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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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日本外科学会雑誌 112(1) 2011年5月25日
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日本外科学会雑誌 112(1) 2011年5月25日
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DISEASES OF THE COLON & RECTUM 54(5) 586-592 2011年5月 査読有りBACKGROUND: Recurrence of Crohn's disease usually occurs at anastomotic sites. OBJECTIVE: A new anastomosis technique (Kono-S anastomosis) designed to minimize anastomotic restenosis was compared with conventional anastomoses. DESIGN AND SETTINGS: The Kono-S anastomosis technique was first used for Crohn's disease in 2003 at the Asahikawa Medical University Hospital. The resection is accomplished by transecting the bowel with a linear cutter so that the mesentery side is located in the center of the stump. Both stumps are sutured to create a supporting column to maintain the diameter and dimension of the anastomosis. Longitudinal enterotomies are made at the antimesenteric sides of the 2 segments of intestine. The side-to-side antimesenteric anastomosis is then performed in transverse fashion. The medical records and follow-up details of all patients undergoing this procedure were reviewed. PATIENTS: From 2003 to 2009, 69 patients with Crohn's disease who underwent Kono-S anastomosis (group S) were compared with 73 historical patients with Crohn's disease who underwent conventional anastomosis (group C) from 1993 to 2003. MAIN OUTCOME MEASURES: A Kaplan-Meier analysis of the follow-up data on surgical recurrence at the anastomosis was performed. The endoscopic recurrence score at the anastomosis was calculated. RESULTS: The median endoscopic recurrence score in group S was significantly lower than that in group C (2.6 vs 3.4; P = .008). The Kaplan-Meier analysis showed a lesser probability of anastomotic surgical recurrence in the S group at 5 years (0% vs 15%; P = .0013). The absence of postoperative infliximab did not affect the restenosis rate in group S. LIMITATIONS: This study was limited by its historical retrospective nature. CONCLUSION: The Kono-S anastomosis appears to be effective in preventing anastomotic surgical recurrence in Crohn's disease.
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JOURNAL OF GASTROENTEROLOGY 46(2) 203-211 2011年2月 査読有りBecause the rate of recurrence after curative resection for T1 colorectal cancer is low, the characteristics of recurrence remain obscure. This multicenter study attempted to clarify the characteristics of recurrence after curative resection for T1 colorectal cancer. We analyzed the associations between recurrence and various clinicopathological features in 798 patients who had undergone curative resection alone for T1 colorectal cancer at 14 hospitals between 1991 and 1996. The rate of lymph node metastasis (LNM) in patients with T1 colorectal cancer was 10.5% (84/798), and 18 (2.3%) of the 798 patients developed recurrence during the median follow-up of 7.8 years. The recurrence rates in patients with colon cancer with and without LNM were 3.6 and 1.3%, respectively (p = 0.19). These rates in patients with cancer of the rectum were 25.0 and 1.1% (p < 0.0001). Among various parameters, histological grade (p < 0.0001), location (p = 0.025), LNM (p < 0.0001), and venous invasion (p = 0.0013) were risk factors for recurrence. Among them, LNM (p = 0.0008) and histological grade (p = 0.041) were independent risk factors for recurrence after curative resection for T1 colorectal cancer. Time to recurrence was more likely to be shorter for patients with, than without nodal involvement. In patients with an unfavorable histological grade, all recurrences developed within 1 year. The recurrence rate after curative resection for node-negative T1 colorectal cancer was very low. The effectiveness of surveillance to detect recurrence after curative resection for T1 colorectal cancer should be validated in further studies.
