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Pancreatic Neoplasms: HELP
Articles by Masanao Kurata
Based on 25 articles published since 2010
(Why 25 articles?)
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Between 2010 and 2020, Masanao Kurata wrote the following 25 articles about Pancreatic Neoplasms.
 
+ Citations + Abstracts
1 Clinical Trial Multicenter Phase II Study of Intravenous and Intraperitoneal Paclitaxel With S-1 for Pancreatic Ductal Adenocarcinoma Patients With Peritoneal Metastasis. 2017

Satoi, Sohei / Fujii, Tsutomu / Yanagimoto, Hiroaki / Motoi, Fuyuhiko / Kurata, Masanao / Takahara, Naminatsu / Yamada, Suguru / Yamamoto, Tomohisa / Mizuma, Masamichi / Honda, Goro / Isayama, Hiroyuki / Unno, Michiaki / Kodera, Yasuhiro / Ishigami, Hironori / Kon, Masanori. ·*Department of Surgery, Kansai Medical University †Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine ‡Department of Surgery, Tohoku University Graduate School of Medicine §Department of Surgery, University of Tsukuba ¶Department of Gastroenterology, Graduate School of Medicine, the University of Tokyo ||Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital **Department of Chemotherapy, the University of Tokyo. ·Ann Surg · Pubmed #28059968.

ABSTRACT: OBJECTIVE: To evaluate the clinical efficacy and tolerability of intravenous (i.v.) and intraperitoneal (i.p.) paclitaxel combined with S-1, "an oral fluoropyrimidine derivative containing tegafur, gimestat, and otastat potassium" in chemotherapy-naive pancreatic ductal adenocarcinoma (PDAC) patients with peritoneal metastasis. BACKGROUND: PDAC patients with peritoneal metastasis (peritoneal deposits and/or positive peritoneal cytology) have an extremely poor prognosis. An effective treatment strategy remains elusive. METHODS: Paclitaxel was administered i.v. at 50 mg/m and i.p. at 20 mg/m on days 1 and 8. S-1 was administered at 80 mg/m/d for 14 consecutive days, followed by 7 days of rest. The primary endpoint was 1-year overall survival (OS) rate. The secondary endpoints were antitumor effect and safety (UMIN000009446). RESULTS: Thirty-three patients who were pathologically diagnosed with the presence of peritoneal dissemination (n = 22) and/or positive peritoneal cytology (n = 11) without other organ metastasis were enrolled. The tumor was located at the pancreatic head in 7 patients and the body/tail in 26 patients. The median survival time was 16.3 (11.47-22.57) months, and the 1-year survival rate was 62%. The response rate and disease control rate in assessable patients were 36% and 82%, respectively. OS in 8 patients who underwent conversion surgery was significantly higher than that of nonsurgical patients (n = 25, P = 0.0062). Grade 3/4 hematologic toxicities occurred in 42% of the patients and nonhematologic adverse events in 18%. One patient died of thrombosis in the superior mesenteric artery. CONCLUSIONS: This regimen has shown promising clinical efficacy with acceptable tolerability in chemotherapy-naive PDAC patients with peritoneal metastasis.

2 Clinical Trial A Phase I Study of S-1 and Gemcitabine with Concurrent Radiotherapy in Patients with Non-Metastatic Advanced Pancreatic Cancer. 2015

Kobayashi, Shin / Honda, Goro / Kurata, Masanao / Okuda, Yukihiro / Sakamoto, Katsunori / Karasawa, Katsuyuki / Chang, Tachen / Egawa, Naoto / Kamisawa, Terumi / Omuro, Yasushi / Tsuruta, Koji. · ·Hepatogastroenterology · Pubmed #26902051.

ABSTRACT: BACKGROUND/AIMS: To determine the recommended dose (RD) for full-dose S-1 and low-dose gemcitabine combined with radiotherapy in patients with non-metastatic advanced pancreatic cancer. METHODOLOGY: Adult patients with non-metastatic advanced pancreatic cancer (Union for International Cancer Control T stage 3 or 4) were eligible. The weekly intravenous gemcitabine (level 0-1: 200 mg/ml,level 2: 300 mg/m on Days 1, 8, 15, 22, 29, 36) dose was escalated starting from level 1 in a 3+3 design along with full dose twice-daily oral S-1 (level 0: 60 mg/m2/day, level 1-2: 80 mg/ml/day), and was administered on the same days as radiotherapy (1.8 Gy x 28 days). RESULTS: Eight patients were included in this study. A dose-limiting toxicity (DLT) (grade 4 neutropenia) was observed in one of the first three patients in level 1, and three additional patients received the level 1 dose without any severe adverse events. DLTs (grade 3/4 neutropenia) were then observed in the first two patients given level 2 dose. Therefore, level 1 was designated as the RD. Common grade 3/4 toxicities included neutropenia (62.5%), anorexia (37.5%), and pneumonitis (12.5%). CONCLUSIONS: The combination of S-1 and gemcitabine with concurrent radiotherapy is a feasible regimen at the level 1 dose.

3 Article Decreased serum carbohydrate antigen 19-9 levels after neoadjuvant therapy predict a better prognosis for patients with pancreatic adenocarcinoma: a multicenter case-control study of 240 patients. 2019

Aoki, Shuichi / Motoi, Fuyuhiko / Murakami, Yoshiaki / Sho, Masayuki / Satoi, Sohei / Honda, Goro / Uemura, Kenichiro / Okada, Ken-Ichi / Matsumoto, Ippei / Nagai, Minako / Yanagimoto, Hiroaki / Kurata, Masanao / Fukumoto, Takumi / Mizuma, Masamichi / Yamaue, Hiroki / Unno, Michiaki / Anonymous1210984. ·Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan. · Department of Surgery, Tohoku University Graduate School of Medicine, 1-1, Seiryo-machi, Aobaku, Sendai, Miyagi, 980-8574, Japan. fmotoi@surg.med.tohoku.ac.jp. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, 734-8553, Japan. · Department of Surgery, Nara Medical University, Nara, 634-8521, Japan. · Department of Surgery, Kansai Medical University, Osaka, 573-1010, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, 113-8677, Japan. · Second Department of Surgery, Wakayama Medical University, Wakayama, 641-8510, Japan. · Department of Surgery, Kindai University Faculty of Medicine, Osaka, 577-8502, Japan. · Department of Gastointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Tsukuba, 305-8575, Japan. · Department of Surgery, Kobe University Graduate School of Medicine, Kobe, 650-0017, Japan. ·BMC Cancer · Pubmed #30898101.

