischemia-reperfusion injury. We examined the influence of ischemic time on surgical factors, posthepatectomy liver function and morbidity. Methods: The clinical records of 296 patients who underwent an elective hepatectomy for liver disease between 2004 and 2013 were retrospectively examined. Univariate and multivariate analyses of clinicopathological and surgical factors associated withhepatic-inflow occlusion time were performed. Results: The mean and median times of total hepatic-inflow occlusion were 47±23 minutes (5-173 mL) and 45 minutes, respectively. The occlusion time was significantly correlated with increased indocyanine-green retention rate, total operation time, amount of blood loss or red cell transfusion, postoperative morbidity and hospital stay (each p<0.05). Blood loss upon the use of occlusion tended to be lower than that in its absence (568±602 mL vs. 887±841 mL) (p=0.075). The occlusion time was shorter in limited resection and longer in central bi-segmentectomy or sectionectomy (p<0.05). The occlusion time was significantly correlated with the maximum alanine aminotransferase level (r=0.291, p<0.01). The predictive cut-off value of occlusion time for these correlated parameters ranged between 45 and 46.5 minutes (p<0.05). Hepatic-inflow occlusion was not associated with morbidity in cirrhosis. Conclusion: A longer ischemic time induced increased blood loss or related transfusion, operating time, postoperative liver injury, complication rate and duration of hospital stay.
DOI： 10.11343/amn.60.109
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Tominaga T., Tsuchiya T., Mochinaga K., Arai J., Yamasaki N., Matsumoto K., Miyazaki T., Nagasaki T., Nanashima A., Tsukamoto K., Nagayasu T.
BMC Cancer 16 ( 1 ) 354 - 354 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：BMC Cancer
© 2016 The Author(s).Background: It has been shown that epidermal growth factor receptor (EGFR) mutation status is associated with 5-fluorouracil (5-FU) sensitivity in non-small-cell lung cancer (NSCLC). However, the relationship between EGFR mutation status and dihydropyrimidine dehydrogenase (DPD), a 5-FU degrading enzyme, is unknown. Methods: We elucidated the crosstalk among the EGFR signal cascade, the DPD gene (DPYD), and DPD protein expression via the transcription factor Sp1 and the effect of EGFR mutation status on the crosstalk. Results: In the PC9 (exon19 E746-A750) study, EGF treatment induced up-regulation of both Sp1 and DPD; gefitinib, an EGFR-tyrosine kinase inhibitor (EGFR-TKI), and mithramycin A, a specific Sp-1 inhibitor, suppressed them. Among EGFR-mutated (PC9, HCC827; exon19 E746-A750 and H1975; exon21 L858R, T790M, gefitinib resistant) and -non-mutated (H1437, H1299) cell lines, EGF administration increased DPYD mRNA expression only in mutated cells (p < 0.05). Accordingly, gefitinib inhibited DPD protein expression only in PC9 and HCC827 cells, and mithramycin A inhibited it in EGFR-mutated cell lines, but not in wild-type. FU treatment decreased the level of cell viability more in gefitinib-treated EGFR-TKI sensitive cell lines. Further, combination treatment of FU and mithramycin A suppressed cell viability even in a gefitinib resistant cell line. Conclusions: The EGFR signal cascade regulates DPD expression via Sp1 in EGFR mutant cells. These results might be a step towards new therapies targeting Sp1 and DPD in NSCLC with different EGFR mutant status.
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Nanashima A., Imamura N., Tsuchimochi Y., Hiyoshi M., Fujii Y.
International Journal of Surgery Case Reports 25 66 - 70 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：International Journal of Surgery Case Reports
© 2016 The Author(s). Published by Elsevier Ltd on behalf of IJS Publishing Group Ltd. This is an openaccess article under the CC BY-NC-ND license.Introduction This case report is intended to inform pancreas surgeons of our experience in operative management of aberrant pancreatic artery. Presentation of case A 63-year-old woman was admitted to our institute's Department of Surgery with obstructive jaundice, and the pancreas head tumor was found. To improve liver dysfunction, an endoscopic retrograde nasogastric biliary drainage tube was placed in the bile duct. Endoscopic fine-needle aspiration showed a pancreas head carcinoma invading the common bile duct, the aberrant right hepatic artery arising from the superior mesenteric artery, and the portal vein. Enhanced computed tomography showed the communicating artery between the right and left hepatic artery via the hepatic hilar plate. By way of imaging preoperative examination, a pancreaticoduodenectomy combined resection of the aberrant right hepatic artery and portal vein was conducted without arterial anastomosis. Hepatic arterial flow was confirmed by intraoperative Doppler ultrasonography, and R0 resection without tumor exposure at the dissected plane was achieved. The patient's postoperative course was uneventful. Discussion In this case report, perioperative detail examination by imaging diagnosis with respect to hepatic arterial communication to achieve curative resection in a pancreas head cancer was necessary. Non-anastomosis of hepatic artery was achieved, and the necessity of R0 resection was stressed by such management. Conclusion By the preoperative and intraoperative imaging managements conducted, combined resection of the aberrant right hepatic artery without anastomosis was achieved by pancreaticoduodenectomy for pancreas head cancer. However, improvements in imaging diagnosis and careful management of R0 resection are important.
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Kanemaru Mikio, Nanashima Atsushi, Iwamura Takeshi, Sueta Hideto, Sano Koichiro, Uchiyama Syuichiro, Magata Hisato
The Japanese Journal of Gastroenterological Surgery 49 ( 8 ) 721 - 729 2016
Language：English Publishing type：Research paper (scientific journal) Publisher：The Japanese Society of Gastroenterological Surgery
<p>Here we report a case of a survivor who twice underwent surgical resection for recurrences. A 67-year-old man underwent total gastrectomy and D2 lymph node dissection for a stage IIIA adenocarcinoma of the esophagogastric junction. Three years later, he underwent partial resection of the liver for metastasis of segment 8 of the liver. One year and 5 months after hepatectomy, he underwent distal pancreatectomy and splenectomy for metastasis of the lymph nodes along the distal splenic artery. At 6 years and 6 months after initial surgery and 2 years after the last surgery, no sign of recurrent cancer has been identified by endoscopical and radiological follow-up examinations. This case report shows the benefit of surgical resection for recurrent cancer of the esophagogastric junction.</p>