研究者業績
基本情報
論文
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Asian Journal of Surgery 41(2) 192-196 2018年3月1日 査読有りObjective: The treatment policy of colorectal cancer in elderly patients is controversial due to a lack of specific guidelines. To clarify the present management of colorectal cancer for aged patients, a questionnaire survey was conducted by the Japanese Society for Cancer of the Colon and Rectum. Methods: Questionnaire forms were sent to the 430 member institutions of the Japanese Society for Cancer of the Colon and Rectum. Results: The response rate of the surgical department to the questionnaire was 39%. Performance status was used for preoperative assessments, and electrocardiogram and ultrasonic cardiograms were conducted for cardiovascular evaluations in many institutions. The same extent of surgical procedures was often adopted for elderly and younger patients, and the frequency of a laparoscopic procedure was the same regardless of a patient's age. A simultaneous hepatectomy for hepatic metastasis was considered in one-third of institutions. In many institutions, intersphincteric resection for patients with possible sphincter-saving surgery was not considered for elderly patients with low rectal cancer. Conclusion: Japanese Society for Cancer of the Colon and Rectum member institutions often used the same surgical treatment strategies for both elderly and younger patients with the exception of performing intersphincteric resection.
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SURGERY TODAY 48(1) 33-43 2018年1月 査読有りTo assess the working styles of men and women working as surgeons in Japan. In July, 2014, the Japan Surgical Society invited all their members (n = 29,861), through an internet campaign, to participate in a nationwide survey of surgeons. The items investigated in this descriptive study included demographic information and working styles, based on a questionnaire. In total, 6211 surgeons participated (response rate 20.8%, 5586 men and 625 women). The largest age stratum was 40-49 years for men and 30-39 years for women. Overall, respondents identified their labor contract, including salary and work hours, as the highest priority for improvement. Women with children were more likely to be part-time employees, work fewer hours, and take fewer house calls/on-calls than their male counterparts. Moreover, women of all ages earned a lower annual income than men, irrespective of whether they had children. Perception scores for discrimination related to work and promotion were significantly higher among women than men (p < 0.01 and p = 0.011, respectively). A significant difference in working style was observed between men and women working as surgeons in Japan.
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CANCER CHEMOTHERAPY AND PHARMACOLOGY 79(5) 1021-1029 2017年5月 査読有りAlthough hypersensitivity reactions (HSRs) to oxaliplatin (L-OHP) therapy are well-documented, few reports have compared different therapies in terms of HSR occurrence. In this study, we compared the frequency and pattern of HSRs to modified FOLFOX6 (mFOLFOX6; 5-fluorouracil, levofolinate calcium and L-OHP infusions) and XELOX (capecitabine and L-OHP) therapies, and sought to identify risk factors associated with HSRs. Patients who had received mFOLFOX6 or XELOX chemotherapeutic regimens for unresectable colon or rectal cancer or as adjuvant chemotherapy following colon cancer surgery between April 2012 and August 2015 were included. Potential correlation between treatment modalities (regimen, dosage and route of administration of L-OHP, and injection timing for dexamethasone administration) and HSRs was assessed. Among the 240 patients included in the study, 136 had received mFOLFOX6 therapy and 104 had received XELOX therapy. Although the frequency of HSRs did not differ between the two groups, incidence of HSRs in the first cycle was higher in the XELOX therapy group. Treatment method or cumulative dosage was not identified as a risk factor for HSR; however, the incidence of aegrade-2 HSR was higher in cases where the cumulative L-OHP dosage was ae600 mg/m(2) and in patients in whom dexamethasone was not co-infused with L-OHP. Although HSR rates were comparable among patients treated with mFOLFOX6 and XELOX, HSRs tended to occur more frequently during the first cycle of XELOX therapy as compared to that with mFOLFOX6 therapy. Our findings warrant careful assessment of aegrade-2 HSRs in patients who are prescribed cumulative L-OHP dosages of ae600 mg/m(2).