ABSTRACT: BACKGROUND: Carbohydrate antigen (CA) 19-9 levels after resection are considered to predict prognosis; however, the significance of decreased CA19-9 levels after neoadjuvant therapy has not been clarified. This study aimed to define the prognostic significance of decreased CA19-9 levels after neoadjuvant therapy in patients with pancreatic adenocarcinoma. METHODS: Between 2001 and 2012, 240 consecutive patients received neoadjuvant therapy and subsequent resection at seven high-volume institutions in Japan. These patients were divided into three groups: Normal group (no elevation [≤37 U/ml] before and after neoadjuvant therapy), Responder group (elevated levels [> 37 U/ml] before neoadjuvant therapy but decreased levels [≤37 U/ml] afterwards), and Non-responder group (elevated levels [> 37 U/ml] after neoadjuvant therapy). Analyses of overall survival and recurrence patterns were performed. Uni- and multivariate analyses were performed to clarify the clinicopathological factors influencing overall survival. The initial metastasis sites were also evaluated in these groups. RESULTS: The Responder group received a better prognosis than the Non-responder group (3-year overall survival: 50.6 and 41.6%, respectively, P = 0.026), but the prognosis was comparable to the Normal group (3-year overall survival: 54.2%, P = 0.934). According to the analysis of the receiver operating characteristic curve, the CA19-9 cut-off level defined as no elevation after neoadjuvant therapy was ≤103 U/ml. The multivariate analysis revealed that a CA19-9 level ≤ 103 U/ml, (P = 0.010, hazard ratio: 1.711; 95% confidence interval: 1.133-2.639), tumor size ≤27 mm (P = 0.040, 1.517; (1.018-2.278)), a lack of lymph node metastasis (P = 0.002, 1.905; (1.276-2.875)), and R0 status (P = 0.045, 1.659; 1.012-2.627) were significant predictors of overall survival. Moreover, the Responder group showed a lower risk of hepatic recurrence (18%) compared to the Non-responder group (31%), though no significant difference in loco-regional, peritoneal or other distant recurrence were observed between groups (P = 0.058, P = 0.700 and P = 0.350, respectively). CONCLUSIONS: Decreased CA19-9 levels after neoadjuvant therapy predicts a better prognosis, with low incidence of hepatic recurrence after surgery.

4 Article Sustained Elevation of Postoperative Serum Level of Carbohydrate Antigen 19-9 is High-Risk Stigmata for Primary Hepatic Recurrence in Patients with Curatively Resected Pancreatic Adenocarcinoma. 2019

Motoi, Fuyuhiko / Murakami, Yoshiaki / Okada, Ken-Ichi / Matsumoto, Ippei / Uemura, Kenichiro / Satoi, Sohei / Sho, Masayuki / Honda, Goro / Fukumoto, Takumi / Yanagimoto, Hiroaki / Kinoshita, Shoichi / Kurata, Masanao / Aoki, Shuichi / Mizuma, Masamichi / Yamaue, Hiroki / Unno, Michiaki / Anonymous4720964. ·Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. fmotoi@surg.med.tohoku.ac.jp. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan. · Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8510, Japan. · Department of Surgery, Faculty of Medicine, Kindai University, 377-2 Ohno-higashi, Osaka-Sayama, Osaka, 589-8511, Japan. · Department of Surgery, Kansai Medical University, 2-3-1 Shinmachi, Hirakata, Osaka, 573-1191, Japan. · Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, 7-5-2 Kusunoki-cho, Chuo-ku, Kobe, 650-0017, Japan. · Department of Surgery, Tohoku University Graduate School of Medicine, 1-1 Seiryo-machi, Aoba-ku, Sendai, 980-8574, Japan. ·World J Surg · Pubmed #30298281.

ABSTRACT: BACKGROUND: Survival after surgery for pancreatic adenocarcinoma (PA) is poor and heterogeneous, even for curative (R0) resection. Serum carbohydrate antigen (CA) 19-9 levels are important prognostic markers for resected PA. However, sustained elevation of CA19-9 in association with the patterns of recurrence has been rarely investigated. METHODS: Patients who underwent R0 resection (n = 539) were grouped according to postoperative serum CA19-9 levels (Group E: sustained elevation; Group N: no elevation). Clinicopathological factors, patterns of recurrence, and survival were compared between the groups. RESULTS: Group E (n = 159) had significantly shorter median overall survival (17.1 vs. 35.4 months, p < 0.0001) than Group N (n = 380). Postoperative CA19-9 elevation was a significant independent predictor of poor survival in multivariate analysis (hazard ratio 1.98, p < 0.0001). The rate of hepatic recurrence in Group E was 2.6-fold higher than in Group N (45% vs. 17%, p < 0.0001). Postoperative CA19-9 elevation was a strongest independent predictor of primary hepatic recurrence (p < 0.0001) by a multiple regression model. Loco-regional, peritoneal, and other distant recurrence did not differ between the groups. The extent of preoperative CA19-9 elevation was correlated sustained elevation of CA19-9 after surgery (p < 0.0001) and primary hepatic recurrence (p = 0.0019). CONCLUSIONS: Sustained CA19-9 elevation was strong predictor of primary hepatic recurrence and short survival in cases of R0 resection for PA.

5 Article Surgical resection of hepatic and rectal metastases of pancreatic acinar cell carcinoma (PACC): a case report. 2018

Ohara, Yusuke / Oda, Tatsuya / Enomoto, Tsuyoshi / Hisakura, Katsuji / Akashi, Yoshimasa / Ogawa, Koichi / Owada, Yohei / Domoto, Yu / Miyazaki, Yoshihiro / Shimomura, Osamu / Kurata, Masanao / Ohkohchi, Nobuhiro. ·Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. · Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, Ibaraki, 305-8575, Japan. tatoda@md.tsukuba.ac.jp. ·World J Surg Oncol · Pubmed #30075727.

ABSTRACT: BACKGROUND: Pancreatic acinar cell carcinoma (PACC), a rare variant of pancreatic malignancy, is generally managed the same way as pancreatic ductal adenocarcinoma (PDAC). Surgical resection is the gateway to curing it; however, once it metastasizes (usually to the liver, lungs, lymph nodes, or peritoneal cavity), systemic chemotherapy has been the only option, but with unfavorable results. CASE PRESENTATION: A 67-year-old man with symptoms of loss of appetite and weight underwent surgery for malignancy of the pancreatic tail extending into the entire pancreas. The pathological diagnosis was PACC following total pancreatectomy. Twenty-four months after the pancreatectomy, a solitary liver metastasis was treated by partial hepatectomy, and, subsequently, 4 months later, he presented with melena. Further examination revealed a type-2 rectal tumor. Histological examination following biopsy revealed it to be rectal metastasis of PACC, and it was treated by abdominoperineal resection. Subsequently, the patient did not have tumor recurrence as of 40 months after pancreatectomy. CONCLUSIONS: This is a rare case of PACC presenting with metachronal metastases in the liver and rectum, and we successfully treated them by surgical resections. Since the malignant behavior of PACC is usually less than that of PDAC, surgical resection could be an option even for metastatic lesions when the number and extent of metastases are limited.

