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      • KCI등재

        Advantages of Function-Preserving Gastrectomy for Older Patients With Upper-Third Early Gastric Cancer: Maintenance of Nutritional Status and Favorable Survival

        Manabu Ohashi,Masayoshi Terayama,Satoshi Ida,Masaru Hayami,Rie Makuuchi,Koshi Kumagai,Takeshi Sano,Souya Nunobe 대한위암학회 2023 Journal of gastric cancer Vol.23 No.2

        Purpose: The incidence of early gastric cancer is increasing in older patients alongside life expectancy. For early gastric cancer of the upper third of the stomach, laparoscopic function-preserving gastrectomy (LFPG), including laparoscopic proximal gastrectomy (LPG) and laparoscopic subtotal gastrectomy (LSTG), is expected to be an alternative to laparoscopic total gastrectomy (LTG). However, whether LFPG has advantages over LTG in older patients remains unknown. Materials and Methods: We retrospectively analyzed data of consecutive patients aged ≥75 years who underwent LTG, LPG, or LSTG for cT1N0M0 gastric cancer between 2005 and 2019. Surgical and nutritional outcomes, including blood parameters, percentage body weight (%BW) and percentage skeletal muscle index (%SMI) were compared between LTG and LPG or LSTG. Survival outcomes were also compared between LTG and LFPG groups. Results: A total of 111 patients who underwent LTG (n=39), LPG (n=48), and LSTG (n=24) were enrolled in this study. To match the surgical indications, LTG was further categorized into “LTG for LPG” (LTG-P) and “LTG for LSTG” (LTG-S). No significant differences were identified in the incidence of postoperative complications among the procedures. Postoperative nutritional parameters, %BW and %SMI were better after LPG and LSTG than after LTG-P and LTG-S, respectively. The survival outcomes of LFPG were better than those of LTG. Conclusions: LFPG is safe for older patients and has advantages over LTG in terms of postoperative nutritional parameters, body weight, skeletal muscle-sparing, and survival. Therefore, LFPG for upper early gastric cancer should be considered in older patients.

      • KCI등재

        Clinical Impact of Polyglycolic Acid Mesh to Reduce Pancreas-Related Complications After Minimally Invasive Surgery for Gastric Cancer: A Propensity Score Matching Analysis

        Manabu Ohashi,Motonari Ri,Rie Makuuchi,Masaru Hayami,Takeshi Sano,Souya Nunobe 대한위암학회 2024 Journal of gastric cancer Vol.24 No.2

        Purpose: Prevention of pancreas-related complications after gastric cancer surgery is critical. Polyglycolic acid (PGA) mesh reduces postoperative pancreatic fistula formation following pancreatic resection. However, the clinical efficacy of PGA mesh in gastric cancer surgery has not been adequately investigated. Materials and Methods: This retrospective study compared the short-term outcomes between two groups: patients who underwent minimally invasive R0 gastrectomy for gastric cancer with the use of a PGA mesh (PGA group) and those without the use of a PGA mesh (non-PGA group) at the Cancer Institute Hospital, Tokyo, between January 2019 and May 2023. Propensity score matching (PSM) was performed to adjust for the possible confounding factors. Results: A total of 834 patients were initially included, of whom 614 (307 in each group) remained after PSM. The amylase levels in the drained abdominal fluid on postoperative days 1 and 3 were similar between the PGA and non-PGA groups. The PGA group had a significantly lower incidence of pancreas-related complications of Clavien-Dindo grade ≥2 than that in the non-PGA group (6.8% vs. 2.9%, P=0.025). In subgroup analyses, the odds ratio for pancreas-related complications appeared to be better in the PGA group than in the non-PGA group in patients with American Society of Anesthesiologists Physical Status Classification score of 2 or 3, those operated via a laparoscopic approach, and those undergoing procedures other than proximal gastrectomy. Conclusions: The use of PGA mesh significantly reduced pancreas-related complications after minimally invasive surgery for gastric cancer and might thus benefit patients at risk of such complications.