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日本外科系連合学会誌 36(6) 913-919 2011年【目的】結腸MP癌（MP）の特徴と適切なリンパ節郭清範囲を明らかにする．<BR>【対象と方法】D3郭清を施行し，組織学的にMPと診断された結腸癌84例を対象に，左半MP71例（左MP）と右半MP13例（右MP）を臨床的に比較し，さらにMPをSS癌（SS）180例と臨床病理学的に比較検討した．<BR>【結果】根治度A手術の施行率，リンパ節転移率，２群または３群の所属リンパ節（遠隔リンパ節）への転移率，再発率，５年生存率は左MPと右MPで差を認めなかった．根治度Aの手術が施行されたMP（80例）のリンパ節転移率は23.8％で，SS（167例）の33.5％に比し低率の傾向にあったが，遠隔所属リンパ節への転移率は7.5％でSSの7.8％と差を認めず，遠隔リンパ節転移例における再発率はMPで33.3％，SSで15.4％と差を認めなかった．MPの根治度A手術症例における５年生存率は93.2％で，SSの85.5％と差を認めなかった．<BR>【結語】結腸MPはSSと遠隔リンパ節への転移率，再発率，予後に差がなく，SSと同様な郭清が必要と考えられた．
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日本腹部救急医学会雑誌 31(6) 855-859 2011年腹腔鏡下手術における偶発症の中には，血管損傷，腸管損傷，臓器損傷などがあげられる。これらの偶発症の発生率は，減少していないのが現状である。当院で施行した腹腔鏡下大腸切除術症例は446例あり，血管損傷例は14例，腸管損傷例は9例，臓器損傷は1例であった。開腹手術へのコンバート症例は12（2.6％）例であり，血管損傷例で開腹移行した症例はなかった。偶発症を起こさないためにも定型化した手術手技を行い，使用器具の正確な理解，操作方法，術者，助手，スコピストが三位一体となり協調操作を行い，視野の確保をし，解剖学的膜構造，剥離層の理解をすることが重要であると考えられる。
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日本腹部救急医学会雑誌 31(3) 579-582 2011年直腸肛門内圧検査は，直腸肛門部の機能検査の中心となる検査である。今回，直腸肛門内圧検査にて直腸穿孔を発症した2例を経験し，発表に関して患者，家族の同意も得られたので報告する。症例1：40歳台の男性。直腸癌にて超低位前方切除＋横行結腸人工肛門造設術を施行。術後3ヵ月目の人工肛門閉鎖前に直腸肛門内圧検査（含，直腸感覚検査）を施行した。直腸感覚検査にて腹痛が出現，穿孔性腹膜炎にて緊急手術を施行した。症例2：70歳台の女性。直腸脱に対し経肛門的脱出腸管切除術（自動縫合器使用）を施行。術後6ヵ月目に直腸肛門内圧検査（含，直腸感覚検査）を施行した。検査後より下血が出現し，直腸穿孔にて約3週間の保存的治療を施行した。直腸感覚検査で用いたオバタメトロバルーンカテーテルは，個体に因らす簡便に行える検査器具である。しかし，吻合部に圧力がかかり易いため，術後検査には十分注意する必要がある。
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日本大腸肛門病学会雑誌 64(10) 873-878 2011年便失禁に関する外科治療の報告は多数存在するが，概してそのエビデンスレベルは低く，疾患の性質上，ランダム化比較試験などの大規模試験が困難である．肛門括約筋形成術などの標準的治療から現在のトピックスである仙骨神経刺激療法などの低侵襲手術の試みが欧米を中心に行われており，本邦における外科治療のガイドライン作成が急務である．<br> 便失禁の外科治療が今回のテーマである「標準化」となるためには，それぞれの治療法の特徴を十分に周知する必要がある．そのために，本邦で行われている肛門括約筋形成術，有茎薄筋移植術やストーマ造設術以外に，現時点では本邦において未承認の仙骨神経刺激療法などの外科治療も含めて文献的考察を加えて紹介する．<br>
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日本大腸肛門病学会雑誌 64(10) 873-878 2011年便失禁に関する外科治療の報告は多数存在するが，概してそのエビデンスレベルは低く，疾患の性質上，ランダム化比較試験などの大規模試験が困難である．肛門括約筋形成術などの標準的治療から現在のトピックスである仙骨神経刺激療法などの低侵襲手術の試みが欧米を中心に行われており，本邦における外科治療のガイドライン作成が急務である．<br> 便失禁の外科治療が今回のテーマである「標準化」となるためには，それぞれの治療法の特徴を十分に周知する必要がある．そのために，本邦で行われている肛門括約筋形成術，有茎薄筋移植術やストーマ造設術以外に，現時点では本邦において未承認の仙骨神経刺激療法などの外科治療も含めて文献的考察を加えて紹介する．<br>
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臨床外科 65(13) 1654-1661 2010年12月大腸癌手術の原則は,膜構造を維持し癌細胞散布をさせないようにen-blockに切除を行うことである.この原則を守り,視野が限られる腹腔鏡下大腸切除術を円滑に進めるには,出血をコントロールしながら膜構造を維持した手術を行うことが重要である.そのポイントは,(1)中小血管,実質臓器,間膜構造などの解剖学的位置関係を十分理解し,出血しやすい部位を把握しておくこと,(2)腹腔鏡下手術の特徴に配慮した,鉗子やエネルギー源の器具の適切な選択や手技を行うこと,(3)助手との連携によって,良好な視野展開で手術を進める,(4)細かな血管でも止血する,(5)出血時には出血源や出血量に応じた適切な器具を選択し,止血を的確に行うこと,などである.これらを遵守することで,癌手術の原則を守った腹腔鏡下手術が可能となる.(著者抄録)
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JAPANESE JOURNAL OF CLINICAL ONCOLOGY 40(11) 1073-1080 2010年11月 査読有りInteraction of CA19-9 with E-selectin is involved in initiation of hematogenous metastases. We investigated whether serum concentrations of E-selectin and CA19-9 are good predictors of hematogenous metastases and prognosis in colorectal cancer. Pre-operative serum samples were obtained from 152 patients with colorectal cancer, and from 28 healthy volunteers. Correlation between serum E-selectin and CA19-9 was studied in terms of clinically detected hematogenous metastases and prognosis of patients. Low serum concentration of E-selectin was defined as < 50 U/ml in healthy volunteers, and on that basis, 20.4% of all patients belonged to the high E-selectin group. Several distinctive characteristics were observed in the clinical course of patients with high serum concentrations of both CA19-9 and E-selectin. The rate of Dukes' D cancer was significantly higher, and curative surgery was performed less frequently in patients with high serum concentrations of both CA19-9 and E-selectin (60 and 40%) than in others. However, there was no significant difference in the frequency of recurrence after curative surgery between patients with high serum concentrations of both CA19-9 and E-selectin (25.0%) and others. Overall the 5-year survival rate was significantly lower in patients with high serum concentrations of both CA19-9 and E-selectin (34.3%) than in other patients. Even if the serum concentration of CA19-9 was high, prognosis was not poor in patients with low serum concentration of E-selectin. These results suggested that it was useful to measure both CA19-9 and E-selectin as markers of hematogenous metastases and as predictors of prognosis in colorectal cancer.
