Papers - NANASHIMA Atsushi
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The relationship between circulating interleukin-6 and carcinoembryonic antigen in patients with colorectal cancer.
Nakagoe T, Tsuji T, Sawai T, Tanaka K, Hidaka S, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T, Sugawara K, Inokuchi N, Kamihira S
Anticancer research 23 ( 4 ) 3561 - 4 2003.7
Language：Japanese Publishing type：Research paper (scientific journal)
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Nanashima A., Yoshinaga M., Yamaguchi H., Shibasaki S., Ide N., Jo K., Nakagoe T.
Acta Medica Nagasakiensia 48 ( 1-2 ) 23 - 27 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
This study was designed to provide an immunohistochemical analysis of tumor biological factors in 28 patients who underwent hepatectomy for cholangiocellular carcinoma (CCC). Analyzed factors were microvessel counts (stained by CD34) and proliferating cell nuclear antigen (PCNA). PCNA L.I. was correlated with serum level of CA19-9, which was correlated with a higher recurrence rate and shorter patient survivals. Microvessel counts were negatively correlated with tumor size. Furthermore, the microvessel count in CCC with mass-forming (MF) plus periductal infiltrating (PI) type associated with poorer survivals, was significantly lower compared to that of CCC with MF type or PI type. Neither microvessel counts nor PCNA L.I. were associated with any other clinicopathologic factors or cancer recurrence. The five-year overall and cancer-free survival rates were 26% and 13%, respectively. Patients with MF plus PI type, poorer differentiated carcinoma, stage 4A and higher CA19-9 level had shorter cancer-free and overall survivals after hepatectomy (p < 0.05). Cancer-free and overall survivals in patients with lower microvessel counts tended to be slightly worse but were not significantly different. Although tumor microvessel count and proliferating activity were correlated with prognostic clinicopathologic parameters, both factors might not be prognostic markers for predicting CCC recurrence and patient survival.
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Changes of branched chain amino acids and tyrosine ratio (BTR) after hepatectomy
Nanashima A., Yamaguchi H., Shibasaki S., Abo T., Morino S., Yoshinaga M., Sawai T., Tanaka K., Hidaka S., Tsuji T., Nakagoe T., Ayabe H.
Acta Medica Nagasakiensia 48 ( 1-2 ) 29 - 33 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
To clarify the clinical usefulness of measuring branched chain amino acids and tyrosine ratio (BTR), which is correlated with Fischer's ratio, we examined the serum BTR level in 33 patients with liver diseases. Serum levels of branched-chain amino acids (BCAAs) and tyrosine were measured by the new enzymatic method, which costs inexpensive and is immediate compared to measuring Fischer's ratio. BTR was calculated as ratio of concentration of BCAA to tyrosine. BTR was correlated with levels of albumin, transaminase and cholinesterase and was lower in patients with chronic viral hepatitis, Child B cirrhosis and portal hypertension. In 19 patients who underwent hepatic resection included 8 for major hepatectomy, resected volume, blood loss, operation time and background of liver diseases were not associated with changes of BTR after hepatectomy. In patients with prolonged jaundice, postoperative BTR level was significantly lower between day 1 and 7 after hepatectomy. We concluded that serum BTR level was correlated with poor liver function and monitoring of BTR levels after hepatectomy may be useful to evaluate degree of hepatic damage after liver surgery.
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Nakagoe T., Sawai T., Tsuji T., Tanaka K., Hidaka S., Nanashima A., Shibasaki S., Yamaguchi H., Yasutake T.
Acta Medica Nagasakiensia 48 ( 1-2 ) 81 - 84 2003.6
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Management of a rectovaginal fistula (RVF) following low circular-stapled colorectal anastomosis is difficult and often unsatisfactory. We report herein the case of a 66-year-old woman who developed a RVF following low anterior resection using the double-stapling technique for rectal cancer. The RVF spontaneously closed with nonoperative treatment that included simple observation without dietary restrictions. The spontaneous closure occurred within approximately 25 days. Minimally symptomatic patients may be candidates for nonoperative treatment.
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Preoperative serum level of CA19-9 predicts recurrence after curative surgery in node-negative colorectal cancer patients.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H, Arisawa K
Hepato-gastroenterology 50 ( 51 ) 696 - 9 2003.5
Language：Japanese Publishing type：Research paper (scientific journal)
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The use of a mini-laparotomy in total abdominal colectomy for mucosal ulcerative colitis.
Nakagoe T, Sawai T, Tsuji T, Jibiki MA, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Hepato-gastroenterology 50 ( 51 ) 704 - 8 2003.5
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Sawai T., Tsuji T., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H., Arisawa K.