      • KCI등재

        Gastric Adenocarcinoma of Fundic Gland Type with Aggressive Transformation and Lymph Node Metastasis: a Case Report

        Yasuhiro Okumura,Manabu Takamatsu,Manabu Ohashi,Yorimasa Yamamoto,Noriko Yamamoto,Hiroshi Kawachi,Satoshi Ida,Koshi Kumagai,Souya Nunobe,Naoki Hiki,Takeshi Sano 대한위암학회 2018 Journal of gastric cancer Vol.18 No.4

        A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.

      • Advantages of Function-Preserving Gastrectomy for Older Patients With Upper-Third Early Gastric Cancer: Maintenance of Nutritional Status and Favorable Survival

        Masayoshi Terayama,Manabu Ohashi,Satoshi Ida,Masaru Hayami,Rie Makuuchi,Koshi Kumagai,Takeshi Sano,Souya Nunobe The Korean Gastric Cancer Association 2023 대한위암학회지 Vol.23 No.2

        Purpose: The incidence of early gastric cancer is increasing in older patients alongside life expectancy. For early gastric cancer of the upper third of the stomach, laparoscopic function-preserving gastrectomy (LFPG), including laparoscopic proximal gastrectomy (LPG) and laparoscopic subtotal gastrectomy (LSTG), is expected to be an alternative to laparoscopic total gastrectomy (LTG). However, whether LFPG has advantages over LTG in older patients remains unknown. Materials and Methods: We retrospectively analyzed data of consecutive patients aged ≥75 years who underwent LTG, LPG, or LSTG for cT1N0M0 gastric cancer between 2005 and 2019. Surgical and nutritional outcomes, including blood parameters, percentage body weight (%BW) and percentage skeletal muscle index (%SMI) were compared between LTG and LPG or LSTG. Survival outcomes were also compared between LTG and LFPG groups. Results: A total of 111 patients who underwent LTG (n=39), LPG (n=48), and LSTG (n=24) were enrolled in this study. To match the surgical indications, LTG was further categorized into "LTG for LPG" (LTG-P) and "LTG for LSTG" (LTG-S). No significant differences were identified in the incidence of postoperative complications among the procedures. Postoperative nutritional parameters, %BW and %SMI were better after LPG and LSTG than after LTG-P and LTG-S, respectively. The survival outcomes of LFPG were better than those of LTG. Conclusions: LFPG is safe for older patients and has advantages over LTG in terms of postoperative nutritional parameters, body weight, skeletal muscle-sparing, and survival. Therefore, LFPG for upper early gastric cancer should be considered in older patients.

      • SCOPUSKCI등재

        Gastric Adenocarcinoma of Fundic Gland Type with Aggressive Transformation and Lymph Node Metastasis: a Case Report

        Okumura, Yasuhiro,Takamatsu, Manabu,Ohashi, Manabu,Yamamoto, Yorimasa,Yamamoto, Noriko,Kawachi, Hiroshi,Ida, Satoshi,Kumagai, Koshi,Nunobe, Souya,Hiki, Naoki,Sano, Takeshi The Korean Gastric Cancer Association 2018 Journal of gastric cancer Vol.18 No.4

        A 55-year-old man visited our hospital for a detailed examination of a gastric submucosal tumor that was first detected 10 years prior. The tumor continued to grow and had developed a depressed area in its center. A histopathological examination of biopsy specimens revealed gastric adenocarcinoma of the fundic gland type (GA-FG). It was diagnosed as T2 based on the invasion depth as determined by white-light endoscopy and endoscopic ultrasonography. A total gastrectomy with lymphadenectomy was performed and a GA-FG in the mucosa and submucosa was confirmed histopathologically. However, there was a gradual transition to an infiltrative tubular adenocarcinoma with poorly differentiated components in the muscular and subserosal layers. Metastasis was identified in a dissected lymph node (LN). This is the first report of a GA-FG progressing to an aggressive cancer with LN metastasis. These findings modify our understanding of the pathophysiology of GA-FG.