6 Article Is distal pancreatectomy with en-bloc celiac axis resection effective for patients with locally advanced pancreatic ductal adenocarcinoma? -Multicenter surgical group study. 2018

Yamamoto, Tomohisa / Satoi, Sohei / Kawai, Manabu / Motoi, Fuyuhiko / Sho, Masayuki / Uemura, Ken-Ichiro / Matsumoto, Ippei / Honda, Goro / Okada, Ken-Ichi / Akahori, Takahiro / Toyama, Hirochika / Kurata, Masanao / Yanagimoto, Hiroaki / Yamaue, Hiroki / Unno, Michiaki / Kon, Masanori / Murakami, Yoshiaki. ·Department of Surgery, Kansai Medical University, Japan. · Department of Surgery, Kansai Medical University, Japan. Electronic address: satoi@hirakata.kmu.ac.jp. · Second Department of Surgery, Wakayama Medical University, Japan. · Department of Surgery, Tohoku University Graduate School of Medicine, Japan. · Department of Surgery, Nara Medical University, Japan. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Japan. · Department of Surgery, Kindai University Faculty of Medicine, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Japan. · Department of Gastrointestinal and Hepato-Biliary-Pancreatic Surgery, Faculty of Medicine, University of Tsukuba, Japan. ·Pancreatology · Pubmed #29153701.

ABSTRACT: OBJECTIVES: We retrospectively investigated the operative outcomes of patients who underwent distal pancreatectomy (DP) for invasive pancreatic ductal adenocarcinoma (PDAC) located at the body and tail. METHODS: Data from 395 patients with PDAC who underwent DP with margin-negative resection (R0 or R1) were collected from seven high-volume centers in Japan from 2001 to 2012. Among them, 72 patients underwent DP with en-bloc celiac axis resection (DP-CAR). The remaining 323 patients underwent conventional DP with splenectomy (DP-S). To determine the efficacy of DP-CAR, clinicopathological data were compared between the DP-CAR and the DP-S groups. RESULTS: The DP-S group consisted mainly of patients with resectable disease (93%), and conversely, all patients in the DP-CAR group had borderline resectable or unresectable disease. The overall morbidity was significantly higher in the DP-CAR group than in the DP-S group (63% vs 47%, respectively; P = 0.017). The median survival time (MST) of the DP-CAR group was significantly shorter than that of the DP-S group (17.5 vs 28.6 months, respectively; P = 0.004). However, the MST of patients in the DP-CAR group (n = 61, 85%) who received adjuvant therapy was significantly longer than that of patients in the DP-S group (n = 65, 20%) who underwent R1 resection (21.9 vs 16.7 months, respectively; P = 0.024). CONCLUSION: DP-CAR followed by adjuvant chemotherapy provided an acceptable overall survival rate in patients with highly advanced PDAC, but should be performed with great caution because of high morbidity. Patients with a high risk of positive surgical margins with DP-S may be candidates for DP-CAR.

7 Article Retrospective Study of the Correlation Between Pathological Tumor Size and Survival After Curative Resection of T3 Pancreatic Adenocarcinoma: Proposal for Reclassification of the Tumor Extending Beyond the Pancreas Based on Tumor Size. 2017

Kurata, Masanao / Honda, Goro / Murakami, Yoshiaki / Uemura, Kenichiro / Satoi, Sohei / Motoi, Fuyuhiko / Sho, Masayuki / Matsumoto, Ippei / Kawai, Manabu / Yanagimoto, Hiroaki / Fukumoto, Takumi / Nagai, Minako / Gosho, Masahiko / Unno, Michiaki / Yamaue, Hiroki / Anonymous430910. ·Department of Gastrointestinal and Hepato-biliary-Pancreatic Surgery, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan. mkurata@md.tsukuba.ac.jp. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Surgery, Kansai Medical University, Osaka, Japan. · Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan. · Department of Surgery, Nara Medical University, Nara, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Department of Clinical Trial and Clinical Epidemiology, University of Tsukuba, Tsukuba, Japan. ·World J Surg · Pubmed #28620676.

ABSTRACT: BACKGROUND: Even though most patients who undergo resection of pancreatic adenocarcinoma have T3 disease with extra-pancreatic tumor extension, T3 disease is not currently classified by tumor size. The aim of this study was to modify the current TNM classification of pancreatic adenocarcinoma to reflect the influence of tumor size. METHODS: A total of 847 consecutive pancreatectomy patients were recruited from multiple centers. Optimum tumor size cutoff values were calculated by receiver operating characteristics analysis for tumors limited to the pancreas (T1/2) and for T3 tumors. In our modified TNM classification, stage II was divided into stages IIA (T3aN0M0), IIB (T3bN0M0), and IIC (T1-3bN1M0) using tumor size cutoff values. The usefulness of the new classification was compared with that of the current classification using Akaike's information criterion (AIC). RESULTS: The optimum tumor size cutoff value distinguishing T1 and T2 was 2 cm, while T3 was divided into T3a and T3b at a tumor size of 3 cm. The median survival time of the stages IIA, IIB, and IIC were 44.7, 27.6, and 20.3 months, respectively. There were significant differences of survival between stages IIA and IIB (P = 0.02) and between stages IIB and IIC (P = 0.03). The new classification showed better performance compared with the current classification based on the AIC value. CONCLUSIONS: This proposed new TNM classification reflects the influence of tumor size in patients with extra-pancreatic tumor extension (T3 disease), and the classification is useful for predicting mortality.

8 Article [Neoadjuvant Chemotherapy Using S-1 for Pancreatic Cancer - Mid-Term Results]. 2016

Homma, Yuki / Honda, Goro / Sakamoto, Katsunori / Kurata, Masanao / Honjo, Masahiko / Hirata, Yoshihiro / Shinya, Satoshi. ·Dept. of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital. ·Gan To Kagaku Ryoho · Pubmed #27760934.