Hepato-Gastroenterology 50 ( 51 ) 696 - 699 2003.5
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Hepato-Gastroenterology
Background/Aims: We hypothesize that a subset of node-negative colorectal cancer patients exists that is at high risk for recurrence after curative surgery. Preoperative serum levels of sialyl Lewisa (CA19-9), sialyl Lewisx (SLX), sialyl Tn (STN), and carcinoembryonic (CEA) antigens were analyzed for their value in predicting for such a group. Methodology: One-hundred-forty-five patients with node-negative, T1-4, M0 colorectal cancers were divided into groups of low or high serum antigen levels. Disease-free interval served as the endpoint in evaluating the prognostic strength of each variable. Results: Twenty-seven patients (18.6%) were included in the high group for CA19-9 antigen, 11 (7.6%) for SLX, 13 (9.0%) for STN, and 51 (35.2%) for CEA. The median follow-up was 62.1 months. As compared to those with low levels, patients with elevated CA19-9 had a shorter disease-free interval (P=0.0026). No significant difference in disease-free interval was noted between low and high groups of SLX, STN, and CEA antigens. Cox regression analysis identified elevated serum CA19-9 level as a predictor for decreased disease-free interval, independent of T-stage or tumor location. Conclusions: Elevated preoperative serum levels of CA19-9 may serve as a useful marker in identifying patients with node-negative colorectal cancers at high risk for recurrence after surgery.
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Nakagoe T., Tanaka K., Yasutake T., Sawai T., Tsuji T., Nanashima A., Shibasaki S., Yamaguchi H., Ayabe H.
Digestive Surgery 20 ( 2 ) 141 - 146 2003.4
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Digestive Surgery
Background/Aims: The aim of this study was to clarify long-term outcomes of endoscopic mucosal resection (EMR) using a modified Buess technique for mucosal gastric cancer. Methods: The procedure included en bloc mucosal resection using a Buess-type rectoscope into the gastric lumen via a temporary gastrostomy under video camera guidance. We reviewed 5 patients who underwent this procedure between 1995 and 1997 with a single mucosal cancer of the stomach that was unsuitable for en bloc excision by endoscopic snare diathermy. Results: All tumors were superficial elevated types (type 0-IIa) located in the middle third and posterior wall of the stomach. Median maximum tumor diameter was 2.2 (range 1.1-3.5) cm. There was no operative mortality. One patient developed a hemorrhagic gastric ulcer postoperatively. All tumors histologically showed curative potential of the mucosal resection without margin involvement. During a median follow-up period of 64 (50-77) months, none of the patients developed local recurrence. One patient had an early gastric cancer that metachronously developed at another stomach site. Conclusion: Intragastric EMR using a modified Buess technique appears to be a useful treatment for cure of mucosal gastric cancer for a limited group of patients unsuitable for complete en bloc excision by endoscopic snare diathermy. Copyright © 2003 S. Karger AG, Basel.
DOI： 10.1159/000069391
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Gasless video endoscopic transanal excision of rectal tumors incompletely removed by colonoscopic snare polypectomy.
Nakagoe T, Ishikawa H, Sawai T, Tsuji T, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Journal of laparoendoscopic & advanced surgical techniques. Part A 13 ( 2 ) 99 - 103 2003.4
Language：Japanese Publishing type：Research paper (scientific journal)
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Distal intramural spread is an independent prognostic factor for distant metastasis and poor outcome in patients with rectal cancer: a multivariate analysis.
Nakagoe T, Yamaguchi E, Tanaka K, Sawai T, Tsuji T, Shibasaki S, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
Annals of surgical oncology 10 ( 2 ) 163 - 70 2003.3
Language：Japanese Publishing type：Research paper (scientific journal)
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Local rectal tumor resection results: gasless, video-endoscopic transanal excision versus the conventional posterior approach.
Nakagoe T, Sawai T, Tsuji T, Shibazaki S, Jibiki M, Nanashima A, Yamaguchi H, Yasutake T, Ayabe H
World journal of surgery 27 ( 2 ) 197 - 202 2003.2
Language：Japanese Publishing type：Research paper (scientific journal)
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Nakagoe T., Sawai T., Tsuji T., Shibazaki S., Jibiki M., Nanashima A., Yamaguchi H., Yasutake T., Ayabe H.
