研究者詳細 - 秋山　有史

論文 - 秋山　有史

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当科における腹腔鏡下噴門側胃切除の再建法 Side-Overlap法

佐藤慧, 秋山有史, 二階春香, 遠藤史隆, 馬場誠明, 千葉丈広, 木村聡元, 高原武志, 岩谷岳, 大塚幸喜, 新田浩幸, 水野大, 肥田圭介, 佐々木章

日本内視鏡外科学会雑誌 ( (一社)日本内視鏡外科学会 ) 23 ( 7 ) OS199 - 2 2018年12月

Thoracoscopic esophagectomy with total meso-esophageal excision reduces regional lymph node recurrence.

Yuji Akiyama, Takeshi Iwaya, Fumitaka Endo, Haruka Nikai, Kei Sato, Shigeaki Baba, Takehiro Chiba, Toshimoto Kimura, Takeshi Takahara, Koki Otsuka, Hiroyuki Nitta, Masaru Mizuno, Yusuke Kimura, Keisuke Koeda, Akira Sasaki

Langenbeck's archives of surgery 403 ( 8 ) 967 - 975 2018年12月 [査読有り] [国際誌]

PURPOSE: We investigated the operative outcomes of thoracoscopic esophagectomy (TE) in the prone position, using the concept of total meso-esophageal excision for esophageal cancer. METHODS: The medical records of 140 consecutive patients with esophageal cancer who underwent radical esophagectomy by TE were reviewed retrospectively, and operative outcomes were compared between patients treated before (non-meso-esophagus; non-ME group) and after (ME group) the introduction of total meso-esophageal excision (ME). RESULTS: There were no significant differences between the groups in postoperative morbidity (non-ME group vs. ME group, 28.3% vs. 41.4%, p = 0.119), 30-day mortality (non-ME group vs. ME group, 0% vs. 1.1%; p = 0.433), and in-hospital mortality (non-ME group vs. ME group, 1.9% vs. 0%, p = 0.199). Although overall survival and relapse-free survival did not differ significantly between the groups, the overall recurrence rate was significantly lower in the ME group than the non-ME group (non-ME group vs. ME group, 43.4% vs. 23%, p = 0.011). In particular, the rate of regional lymph node recurrence in the mediastinum was lower in the ME group (non-ME group vs. ME group, 11.3% vs. 2.3%; p = 0.026). CONCLUSIONS: Our results suggest that the ME procedure might be one of the procedures that reduce regional lymph node recurrence in the mediastinum without any deterioration in short-term outcomes.

DOI PubMed

化学放射線療法後PET-CT陽性を示した病理学的完全奏効食道癌の1例

梅邑晃, 秋山有史, 岩谷岳, 杉本亮, 菅井有, 千葉丈広, 肥田圭介, 佐々木章

日本臨床外科学会雑誌 ( 日本臨床外科学会 ) 79 ( 11 ) 2246 - 2251 2018年11月

症例は64歳,女性.嚥下困難を主訴に受診し,上部消化管内視鏡検査(esophagogastroduodenoscopy:EGD)で胸部食道に2型腫瘍を認め,生検で扁平上皮癌であった.治療前診断T3N1M0 Stage IIIとして,biweekly DCFによる導入化学療法を開始したが高度肝障害を認め中止し,low dose FP療法を併用した化学放射線療法(chemoradiotherapy:CRT)を施行した.後治療を1年間継続しPET-CT検査を施行したところ局所に集積を認めた.EGDやCT検査で腫瘍の確定診断は得られず,食道癌再燃と診断し救済手術を施行したが,病理学的完全奏効であった.本症例のように,原発巣の遺残や再発の確定診断を得られない場合にPET-CT検査が有用であるとの報告があるが,感度や特異度,腫瘍のviability評価や治療の効果判定に関しては更なる検討が必要である.(著者抄録)

Digital PCRを用いた食道癌患者における症例特異的血漿中遊離DNAモニタリング(Patient-specific circulating tumor DNA monitoring using digital PCR in esophageal squamous cell cancer patients)