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消化器外科nursing 15(5) 444-449 2010年5月
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日本外科学会雑誌 111(2) 2010年3月5日
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日本外科学会雑誌 111(2) 2010年3月5日
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日本外科学会雑誌 111(2) 2010年3月5日
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日本外科学会雑誌 111(2) 2010年3月5日
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日本消化器外科学会雑誌 43(9) 1002-1006 2010年大腸癌に対するda Vinci Surgical System<sup>®</sup>を用いたロボット手術は医学中央雑誌およびPubMedで「大腸癌（colorectal cancer）」, 「ロボット手術（robot surgery）」をキーワードとして1999年10月から2009年9月末までの10年間において，検索しえた範囲内で本邦での報告はなく，本症例が初の報告である．症例は77歳の男性でBMIは22.4であった．S状結腸腫瘍に対して内視鏡下粘膜切除術を施行した結果，病理組織学的検査でSM浸潤度1,000 μm以上であったため，追加手術目的にて外科へ紹介となった．内側アプローチによる下腸間膜動脈周囲のリンパ節郭清や血管処理，外側からのS状結腸の授動，直腸の剥離操作などをロボット手術下に施行した．初例のため，手術時間は要したが，術後に特記すべき合併症は認めず，術後6日目に軽快退院となった．今回教室で経験したロボット支援下手術によるS状結腸切除術について文献的考察を加えて報告する．
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日本大腸肛門病会誌 63(1) 6-14 2010年1月1日 査読有り直腸肛門内圧検査における引き抜き検査と直腸刺激検査について検討を行った．対象は，2007年9月から2008年8月に直腸肛門内圧検査を施行した71例である．測定の体位は左側臥位とし，water perfusion型のカテーテルを用いて引き抜き法で行った．直腸肛門の刺激には，径7mmのオバタメトロバルーンカテーテルを使用した．引き抜き検査を3回施行し，生理的肛門管長（HPZ）と肛門管最大静止圧（MRP）を測定．各測定値のばらつきや平均値（mean），中央値（median）など様々な測定値を検討した結果，年齢や性別，便失禁の程度と最も相関するのは，引き抜き検査3回目の値であった．また直腸刺激検査では，便意発現最少量（FS）や最大耐用量（MTV）は年齢や性別，便失禁の程度と明らかな相関関係を認めなかった．しかし耐用量（TV）=（最大耐用量（MTV）-便意発現最少量（FS））を用いると，年齢や性別，便失禁の程度と相関関係を認めた．今後，耐用量（TV）は便失禁の指標となる可能性が示唆された．<br>
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日本消化器外科学会雑誌 43(9) 1002-1006 2010年 査読有り大腸癌に対するda Vinci Surgical System^[○!R]を用いたロボット手術は医学中央雑誌およびPubMedで「大腸癌(colorectal cancer)」,「ロボット手術(robot surgery)」をキーワードとして1999年10月から2009年9月末までの10年間において,検索しえた範囲内で本邦での報告はなく,本症例が初の報告である.症例は77歳の男性でBMIは22.4であった.S状結腸腫瘍に対して内視鏡下粘膜切除術を施行した結果,病理組織学的検査でSM浸潤度1,000μm以上であったため,追加手術目的にて外科へ紹介となった.内側アプローチによる下腸間膜動脈周囲のリンパ節郭清や血管処理,外側からのS状結腸の授動,直腸の剥離操作などをロボット手術下に施行した.初例のため,手術時間は要したが,術後に特記すべき合併症は認めず,術後6日目に軽快退院となった.今回教室で経験したロボット支援下手術によるS状結腸切除術について文献的考察を加えて報告する.
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Physical Review B - Condensed Matter and Materials Physics 80(24) 2009年12月21日We have used a femtosecond pump-probe impulsive Raman technique to explore the ultrafast dynamics of micelle suspended single-walled carbon nanotubes (SWNTs) in various pH environments. The structures of coherent phonon spectra of the radial breathing modes exhibit significant pH dependence, to which we attribute the effect of the protonation at the surface of SWNTs, resulting in the modification of electronic properties of semiconductor SWNTs. Analysis of the time-domain data using a time-frequency transformation uncovers also a second transient longitudinal breathing mode, which vanishes after 1 ps of the photoexcitation. © 2009 The American Physical Society.
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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