World Journal of Surgery 27 ( 2 ) 197 - 202 2003.2
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：World Journal of Surgery
This study compares surgical outcomes for local resection of rectal tumors by two approaches: (1) gasless, video-endoscopic transanalrectal tumor excision (gasless VTEM); and (2) a conventional posterior approach. Gasless VTEM involves a modification of transanal endoscopic microsurgery (TEM) that incorporates a standard laparoscopic video camera without a CO 2 insufflation system. A series of 42 patients with 45 rectal tumors (9 adenomas, 36 adenocarcinomas) who underwent gasless VTEM between 1993 and 2000 were studied prospectively. The control group consisted of 26 similar patients who underwent conventional surgery (transsacral or transsphincteric approach) between 1985 and 1993. Age, gender ratio, tumor localization, maximum tumor diameter, and histology for the cases and the controls were similar, whereas operating time and blood loss were significantly greater in the control group (p < 0.001 and p < 0.001, respectively). The postoperative intervals until able to walk, urinary catheter removal, solid food intake, and discharge from hospital were significantly shorter in the gasless VTEM group (p < 0.001, p = 0.002, p < 0.001, and p < 0.001, respectively); analgesic requirements were significantly less (p < 0.001). There was no operative mortality in either group. Postoperative complications developed significantly less frequently in the gasless VTEM group than in the control group (7.1% vs. 38.5%; p = 0.003). During the median follow-up length of 73.3 months, no patient developed tumor recurrence in the gasless VTEM group, whereas one patient did in the control group. In conclusion, gasless VTEM is less invasive and allows shorter hospitalizations and reduced complications than the conventional posterior approach, thereby providing an attractive alternative for selected patients.
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Genetic analysis of radiation-associated rectal cancer.
Tsuji T, Sawai T, Nakagoe T, Hidaka S, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Tagawa Y
Journal of gastroenterology 38 ( 12 ) 1185 - 8 2003
Language：Japanese Publishing type：Research paper (scientific journal)
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Successful resection of a duodenal fistula complicated with recurrent Crohn's disease at the site of previous ileocolonic anastomosis: report of a case.
Nakagoe T, Sawai T, Tsuji T, Nanashima A, Shibasaki S, Yamaguchi H, Yasutake T
Surgery today 33 ( 7 ) 537 - 41 2003
Language：Japanese Publishing type：Research paper (scientific journal)
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Hisamatsu T., Nanashima A., Izumikawa K., Haga H., Hayakawa T., Hara K., Izumikawa K.
Japanese Journal of Gastroenterological Surgery 36 ( 11 ) 1587 - 1592 2003
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Gastroenterological Surgery
A 76-year old man with a history of chronic viral hepatitis and obstinate constipation was admitted to our hospital with severe abdominal distension. The patient had no remarkable abdominal pain or signs of any inflammatory disorders. An abdominal X-ray film showed massive intra-abdominal free-air, but no signs of ulceration or perforation were found in an upper GI series. However, a 3cm multi-cystic lesion was found in the lower intestines, protruding into the abdominal cavity next to the site of the massive free-air, ascites observed on CT images. Pneumatosis cystoides intestinalis (PCI) was thought to be the most probable diagnosis, and an emergency laparoscopy was performed to rule out the possibility of intestinal perforation and relieve the patient's symptoms. A laparoscopy examination revealed multiple cystic lesions in the terminal ileum, ascites, and a liver with the appearance of chronic hepatitis; no evidence of intestinal perforation was seen even in the area of the multiple cystic lesions. Other PCI in the colon was observed by postoperative colonoscopy. The patient recovered without any complications. Although conservative therapy has been described as a common initial treatment for patients with PCI, our experience suggests that performing a laparoscopy examination may be useful not only for confirming the diagnosis, but for reducing the massive pneumoperitoneum resulting from severe constipation in patients with PCI.
DOI： 10.5833/jjgs.36.1587
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Nanashima A.
Acta Medica Nagasakiensia 47 ( 3-4 ) 127 - 131 2002.12
Authorship：Lead author, Corresponding author Language：English Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
The author has experienced to practice the clinical works of cadaveric liver transplantation at a single transplantation center in Australia between 1999 and 2000. Hepatic arterial thrombosis causes higher rates of morbidity and mortality after liver transplantation. To know the associated factors, pathogenesis and patient outcome, data of 99 adult patients who underwent liver transplantation by the database for past two years were analysed. Ten patients (10%) had hepatic arterial thrombosis (HAT group). In donor demographics, brain death caused by cerebral stroke in the HAT group (90%) was significantly more than that in the non HAT group (49%) (p < 0.05). The mean amount of blood transfusion in the HAT group (26665ml) was significantly greater than that in the control group (15606ml) (p < 0.05). The mean hepatic arterial flow measured by Doppler flowmeter in the HAT group (214ml/min.) was lower than that in the control group (399ml/min) (p < 0.01). The rate of in-hospital death or retransplantation caused by severely biliary abscess with hepatic infarction or graft failure in the HAT group (40%) tended to be higher compared to the control group (13%) (p=0.053). In conclusion, decrease of bleeding and blood transfusion, and obtaining the adequate arterial blood flow during operation were important to prevent hepatic arterial thrombosis causing higher morbidity and mortality after liver transplantation.
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Nakagoe T., Ishikawa H., Sawai T., Tsuji T., Tanaka K., Hidaka S., Shibasaki S., Nanashima A., Yamaguchi H., Yasutake T.