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SURGERY TODAY 46(7) 860-871 2016年7月 査読有りPurpose We devised a simple dichotomous classification system and showed sufficient reproducibility to indicate treatment strategies for peritoneal metastasis of colorectal cancer. Methods We included 67 patients with peritoneal metastasis of colorectal cancer and classified them according to the largest lesion size, number of lesions and number of regional peritoneal metastases. The oncological data were recorded and compared. Results According to the univariate analyses, the prognoses were significantly better in patients with <= 3 disseminated lesions than in those with >= 4, and in patients with disseminated lesions in only one region than in those with >= 2 lesions. A multivariate analysis showed that primary tumor resection and the presence of peritoneal metastases in only one region were favorable factors for the patient survival. Patients with disseminated lesions in only one region (localized group) and those with nonlocalized lesions had three-year survival rates of 45.6 and 12.2 %, respectively. Finally, primary tumor resection improved the prognoses in both the localized and nonlocalized groups. Conclusions Colorectal cancer patients were categorized into localized and nonlocalized groups according to the number of regions with peritoneal metastasis, and significant prognostic associations were demonstrated. Subsequent analyses of the oncological data suggested that primary tumor resection contributes to an improved prognosis in all patients with synchronous peritoneal metastases.
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SURGERY TODAY 46(4) 491-500 2016年4月 査読有りPurposes This study prospectively assessed the sexual and urinary functions, as well as factors influencing these functions, in patients who underwent open or robotic surgery for rectal cancer. Methods Forty-five consecutive male patients who underwent rectal resection for rectal cancer were prospectively enrolled in this study. Their sexual and urinary functions were assessed through self-administered questionnaires comprising the International Index of Erectile Function (IIEF; sexual function) and the International Prostate Symptom Score (IPSS; urinary function) before and at 3, 6, and 12 months after surgery. Results Fifteen patients who underwent robotic surgery and 22 who underwent open surgery were finally analyzed in this study. The total IIEF score and the individual score items did not change at 3, 6 or, 12 months after open or robotic surgery compared with the preoperative values. However, a univariate analysis revealed that age affected the urinary function 12 months after surgery, while both univariate and multivariate analyses revealed that postoperative complications affected the sexual function 12 months after surgery. Conclusions In this non-randomized comparison, the postoperative sexual and urinary functions were comparable between patients who underwent open rectal surgery and those who underwent robotic rectal surgery. Postoperative complications were a risk factor for sexual dysfunction, while age was a risk factor for urinary dysfunction.
MISC
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日本大腸肛門病学会雑誌 69(抄録号) A285-A285 2016年10月
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日本大腸肛門病学会雑誌 69(4) 205-209 2016年症例は81歳女性,AV3.5cm,前壁中心,1/3周性の直腸癌に対し,超低位前方切除術(sub-total ISR,D3郭清)を施行した.病理は高分化型腺癌,pA,ly1,v2,pN0,pPM0,pDM0,pRM0 stage IIであった.初回手術から1年9ヵ月後に吻合部3時方向に1cm大のSMTを認め,経肛門的腫瘍切除術を施行した.直腸癌の転移として矛盾しない腺癌像であった.更に5ヵ月後,不正性器出血を認め,膣入口部より7cmの左側後壁に3cm大の腫瘍を認めた.膣以外への転移・再発は認められず,経膣的腫瘍切除術を施行した.病理診断は直腸癌の転移と診断され,周囲の脈管内に腺癌の浸潤増殖像を認めた.大腸癌の転移巣としては肝・肺・腹膜が大部分を占め,膣への転移は稀である.また,女性性器悪性腫瘍のなかでも膣癌は1~4%の頻度である.非常に稀な大腸癌膣転移を経験したため,若干の文献的考察を加えて報告する.
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臨床外科 = Journal of clinical surgery 70(2) 192-199 2015年2月
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日本外科系連合学会誌 40(2) 187-195 2015年日本では外科を選択する医師は減少していますが,日本外科学会に新規入会する女性医師は年々増加しており,2008年新入会の22%が女性でした.ところが,日本の女性の年齢別就労人口をみると,M字カーブを描き,30,40代での離職が目立ち,医師も例外ではありません.この現状を打破するために必要な支援を探るため,日本外科学会女性外科医支援委員会と日本女性外科医会が中心となり,2011年6月下旬~8月末に日本医学会分科会に対し,専門医,認定医制度,評議員,役員,委員会委員,男女共同参画,女性医師支援に関しアンケートを行いました.その結果,多くの学会で女性医師支援の活動は行われつつあることがわかりました.しかし,役員,評議員,委員会委員といった意志決定機構における女性の割合は低いままにとどまっています.あらゆる意思決定機関に女性を参入させることが,女性外科医の活動を,ひいては我が国の外科医療そのものを加速させるのではないかと思われました.