      • KCI등재

        Searching for cosmic missing baryons with DIOS - Diffuse Intergalactic Oxygen Surveyor -

        Yasushi Suto,Akihiro Furuzawa,Kazuhisa Mitsuda,Manabu Ishida,Noriko Y. Yamasaki,Ryuichi Fujimoto,Shin Sasaki,Tae Furusho,Takaya Ohashi,Yoshitaka Ishisaki,Yuzuru Tawara 한국물리학회 2004 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.45 No.1

        Approximately 30 to 50 percent of the total baryons in the present universe is supposed to take the form of wa arm/hot intergalactic medium (WHIM) whose X-ray continuum emission is very weak. In order to carry out a direct and homogeneous survey of elusive cosmic missing baryons, we propose a dedicated soft-X-ray mission, DIOS (Diffuse Intergalactic Oxygen Surveyor). The unprecedented energy resolution ( 2eV) of the XSA (X-ray Spectrometer Array) on-board DIOS enables us to identify WHIM with gas temperatures T = 106က7K and overdensity = 10က100 located at z < 0:3 through emission lines of Ovii and Oviii. DIOS, which will hopefully be launched in several years time, promises to open a new window of detection and characterization of cosmic missing baryons and to provide yet another important and complementary tool to trace the large-scale structure of the universe.

      • SCIESCOPUSKCI등재

        TRACING BRIGHT AND DARK SIDES OF THE UNIVERSE WITH X-RAY OBSERVATIONS

        SUTO YASUSHI,YOSHIKAWA KOHJI,DOLAG KLAUS,SASAKI SHIN,YAMASAKI NORIKO Y.,OHASHI TAKAYA,MITSUDA KAZUHISA,TAWARA YUZURU,FUJIMOTO RYUICHI,FURUSHO TAE,FURUZAWA AKIHIRO,ISHIDA MANABU,ISHISAKI YOSHITAKA The Korean Astronomical Society 2004 Journal of The Korean Astronomical Society Vol.37 No.5

        X-ray observations of galaxy clusters have played an important role in cosmology, especially in determining the cosmological density parameter and the fluctuation amplitude. While they represent the bright side of the universe together with the other probes including the cosmic microwave background and the Type Ia supernovae, the resulting information clearly indicates that the universe is dominated by dark components. Even most of cosmic baryons turns out to be dark. In order to elucidate the nature of dark baryons, we propose a dedicated soft-X-ray mission, DIOS (Diffuse Intergalactic Oxygen Surveyor). Recent numerical simulations suggest that approximately 30 to 50 percent of total baryons at z = 0 take the form of the warm-hot intergalactic medium (WHIM) with $10^5K < T < 10^7K $which has evaded the direct detection so far. The unprecedented energy resolution (${\~} 2eV$) of the XSA (X-ray Spectrometer Array) on-board DIGS enables us to identify WHIM with gas temperature $T = 10^6 {\~} 10^7K$ and overdensity $\delta$ = 10 ${\~}$ 100 located at z < 0.3 through emission lines of OVII and OVIII. In addition, WHIMs surrounding nearby clusters are detectable with a typical exposure time of a day, and thus constitute realistic and promising targets for DIOS.

      • KCI등재

        Postprandial Asymptomatic Glycemic Fluctuations after Gastrectomy for Gastric Cancer Using Continuous Glucose Monitoring Device

        Motonari Ri,Souya Nunobe,Satoshi Ida,Naoki Ishizuka,Shinichiro Atsumi,Masaru Hayami,Rie Makuuchi,Koshi Kumagai,Manabu Ohashi,Takeshi Sano 대한위암학회 2021 Journal of gastric cancer Vol.21 No.4