Acta Medica Nagasakiensia 47 ( 3-4 ) 139 - 144 2002.12
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Acta Medica Nagasakiensia
Purpose. The purpose of this study was to determine whether the type of operation [sphincter-saving resection (SSR) or abdominoperineal resection (APR)] for primary adenocarcinoma of the rectum at or below the peritoneal reflection affects survival after non-curative surgery. Methods. This retrospective study included 42 patients who underwent non-curative surgery by the following two types of operation between 1989 and 1998: (1) SSR (n=19 patients) included low anterior resection with either double-stapling technique (n=16) or transanal coloanal anastomosis (n=3); (2) APR (n=23). 'Non-curative' resection implied 'Curability B' and 'Curability C' defined by the Japanese Classification of Colorectal Carcinoma. Outcome measure was disease-specific survival. Univariate and multivariate Cox's regression analyses were used to evaluate data. Median follow-up was 17.2 months at study conclusion. Results. Disease-specific survival after non-curative surgery did not differ between the two types of operations. Multivariate analyses showed that the type of operation was not a significant independent variable in predicting disease-specific survival after surgery. One variable - 'Curability' - was significant predictor of outcome after surgery. Conclusions. The type of operation (SSR or APR) did not affect survival after non-curative resection for adenocarcinoma of the rectum at or below the peritoneal reflection.
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Nakagoe T., Fukushima K., Sawai T., Tsuji T., Jibiki M., Nanashima A., Tanaka K., Yamaguchi H., Yasutake T., Ayabe H., Ishikawa H.
Journal of Experimental and Clinical Cancer Research 21 ( 3 ) 363 - 369 2002.9
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Journal of Experimental and Clinical Cancer Research
Early gastric cancer can be divided morphologically into two categories, penetrating growth type-A (Pen-A type) and other growth types (non-Pen-A types). Sialyl Lewis x antigen has been demonstrated to play an important role in tumor metastasis by serving as a functional ligand in the cell adhesion system. The aim of this study is to ascertain whether or not sialyl Le x antigen expression correlates with tumor growth patterns of early gastric carcinoma. An immunohistochemical assay was performed using monoclonal antibody CSLEX1 in 12 Pen-A type and 79 non-Pen-A type cancers. Scoring was based on the percentage of immunoreactive cells: negative, low expression (≤25%), and high expression ( > 25%). Lymph node metastasis was found more frequently in Pen-A type than non-Pen-A type cancers (P=0.0004). Furthermore, sialyl Le x antigen high expression was detected more often in Pen-A type cancers (7 out of 12; 58.3%) than non-Pen-A type cancers (13 out of 79; 16.5 %) (P=0.0036). Multivariate logistic regression analysis showed that these variables are related independently to the Pen-A type and the non-Pen-A type tumor growth patterns. These data suggest that the difference in sialyl Le x antigen expression between the Pen-A type and non-Pen-A type tumor growth patterns of early gastric cancer may, at least partially, reflect different biological behavior during tumor progression.
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[CPT-11 hepatic arterial injection plus oral UFT administration for liver metastasis of rectal cancer--report of two cases].
Sawai T, Tsuji T, Yamashita H, Hidaka S, Fukuoka H, Shibasaki S, Tanaka K, Nanashima A, Yamaguchi H, Yasutake T, Nakagoe T, Ayabe H
Gan to kagaku ryoho. Cancer & chemotherapy 29 ( 8 ) 1469 - 73 2002.8
Language：Japanese Publishing type：Research paper (scientific journal)
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Sawai T., Tsuji T., Yamashita H., Hidaka S., Fukuoka H., Shibasaki S., Tanaka K., Nanashima A., Yamaguchi H., Yasutake T., Nakagoe T., Ayabe H.
Japanese Journal of Cancer and Chemotherapy 29 ( 8 ) 1469 - 1473 2002.8
Language：Japanese Publishing type：Research paper (scientific journal) Publisher：Japanese Journal of Cancer and Chemotherapy
The first patient was a 51-year-old male who had 5-fluorouracil-resistant recurrent rectal cancer with multiple liver metastases. He was given our new combination chemotherapy consisting of hepatic arterial injection of CPT-11 (20 mg/body) on day 1 and day 2 and oral administration of UFT (300 mg/day) on days 3 to 6 of a 7 day cycle starting in January 2001. Six weeks after the beginning of chemotherapy, the liver metastatic lesions were reduced. He is now living with outpatient treatment. The second patient was a 76-year-old male who had initial recurrent rectal cancer with multiple liver metastases. Thirty-two weeks after the same chemotherapy, the metastatic lesions had completely disappeared. Twelve months have passed since this chemotherapy, and we have not found any recurrent tumor. While significant antitumor effects were observed, there were few adverse events in either patient. These results suggest that combined chemotherapy of CPT-11 by hepatic arterial injection and oral administration of UFT is an effective treatment for liver metastases of rectal cancer.