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手術 = Operation 68(8) 1051-1055 2014年7月
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日本外科学会雑誌 115(2) 2014年3月5日
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日本外科学会雑誌 115(2) 2014年3月5日
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日本外科学会雑誌 115(2) 2014年3月5日
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日本外科学会雑誌 115(2) 2014年3月5日
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日本外科学会雑誌 115(2) 2014年3月5日
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外科 = Surgery : 臨床雑誌 76(3) 267-273 2014年3月
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消化器外科nursing 19(3) 194-199 2014年3月
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日本コンピュータ外科学会誌 16(2) 51-55 2014年Surgery for rectal cancer is required dense surgical operation in a narrow pelvis. Using robotic system for rectal surgery may facilitate more accurate and safe operations. However, in Japan robotic surgery is an early stage and have many problems. All of medical staff with the correct knowledge for the features of robotic system and skills for rectal surgery must be performed. In the future, the robotic surgery will be recognized as the best operations.
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日本臨床外科学会雑誌 75(6) 1461-1472 2014年直腸癌外科治療の対するこれまでの取り組みを概説した.自律神経温存手術の妥当性に関しては,拡大郭清標本を用いて自律神経周囲組織への微小癌を確認した.10%の直腸癌症例で微小癌が見られたが,転移が見られた症例の予後が不良であり全自律神経温存は根治性に影響ないと考えられた.直腸内には手術操作時に遊離癌細胞がほぼ全例で存在するが,直腸内洗浄により除去できる.結腸内にもこれらが見られるので術中操作に注意が必要である.直腸癌手術の体位は,大腿開脚水平位が視野の面から適切な体位であり,この体位を使用して低位の吻合ではIO-DSTによるdouble stapling techniqueは有用で,K式開肛器を使用して安全に施行できる.E式開肛器と種々の技術を併用したMITASによる局所切除はtotal biopsyの手技として低侵襲な手術であり,2012年より保険収載された.直腸癌手術では解剖を十分熟知して手術にあたる必要があり,若い外科医には臨床から出た発想で工夫されることを希望したい.
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癌の臨床 = Japanese journal of cancer clinics 59(6) 651-657 2013年12月
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INVESTIGATIONAL NEW DRUGS 31(5) 1321-1329 2013年10月 査読有りPurpose Continuous treatment with FOLFOX therapy is associated with peripheral nerve toxicity, and to improve this inconvenient side effect various methods of administration are being investigated. A regimen of intermittent oxaliplatin administration by continuous infusion therapy, i.e., modified FOLFOX7 (mFOLFOX7) + bevacizumab, was designed with the goal of alleviating severe peripheral nerve disorders and hematological toxicity. A phase II clinical study was conducted to evaluate the efficacy and safety of this regimen. Methods Previously untreated patients were assigned to mFOLFOX7 (oxaliplatin 85 mg/m(2), levofolinate [l-LV] 200 mg/m(2), 5-fluorouracil [5-FU] 2400 mg/m(2)) + bevacizumab (5 mg/kg) administered every 2 weeks for 8 cycles, maintenance without oxaliplatin for 8 cycles, and reintroduction of mFOLFOX7 + bevacizumab for 8 cycles or until disease progression. Progression free survival (PFS) following the first dose (PFS 1) and following reintroduction of oxaliplatin (PFS 2) were used as indices for assessing the efficacy of intermittent administration. Results Fifty-two patients were enrolled, with median age of 64 years (range, 36-74). Median PFS 1 was 11.8 months (95 % confidence interval [CI], 9.5 to 13.7), median time to treatment failure was 10.3 months (95 % CI, 5.6 to 12.1), percentage of patients with neutropenia of grade 3 or higher was 7.8 %, and percentage with peripheral nerve disorders was 3.9 %. Response rate was 50 %, and 84.4 % of patients who started modified simplified LV5FU2 + bevacizumab were reintroduced to oxaliplatin. Conclusion By excluding 5-FU bolus administration and administering bevacizumab continuously the mFOLFOX7 + bevacizumab regimen with preplanned withdrawal of oxaliplatin showed high tolerability and prevented severe peripheral neuropathy and neutropenia without reducing efficacy.
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TECHNIQUES IN COLOPROCTOLOGY 17(4) 437-440 2013年8月 査読有りThe aim of the present study was to classify the short-term outcomes of local correction of stoma prolapse with a stapler device. The medical records of 11 patients undergoing local correction of stoma prolapse using a stapler device were retrospectively reviewed. No mortality or morbidity was observed after the surgery. Median operative time was 35 min (range 15-75 min), and blood loss was minimal. Median duration of follow-up was 12 months (range 6-55 months). One of the 11 patients had a recurrent stoma prolapse. This technique can be a feasible, safe and minimally invasive correction procedure for stoma prolapse.
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379作成した教科書、教材、参考書
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件名-終了年月日2010概要標準外科学 「小腸および結腸」p 528-544を分担執筆