        Purpose: Although dumping symptoms are thought to involve postprandial glycemic changes, postprandial glycemic variability without dumping symptoms remains poorly understood due to the lack of a method that allows the easy and continuous measurement of blood glucose levels. Materials and Methods: Patients having undergone distal gastrectomy with Billroth-I (DG-BI) or Roux-en-Y reconstruction (DG-RY), total gastrectomy with RY (TG-RY) and pylorus preserving gastrectomy (PPG) for gastric cancer 3 months to 3 years prior, diagnosed as pathological stage I or II, were prospectively enrolled from March 2018 to January 2020. The interstitial tissue glycemic levels were measured every 15 min, up to 14 days by continuous glucose monitoring. Moreover, using a diary recording the diet and symptoms, asymptomatic glucose profiles without sugar supplementation within 3 h postprandially were compared among the four procedures. Results: A total of 40 patients were enrolled, 10 patients for each of the four procedures. There were 47 glucose profiles with DG-BI, 46 profiles with DG-RY, 38 profiles with TG-RY, and 46 profiles with PPG. PPG showed the slowest increase with a subsequent gradual decrease in glucose fluctuations, without hyperglycemia or hypoglycemia, among the four procedures. In contrast, TG-RY and DG-RY showed spike-like glycemic variability, sharp rises during meals, and rapid drops. The glucose profiles of DG-BI were milder than those of RY. Conclusions: The asymptomatic glycemic changes after meals differ among the types of surgical procedures for gastric cancer. Given the mild glycemic fluctuations in PPG and the glucose spikes in TG-RY and DG-RY, pylorus preservation and physiological reconstruction without changes in food pathways may optimize postprandial glucose profiles after gastrectomy.

      • KCI등재

        Pancreatic Compression during Lymph Node Dissection in Laparoscopic Gastrectomy: Possible Cause of Pancreatic Leakage

        Satoshi Ida,Naoki Hiki,Takeaki Ishizawa,Yugo Kuriki,Mako Kamiya,Yasuteru Urano,Takuro Nakamura,Yasuo Tsuda,Yosuke Kano,Koshi Kumagai,Souya Nunobe,Manabu Ohashi,Takeshi Sano 대한위암학회 2018 Journal of gastric cancer Vol.18 No.2

        Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

      • SCOPUSKCI등재

        Pancreatic Compression during Lymph Node Dissection in Laparoscopic Gastrectomy: Possible Cause of Pancreatic Leakage

        Ida, Satoshi,Hiki, Naoki,Ishizawa, Takeaki,Kuriki, Yugo,Kamiya, Mako,Urano, Yasuteru,Nakamura, Takuro,Tsuda, Yasuo,Kano, Yosuke,Kumagai, Koshi,Nunobe, Souya,Ohashi, Manabu,Sano, Takeshi The Korean Gastric Cancer Association 2018 Journal of gastric cancer Vol.18 No.2

        Purpose: Postoperative pancreatic fistula is a serious and fatal complication of gastrectomy for gastric cancer. Blunt trauma to the parenchyma of the pancreas can result from an assistant's forceps compressing and retracting the pancreas, which in turn may result in pancreatic juice leakage. However, no published studies have focused on blunt trauma to the pancreas during laparoscopic surgery. Our aim was to investigate the relationship between compression of the pancreas and pancreatic juice leakage in a swine model. Materials and Methods: Three female pigs were used in this study. The pancreas was gently compressed dorsally for 15 minutes laparoscopically with gauze grasped with forceps. Pancreatic juice leakage was visualized by fluorescence imaging after topical administration of chymotrypsin-activatable fluorophore in real time. Amylase concentrations in ascites collected at specified times was measured. In addition, pancreatic tissue was fixed with formalin, and the histology of the compressed sites was evaluated. Results: Fluorescence imaging enabled visualization of pancreatic juice leaking into ascites around the pancreas. Median concentrations of pancreatic amylase in ascites increased from 46 U/L preoperatively to 12,509 U/L 4 hours after compression. Histological examination of tissues obtained 4 hours after compression revealed necrotic pancreatic acinar cells extending from the surface to deep within the pancreas and infiltration of inflammatory cells. Conclusions: Pancreatic compression by the assistant's forceps can contribute to pancreatic juice leakage. These findings will help to improve the procedure for lymph node dissection around the pancreas during laparoscopic gastrectomy.

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