ABSTRACT: BACKGROUND: Although surgical resection is the only curative strategy for pancreatic cancer, the prognosis of patients with pancreatic cancer remains poor. Recently, neoadjuvant treatment has been frequently employed as a promising treatment. Here, the mid-term results of neoadjuvant chemoradiotherapy(NACRT)using S-1, which has been performed in our hospital since 2008, are reported. METHODS: Seventy-nine patients with resectable or borderline resectable pancreatic ductal adenocarcinoma, who had been intended to undergo NACRT treatment using S-1, were enrolled. The NACRT comprised radiotherapy( 1.8 Gy×28 days)and full-dose twice-daily oral S-1 given on the same days as the radiotherapy. The results of the NACRT and pancreatectomy and the patients' prognoses were evaluated. RESULTS: Fifty-five patients(69.6%)underwent pancreatectomy, with no case of mortality. The curative resection rate was 94.5%. Postoperative adjuvant chemotherapy was administered in 46 patients(83.6%). The 3-year survival rates of all 79 patients and 55 pancreatectomy patients were 40.1% and 50.4%, respectively. CONCLUSION: NACRT using S-1 was found to be feasible, and good mid-term outcomes were obtained. However, analysis of the long-term outcomes and comparisons with other novel anti-cancer drugs are still required.

9 Article Grade B pancreatic fistulas do not affect survival after pancreatectomy for pancreatic cancer: A multicenter observational study. 2016

Kawai, Manabu / Murakami, Yoshiaki / Motoi, Fuyuhiko / Sho, Masayuki / Satoi, Sohei / Matsumoto, Ippei / Honda, Goro / Hirono, Seiko / Okada, Ken-Ichi / Unno, Michiaki / Nakajima, Yoshiyuki / Uemura, Kenichiro / Kwon, A-Hon / Fukumoto, Takumi / Kurata, Masanao / Yamaue, Hiroki. ·Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Division of Gastroenterological Surgery, Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan. · Department of Surgery, Nara Medical University, Nara, Japan. · Department of Surgery, Kansai Medical University, Hirakata, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. Electronic address: yamaue-h@wakayama-med.ac.jp. ·Surgery · Pubmed #27083480.

ABSTRACT: BACKGROUND: Several studies have demonstrated that postoperative complications after pancreatectomy for pancreatic cancer adversely affect survival. The impact on survival of a pancreatic fistula according to the classification of the International Study Group for Pancreatic Surgery has not been fully evaluated. The aim of this multicenter, observational study was to evaluate the impact of pancreatic fistula on pancreatic cancer patients who had undergone pancreatectomy. METHODS: Between 2001 and 2012, 1,397 patients who underwent pancreatectomy for pancreatic cancer at 7 high-volume centers in Japan were reviewed retrospectively. The impact of pancreatic fistula on survival was evaluated by univariate and multivariate analysis. RESULTS: Pancreatic fistula occurred in 327 of 1,397 patients (23.4%) and was classified based on the International Study Group for Pancreatic Surgery as follows: grade A in 9.9%, grade B in 10.6%, and grade C in 2.9% of the patients. Median survival time in no fistula/grade A, grade B, and grade C were 23.6, 26.0, and 9.0 months, respectively. There was no significant difference in overall survival between patients with no fistula/grade A and those with grade B (P = .403); in contrast, overall survival in patients with grade C was worse than in patients without grade C (P < .001). The multivariate Cox proportional hazard analysis demonstrated that grade C pancreatic fistula was an independent prognostic factor (hazard ratio 1.59; 95% confidence interval, 1.03-2.45; P = .035). CONCLUSION: Grade B pancreatic fistula after pancreatectomy does not adversely affect long-term survival, but a grade C pancreatic fistula has a negative impact on long-term survival of patients with pancreatic cancer.

10 Article Prognosis after surgical treatment for pancreatic cancer in patients aged 80 years or older: a multicenter study. 2016

Sho, Masayuki / Murakami, Yoshiaki / Kawai, Manabu / Motoi, Fuyuhiko / Satoi, Sohei / Matsumoto, Ippei / Honda, Goro / Uemura, Kenichiro / Yanagimoto, Hiroaki / Kurata, Masanao / Akahori, Takahiro / Kinoshita, Shoichi / Nagai, Minako / Nishiwada, Satoshi / Fukumoto, Takumi / Unno, Michiaki / Yamaue, Hiroki / Nakajima, Yoshiyuki. ·Department of Surgery, Nara Medical University, Nara, Japan. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan. · Department of Surgery, Kansai Medical University, Osaka, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. ·J Hepatobiliary Pancreat Sci · Pubmed #26763744.

ABSTRACT: BACKGROUND: The optimal therapeutic strategy for very elderly pancreatic cancer patients remains to be determined. The aim of this study was to clarify the role of pancreatic resection in patients 80 years of age or older. METHODS: A retrospective multicenter analysis of 1401 patients who had undergone pancreatic resection for pancreatic cancer was performed. The patients aged ≥ 80 years (n = 99) were compared with a control group <80 years of age (n = 1302). RESULTS: There were no significant differences in the postoperative complications and mortality between the two groups. However, the prognosis of octogenarians was poorer than that of younger patients for both resectable and borderline resectable tumors. Importantly, there were few long-term survivors in the elderly group, especially among those with borderline resectable pancreatic cancer. A multivariate analysis of the prognostic factors in the very elderly patients indicated that the completion of adjuvant chemotherapy was the only significant factor. In addition, preoperative albumin level was the only independent risk factor for a failure to complete adjuvant chemotherapy. CONCLUSION: This study demonstrates that the postoperative prognosis in octogenarian patients was not good as that in younger patients possibly due to less frequent completion of adjuvant chemotherapy.

11 Article Reappraisal of Total Pancreatectomy in 45 Patients With Pancreatic Ductal Adenocarcinoma in the Modern Era Using Matched-Pairs Analysis: Multicenter Study Group of Pancreatobiliary Surgery in Japan. 2016

Satoi, Sohei / Murakami, Yoshiaki / Motoi, Fuyuhiko / Sho, Masayuki / Matsumoto, Ippei / Uemura, Kenichiro / Kawai, Manabu / Kurata, Masanao / Yanagimoto, Hiroaki / Yamamoto, Tomohisa / Mizuma, Masamichi / Unno, Michiaki / Kinoshita, Shoichi / Akahori, Takahiro / Shinzeki, Makoto / Fukumoto, Takumi / Hashimoto, Yasushi / Hirono, Seiko / Yamaue, Hiroki / Honda, Goro / Kwon, Masanori. ·From the *Department of Surgery, Kansai Medical University, Osaka; †Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima; ‡Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai; §Department of Surgery, Nara Medical University, Nara; ∥Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kinki University Faculty of Medicine, Osaka; ¶Second Department of Surgery, Wakayama Medical University, Wakayama; #Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo; and **Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. ·Pancreas · Pubmed #26692442.

ABSTRACT: OBJECTIVE: The aim of this study was to reappraise the clinical role of total pancreatectomy with curative intent in patients with pancreatic ductal adenocarcinoma (PDAC). METHODS: In 2001 to 2011 database from 7 institutions in Japan, 45 (3.1%) of 1451 patients with PDAC underwent total pancreatectomy (TP group), and 885 patients underwent pancreaticoduodenectomy (PD group). A matched-pairs group consisted of 45 patients matched for age, sex, year, resectability status, and neoadjuvant therapy (matched-PD group). Clinicopathological data, overall survival, and disease-free survival were compared between groups. RESULTS: Clinical features of the TP group revealed higher-stage disease, greater surgical stress, a higher frequency of lymph node metastasis, and a lower adjuvant chemotherapy completion rate compared with the PD group (P < 0.05). Overall survival and disease-free survival in the TP group were significantly worse than those in the PD group (P < 0.05). Multivariate analysis revealed resectability status, neoadjuvant therapy, blood transfusion, lymph node metastasis, and adjuvant therapy to be significant prognostic factors. No differences in mortality and morbidity rates were observed between the 2 groups. A matched-pairs analysis revealed similar surgical outcomes and overall survival. CONCLUSIONS: The surgical outcome of total pancreatectomy for patients with PDAC is acceptable. When margin-negative resection is expected, total pancreatectomy should not be abandoned in the modern era.

12 Article Proposed preoperative risk factors for early recurrence in patients with resectable pancreatic ductal adenocarcinoma after surgical resection: A multi-center retrospective study. 2015

Matsumoto, Ippei / Murakami, Yoshiaki / Shinzeki, Makoto / Asari, Sadaki / Goto, Tadahiro / Tani, Masaji / Motoi, Fuyuhiko / Uemura, Kenichiro / Sho, Masayuki / Satoi, Sohei / Honda, Goro / Yamaue, Hiroki / Unno, Michiaki / Akahori, Takahiro / Kwon, A-Hon / Kurata, Masanao / Ajiki, Tetsuo / Fukumoto, Takumi / Ku, Yonson. ·Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan; Department of Surgery, Kinki University Faculty of Medicine, Osaka-Sayama, Japan. Electronic address: ippeimm@gmail.com. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Institute of Biomedical and Health Sciences, Department of Surgery, Hiroshima University, Hiroshima, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Nara Medical University, Nara, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Kansai Medical University, Hirakata, Japan. · Multicenter Study Group of Pancreatobiliary Surgery (MSG-PBS), Japan; Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. ·Pancreatology · Pubmed #26467797.

ABSTRACT: BACKGROUND/OBJECTIVE: Although surgical resection remains the only chance for cure in patients with pancreatic ductal adenocarcinoma (PDAC), postoperative early recurrence (ER) is frequently encountered. The purpose of this study is to determine the preoperative predictive factors for ER after upfront surgical resection. METHODS: Between 2001 and 2012, 968 patients who underwent upfront surgery with R0 or R1 resection for PDAC at seven high-volume centers in Japan were retrospectively reviewed. ER was defined as relapse within 6 months after surgery. Study analysis stratified by resectable (R) and borderline resectable (BR) PDACs was conducted according to the National Comprehensive Cancer Network guidelines. RESULTS: ER occurred in 239 patients (25%) with a median survival time (MST) of 8.8 months. Modified Glasgow prognostic score = 2 (odds ratio (OR) 2.06, 95% confidence interval (CI) 1.05-3.95; P = 0.044), preoperative CA19-9 ≥300 U/ml (OR 1.94, 1.29-2.90; P = 0.003), and tumor size ≥30 mm (OR 1.72, 1.16-2.56; P = 0.006), were identified as preoperative independent predictive risk factors for ER in patients with R-PDAC. In the R-PDAC patients, MST was 35.5, 26.3, and 15.9 months in patients with 0, 1 and ≥2 risk factors, respectively. There were significant differences in overall survival between the three groups (P < 0.001). No preoperative risk factors were identified in BR-PDAC patients with a high rate of ER (39%). CONCLUSIONS: There is a high-risk subset for ER even in patients with R-PDAC and a simple risk scoring system is useful for prediction of ER.

13 Article Impact of Preoperative Biliary Drainage on Long-Term Survival in Resected Pancreatic Ductal Adenocarcinoma: A Multicenter Observational Study. 2015

Uemura, Kenichiro / Murakami, Yoshiaki / Satoi, Sohei / Sho, Masayuki / Motoi, Fuyuhiko / Kawai, Manabu / Matsumoto, Ippei / Honda, Goro / Kurata, Masanao / Yanagimoto, Hiroaki / Nishiwada, Satoshi / Fukumoto, Takumi / Unno, Michiakil / Yamaue, Hiroki. ·Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. umk@hiroshima-u.ac.jp. · Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan. · Department of Surgery, Kansai Medical University, Osaka, Japan. · Department of Surgery, Nara Medical University, Nara, Japan. · Division of Gastroenterological Surgery, Department of Surgery, Tohoku University, Sendai, Japan. · Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. · Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan. · Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan. ·Ann Surg Oncol · Pubmed #26014151.

ABSTRACT: BACKGROUND: This study aimed to evaluate the impact of preoperative biliary drainage (PBD) on the long-term survival of patients with pancreatic ductal adenocarcinoma (PDAC) who underwent pancreaticoduodenectomy (PD). METHODS: A multicenter observational study was performed using a common database of patients with resected PDAC from seven high-volume surgical institutions in Japan. RESULTS: Of 932 patients who underwent PD for PDAC, 573 (62 %) underwent PBD, including 407 (44 %) who underwent endoscopic biliary drainage (EBD) and 166 (18 %) who underwent percutaneous transhepatic biliary drainage (PTBD). The patients who did not undergo PBD and those who underwent EBD had a significantly better overall survival than those who underwent PTBD, with median survival times of 25.7 months (P < 0.001), 22.3 months (P = 0.001), and 16.7 months, respectively. Multivariate analysis showed that seven clinicopathologic factors, including the use of PTBD but not EBD, were independently associated with poorer overall survival. Furthermore, patients who underwent PTBD more frequently experienced peritoneal recurrence (23 %) than those who underwent EBD (10 %; P < 0.001) and those who did not undergo PBD (11 %; P = 0.001). Multivariate analysis demonstrated that the independent risk factors for peritoneal recurrence included surgical margin status (P < 0.001) and use of PTBD (P = 0.004). CONCLUSIONS: Use of PTBD, but not EBD, was associated with a poorer prognosis, with an increased rate of peritoneal recurrence among patients who underwent PD for PDAC.

14 Article National Comprehensive Cancer Network Resectability Status for Pancreatic Carcinoma Predicts Overall Survival. 2015

Murakami, Yoshiaki / Satoi, Sohei / Sho, Masayuki / Motoi, Fuyuhiko / Matsumoto, Ippei / Kawai, Manabu / Honda, Goro / Uemura, Kenichiro / Yanagimoto, Hiroaki / Shinzeki, Makoto / Kurata, Masanao / Kinoshita, Shoichi / Yamaue, Hiroki / Unno, Michiaki. ·Department of Surgery, Institute of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan, mura777@hiroshima-u.ac.jp. ·World J Surg · Pubmed #26013206.

ABSTRACT: BACKGROUND: The aim of this study was to evaluate the validity of preoperative resectability status, as defined by the National Comprehensive Cancer Network (NCCN), from the viewpoint of overall survival. METHODS: A total of consecutive 704 patients with pancreatic head carcinoma who underwent pancreatoduodenectomy with upfront surgery at seven Japanese hospitals between 2001 and 2012 were evaluated retrospectively. According to the NCCN definition of preoperative resectability status, tumors were divided into resectable tumors without vascular contact (R group), resectable tumors with portal or superior mesenteric vein (PV/SMV) contact of ≦180° (R-PV group), borderline resectable(BR) tumors with PV/SMV contact of >180° (BR-PV group), and BR tumors with arterial contact (BR-A group). The relationship between the NCCN definition of preoperative resectability status and overall survival was analyzed. RESULTS: Of the 704 patients, 389, 114, 145, and 56 were classified into the R group, the R-PV group, the BR-PV group, and the BR-A group, respectively. Overall survival of the BR-PV and BR-A groups was significantly worse than that of the R group and R-PV groups (P < 0.05), although there was no significant difference in overall survival between the R group and the R-PV group (P = 0.310). Multivariate analysis revealed that PV/SMV contact of >180° (P = 0.008) and arterial contact (P < 0.001) were independent prognostic factors of overall survival. CONCLUSION: From the viewpoint of overall survival, the NCCN definition of preoperative resectability status was valid.

15 Article Postoperative prognosis of pancreatic cancer with para-aortic lymph node metastasis: a multicenter study on 822 patients. 2015

Sho, Masayuki / Murakami, Yoshiaki / Motoi, Fuyuhiko / Satoi, Sohei / Matsumoto, Ippei / Kawai, Manabu / Honda, Goro / Uemura, Kenichiro / Yanagimoto, Hiroaki / Kurata, Masanao / Fukumoto, Takumi / Akahori, Takahiro / Kinoshita, Shoichi / Nagai, Minako / Nishiwada, Satoshi / Unno, Michiaki / Yamaue, Hiroki / Nakajima, Yoshiyuki. ·Department of Surgery, Nara Medical University, 840 Shijo-cho, Kashihara, Nara, 634-8522, Japan, m-sho@naramed-u.ac.jp. ·J Gastroenterol · Pubmed #25341657.

ABSTRACT: BACKGROUND: The prognosis of pancreatic cancer patients with metastatic para-aortic lymph node (PALN) has been reported to be extremely poor. In general, PALN metastasis has been considered as a contraindication for pancreatic resection. The aim of this study was to reevaluate the postoperative prognostic value of PALN metastasis in pancreatic cancer and to determine the validity of pancreatic surgery. METHODS: Retrospective multicenter analysis of 882 patients who have undergone curative-intent pancreatic resection with pathological evaluation of PALNs for pancreatic ductal adenocarcinoma between 2001 and 2012 was conducted. Clinicopathological data and outcomes were evaluated with univariate and multivariate analysis. RESULTS: In total, 102 (12.4 %) patients had positive metastasis in PALN. Patients with metastatic PALN had significantly poorer survival than those without (17 vs. 23 months; p < 0.001). Multivariable analysis of 822 patients identified adjuvant chemotherapy, primary tumor status, regional lymph node metastasis, portal vein invasion, pre- and post-operative serum CA19-9 levels, and tumor grade as independent prognostic factors. In contrast, PALN metastasis did not have a significant prognostic value. Furthermore, the multivariate prognostic analysis in patients with PALN metastasis revealed that adjuvant chemotherapy and the number of metastatic PALN were significantly associated with long-term survival. Lung metastasis as initial recurrence was observed more often in patients with PALN metastasis in comparison with those without. CONCLUSIONS: Some pancreatic cancer patients with metastatic PALN may survive for longer than expected after pancreatectomy. Adjuvant chemotherapy and the number of metastatic PALN were critical factors for long-term survival of those patients.

16 Article Reappraisal of peritoneal washing cytology in 984 patients with pancreatic ductal adenocarcinoma who underwent margin-negative resection. 2015

Satoi, Sohei / Murakami, Yoshiaki / Motoi, Fuyuhiko / Uemura, Kenichiro / Kawai, Manabu / Kurata, Masanao / Sho, Masayuki / Matsumoto, Ippei / Yanagimoto, Hiroaki / Yamamoto, Tomohisa / Mizuma, Masamichi / Unno, Michiaki / Hashimoto, Yasushi / Hirono, Seiko / Yamaue, Hiroki / Honda, Goro / Nagai, Minako / Nakajima, Yoshiyuki / Shinzeki, Makoto / Fukumoto, Takumi / Kwon, A-Hon. ·Department of Surgery, Kansai Medical University, Osaka, Japan. ·J Gastrointest Surg · Pubmed #25316482.

ABSTRACT: OBJECTIVE: The objective of the present study was to reappraise the clinical value of peritoneal washing cytology (CY) in 984 pancreatic ductal adenocarcinoma patients who underwent margin-negative resection. METHODS: In a 2001-2011 database from seven high-volume surgical institutions in Japan, 69 patients (7%) had positive CY (CY+ group) indicative of M1 disease and 915 patients had negative CY (CY- group). Clinicopathological data and survival were compared between groups. RESULTS: Significant correlations between CY+ and high CA19-9 level, pancreatic body and tail cancer, lymph node metastasis, and a lower frequency of R0 resection were observed. Overall survival (OS) of CY+ patients was significantly worse than that of CY- patients (median survival time [MST], 16 vs. 25 months; 3-year OS rate, 6 vs. 37%; p < 0.001). CY+ patients had a significantly higher rate of post-operative peritoneal carcinomatosis than CY- patients (48 vs. 21%; p < 0.001). Administration of adjuvant chemotherapy did not provide a favorable survival outcome to CY+ patients. The current study showed that patients with M1 disease had acceptable MST after margin-negative resection and a high incidence of peritoneal carcinomatosis within 3 years after surgery, resulting in decreased long-term survival. The development of a new strategy to control peritoneal carcinomatosis when surgical resection is performed in such patients is required.

17 Article Case-control study of diabetes-related genetic variants and pancreatic cancer risk in Japan. 2014

Kuruma, Sawako / Egawa, Naoto / Kurata, Masanao / Honda, Goro / Kamisawa, Terumi / Ueda, Junko / Ishii, Hiroshi / Ueno, Makoto / Nakao, Haruhisa / Mori, Mitsuru / Matsuo, Keitaro / Hosono, Satoyo / Ohkawa, Shinichi / Wakai, Kenji / Nakamura, Kozue / Tamakoshi, Akiko / Nojima, Masanori / Takahashi, Mami / Shimada, Kazuaki / Nishiyama, Takeshi / Kikuchi, Shogo / Lin, Yingsong. ·Sawako Kuruma, Terumi Kamisawa, Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo 113-8677, Japan. ·World J Gastroenterol · Pubmed #25516658.

ABSTRACT: AIM: To examine whether diabetes-related genetic variants are associated with pancreatic cancer risk. METHODS: We genotyped 7 single-nucleotide polymorphisms (SNPs) in PPARG2 (rs1801282), ADIPOQ (rs1501299), ADRB3 (rs4994), KCNQ1 (rs2237895), KCNJ11 (rs5219), TCF7L2 (rs7903146), and CDKAL1 (rs2206734), and examined their associations with pancreatic cancer risk in a multi-institute case-control study including 360 cases and 400 controls in Japan. A self-administered questionnaire was used to collect detailed information on lifestyle factors. Genotyping was performed using Fluidigm SNPtype assays. Unconditional logistic regression methods were used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) for the association between these diabetes-associated variants and pancreatic cancer risk. RESULTS: With the exception of rs1501299 in the ADIPOQ gene (P = 0.09), no apparent differences in genotype frequencies were observed between cases and controls. Rs1501299 in the ADPIOQ gene was positively associated with pancreatic cancer risk; compared with individuals with the AA genotype, the age- and sex-adjusted OR was 1.79 (95%CI: 0.98-3.25) among those with the AC genotype and 1.86 (95%CI: 1.03-3.38) among those with the CC genotype. The ORs remained similar after additional adjustment for body mass index and cigarette smoking. In contrast, rs2237895 in the KCNQ1 gene was inversely related to pancreatic cancer risk, with a multivariable-adjusted OR of 0.62 (0.37-1.04) among individuals with the CC genotype compared with the AA genotype. No significant associations were noted for other 5 SNPs. CONCLUSION: Our case-control study indicates that rs1501299 in the ADIPOQ gene may be associated with pancreatic cancer risk. These findings should be replicated in additional studies.

18 Article Laparoscopic pancreaticoduodenectomy: taking advantage of the unique view from the caudal side. 2013

Honda, Goro / Kurata, Masanao / Okuda, Yukihiro / Kobayashi, Shin / Sakamoto, Katsunori / Takahashi, Keiichi. ·Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan. Electronic address: ghon@cick.jp. ·J Am Coll Surg · Pubmed #24051066.

ABSTRACT: -- No abstract --

19 Article Intraductal papillary mucinous neoplasm of the pancreas and IgG4-related disease: a coincidental association. 2013

Tabata, Taku / Kamisawa, Terumi / Hara, Seiichi / Kuruma, Sawako / Chiba, Kazuro / Kuwata, Go / Fujiwara, Takashi / Egashira, Hideto / Koizumi, Satomi / Endo, Yuka / Koizumi, Koichi / Fujiwara, Junko / Arakawa, Takeo / Momma, Kumiko / Horiguchi, Shinichiro / Hishima, Tsunekazu / Kurata, Masanao / Honda, Goro / Kloppel, Gunter. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo 113-8677, Japan. ·Pancreatology · Pubmed #23890136.

ABSTRACT: BACKGROUND/AIMS: Coexistence of autoimmune pancreatitis (AIP) and pancreatic cancer, elevation of serum IgG4 levels in pancreatic cancer patients, and infiltration of IgG4-positive plasma cells in peritumorous pancreatitis have been described in a few reports. This study examined the relationship between intraductal papillary mucinous neoplasm (IPMN) of the pancreas and peritumorous IgG4-positive lymphoplasmacytic infiltrates. METHODS: Serum IgG4 levels were measured in 54 patients with IPMN (median 70 years, 26 males and 28 females; 13 main duct type and 41 branch duct type). Histological findings focusing on dense lymphoplasmacytic infiltration, storiform fibrosis, and obliterative phlebitis were reviewed, and immunostaining with IgG4 and IgG was performed in 23 surgically resected IPMN cases (18 main duct type and 5 branch duct type). The presence of IgG4-positive plasma cells >10/hpf and an IgG4-positive/IgG-positive plasma cell ratio >40% were considered significant. RESULTS: Serum IgG4 levels were elevated in 2 (4%) IPMN patients. Significant infiltration of IgG4-positive plasma cells was detected in 4 IPMN cases (17%). The IgG4-positive/IgG-positive plasma cell ratio was >40% in all 4 cases. In one case with a markedly elevated serum IgG4 level (624 mg/dL), typical lymphoplasmacytic sclerosing pancreatitis (AIP type 1) lesions surrounded the whole IPMN. In the 3 other cases, infiltration of IgG4-positive plasma cells with fibrosis was focally detected mainly in the periductal area around the IPMN. CONCLUSIONS: In a few patients with IPMNs, IgG4-positive plasma cell infiltration can occur in the peritumorous area. The association of an IPMN with AIP type 1-like changes seems to be exceptional and coincidental.

20 Article Novel device for pancreaticojejunostomy via a pure laparoscopic approach. 2013

Honda, Goro / Kurata, Masanao / Okuda, Yukihiro / Kobayashi, Shin / Yamaguchi, Tatsuro / Matsumoto, Hiroshi / Nakano, Daisuke / Takahashi, Keiichi. ·Department of Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Tokyo, Japan. ghon@cick.jp ·J Am Coll Surg · Pubmed #23619319.

ABSTRACT: -- No abstract --

21 Article Pancreatic cancer causing acute pancreatitis: a comparative study with cancer patients without pancreatitis and pancreatitis patients without cancer. 2013

Minato, Yohei / Kamisawa, Terumi / Tabata, Taku / Hara, Seiichi / Kuruma, Sawako / Chiba, Kazuro / Kuwata, Go / Fujiwara, Takashi / Egashira, Hideto / Koizumi, Koichi / Saito, Itaru / Endo, Yuka / Koizumi, Satomi / Fujiwara, Junko / Arakawa, Takeo / Momma, Kumiko / Kurata, Masanao / Honda, Goro. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan. ·J Hepatobiliary Pancreat Sci · Pubmed #23494612.

ABSTRACT: BACKGROUND/PURPOSE: Although pancreatic cancer produces upstream obstructive pancreatitis, acute pancreatitis is a less common manifestation of pancreatic cancer. This study aimed to clarify the subgroup of pancreatic cancer patients who present with an episode of acute pancreatitis (Group I) in comparison with a matched group of pancreatic cancer patients without pancreatitis (Group II) and another group of acute pancreatitis patients without pancreatic cancer (Group III). METHODS: This was a retrospective comparative study of 18 patients in Group I, 300 patients in Group II and 141 patients in Group III. RESULTS: The mean age of Group I was 63.7 years and the male to female ration was 1:0.3. Serum CA 19-9 levels were elevated in 80 %. The main pancreatic duct was incompletely obstructed in 7 patients. There were no significant differences in location of tumor, clinical stage, resection rate and survival months between Group I and II. Acute pancreatitis secondary to pancreatic cancer was more likely to be mild (94 vs. 72 %,p < 0.05) and relapsed (39 vs. 16 %,p < 0.05) compared with Group III. CONCLUSIONS: Anatomic evaluation of the pancreas should be performed in patients with acute pancreatitis with no obvious etiology, even if the pancreatitis is mild, to search for underlying malignancy.

22 Article Main-duct intraductal papillary mucinous adenoma of the pancreas. 2011

Takuma, Kensuke / Kamisawa, Terumi / Tabata, Taku / Kurata, Masanao / Honda, Goro / Horiguchi, Shin-Ichiro. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·World J Surg Oncol · Pubmed #22112163.

ABSTRACT: BACKGROUND: The prevalence of carcinoma in main-duct intraductal papillary mucinous neoplasm (IPMN) is high, and surgical resection is recommended for all patients with a main-duct IPMN. RESULTS: A main-duct IPMN with typical imagings including protruding lesions in the dilated main pancreatic duct was resected, but the histology was intraductal papillary mucinous adenoma of the pancreas. DISCUSSION: It has been reported that the presence of mural nodules and dilatation of MPD are significantly higher in malignant IPMNs. The presented case had protruding lesions in the dilated main pancreatic duct on endoscopic ultrasonography, but the histology was adenoma. CONCLUSION: Preoperative distinction between benign and malignant IPMNs is difficult.

23 Article Predictors of malignancy and natural history of main-duct intraductal papillary mucinous neoplasms of the pancreas. 2011

Takuma, Kensuke / Kamisawa, Terumi / Anjiki, Hajime / Egawa, Naoto / Kurata, Masanao / Honda, Goro / Tsuruta, Koji / Horiguchi, Shin-Ichiro / Igarashi, Yoshinori. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Tokyo, Japan. ·Pancreas · Pubmed #21206326.

ABSTRACT: OBJECTIVES: Because the prevalence of carcinoma is high in main-duct intraductal papillary mucinous neoplasms (IPMNs) of the pancreas, surgical resection is recommended for all main-duct type IPMNs. This study aimed to investigate the clinical predictors of malignancy and natural history of main-duct IPMNs. METHODS: Preoperative clinical characteristics reliably correlated with malignancy in 26 surgically resected patients with main-duct IPMN, and long-term outcome in 20 conservatively followed patients with main-duct IPMN was examined. RESULTS: Age at diagnosis was significantly older in conservatively followed IPMN patients than in surgically resected IPMN patients. Main pancreatic duct (MPD) dilatation 10 mm or greater and mural nodules were significantly more frequent in malignant IPMNs. Obvious progression of dilatation of the MPD was detected in all 4 conservatively followed patients who developed invasive pancreatic carcinoma. The histology of IPMN at autopsy of 4 conservatively followed patients who died of other causes 21 to 120 months later was adenoma. Seven conservatively followed without malignant findings did not show obvious progression of MPD dilatation. CONCLUSIONS: Although surgical resection is indicated for many main-duct IPMNs, conservative follow-up may be an option for elderly asymptomatic patients with main-duct IPMNs with the MPD less than 10 mm, no obvious mural nodule, and negative cytology.

24 Article Differentiation of autoimmune pancreatitis from pancreatic cancer by diffusion-weighted MRI. 2010

Kamisawa, Terumi / Takuma, Kensuke / Anjiki, Hajime / Egawa, Naoto / Hata, Tastuo / Kurata, Masanao / Honda, Goro / Tsuruta, Kouji / Suzuki, Mizuka / Kamata, Noriko / Sasaki, Tsuneo. ·Department of Internal Medicine, Tokyo Metropolitan Komagome Hospital, Bunkyo-ku, Tokyo, Japan. kamisawa@cick.jp ·Am J Gastroenterol · Pubmed #20216538.

ABSTRACT: OBJECTIVES: We sought to clarify the clinical utility of diffusion-weighted magnetic resonance imaging (DWI) for differentiating autoimmune pancreatitis (AIP) from pancreatic cancer. METHODS: Thirteen AIP patients underwent DWI before therapy, and six of them underwent DWI after steroid therapy. The extent and shape of high-intensity areas were compared with those of 40 pancreatic cancer patients. Apparent diffusion coefficient (ADC) values were calculated in the AIP area before and after steroid therapy in pancreatic cancer patients and in a normal pancreatic body. RESULTS: On DWI, AIP and pancreatic cancer were detected as high-signal intensity areas. The high-intensity areas were diffuse (n=4), solitary (n=6), and multiple (n=3) in AIP patients, but all pancreatic cancer patients showed solitary areas (P<0.001). A nodular shape was significantly more frequent in pancreatic cancer, and a longitudinal shape was more frequently found in AIP (P=0.005). ADC values were significantly lower in AIP (1.012+/-0.112 x 10(-3) mm(2)/s) than in pancreatic cancer (1.249+/-0.113 x 10(-3) mm(2)/s) and normal pancreas (1.491+/-0.162 x 10(-3) mm(2)/s) (P<0.001). Receiver operating characteristic analysis yielded an optimal ADC cutoff value of 1.075 x 10(-3) mm(2)/s to distinguish AIP from pancreatic cancer. After steroid therapy, high-intensity areas on DWI disappeared or were markedly decreased, and the ADC values of the reduced pancreatic lesions increased almost to the values of normal pancreas. CONCLUSIONS: DWI is useful for detecting AIP and for evaluating the effect of steroid therapy. ADC values were significantly lower in AIP than in pancreatic cancer. An ADC cutoff value may be useful for distinguishing AIP from pancreatic cancer.

25 Minor Pancreatic cancer as the fourth cancer in a patient with Peutz-Jeghers syndrome and a history of familial pancreatic cancer. 2011

Tokura, Michiyo / Kamisawa, Terumi / Kuwata, Go / Koizumi, Koichi / Kurata, Masanao / Hishima, Tsunekazu. · ·Pancreas · Pubmed #21160382.

ABSTRACT: -- No abstract --