岩谷岳, 遠藤史隆, 佐々木泰史, 八重樫瑞典, 佐藤慧, 佐々木教之, 秋山有史, 佐々木章, 増田万里, 時野隆至, 西塚哲

日本癌学会総会記事 ( 日本癌学会 ) 77回 930 - 930 2018年09月 [査読有り]

食道癌肉腫の遺伝子変異解析(Exome sequence analysis of carcinomatous and sarcomatous elements of an esophageal carcinosarcoma)

佐々木教之, 岩谷岳, 遠藤史隆, 鴻巣正史, 秋山有史, 佐々木泰史, 時野隆至, 西塚哲

日本癌学会総会記事 ( (一社)日本癌学会 ) 77回 326 - 326 2018年09月

Outcomes of esophagectomy after chemotherapy with biweekly docetaxel plus cisplatin and fluorouracil for advanced esophageal cancer: a retrospective cohort analysis.

Akiyama Y, Sasaki A, Endo F, Nikai H, Amano S, Umemura A, Baba S, Chiba T, Kimura T, Takahara T, Nitta H, Otsuka K, Mizuno M, Kimura Y, Koeda K, Iwaya T

World journal of surgical oncology 16 ( 1 ) 122 - 122 2018年07月 [査読有り] [国際誌]

BACKGROUND: Docetaxel, cisplatin, and 5-fluorouracil (DCF) therapy can cause severe adverse events, including neutropenia and febrile neutropenia. The feasibility of DCF therapy is a concern, particularly for elderly patients, patients with moderate organ disorders, and patients suffering from malnutrition caused by dysphagia or insufficient oral intake. We introduced a biweekly DCF therapy (bDCF) for the purpose of reducing severe adverse events for these fragile patients. This study investigated the feasibility and outcome of an esophagectomy after bDCF therapy for patients with advanced esophageal squamous cell carcinoma. METHODS: Fifty-nine patients with esophageal carcinoma underwent an esophagectomy after DCF or bDCF therapy as primary chemotherapy. DCF was administered to 37 patients in the DCF group, whereas bDCF was administered to 22 patients in the bDCF group. RESULTS: Patients in the bDCF group were significantly older than those in the DCF group (p = 0.016). Heart and pulmonary comorbidities were significantly more common in the bDCF than in the DCF group (p < 0.001 and p = 0.039, respectively). Grade 3 or 4 neutropenia was less frequent in the bDCF than in the DCF group (40.9 vs. 81.1%, p = 0.002). Anorexia was more frequent in the DCF group than in the bDCF group (18.9 vs. 0%, p = 0.030). The clinical response rate of the bDCF group was significantly higher than that of the DCF group (86.4 vs. 62.2%, p = 0.047). There was no significant between-group difference in the postoperative morbidity rate (bDCF 45.5% vs. DCF 32.4%) or in the histological therapeutic effect. CONCLUSION: The results demonstrate that primary bDCF therapy for high-risk patients with advanced esophageal cancer is feasible and safe in both chemotherapeutic and perioperative periods without a reduction in the efficacy of DCF therapy.

DOI PubMed

Therapeutic response monitoring using digital PCR for patient-specific circulating tumor DNA identified by an esophageal squamous cell carcinoma-specific sequencing panel.

Iwaya Takeshi, Endo Fumitaka, Sasaki Yasushi, Akiyama Yuji, Sasaki Akira, Masuda Mari

JOURNAL OF CLINICAL ONCOLOGY 36 ( 15 ) 2018年05月 [査読有り]

DOI

Exploitation of a liquid biopsy system using circulating tumor DNA in esophageal cancer patients.

Iwaya Takeshi, Endo Fuinitaka, Sasaki Yasushi, Yaegashi Mizunori, Chiba Takehiro, Akiyama Yuji, Masuda Mar, Yamada Tesshi, Tokino Takashi, Nishizuka Satoshi

CANCER SCIENCE 109 953 2018年01月 [査読有り]

Investigation of operative outcomes of thoracoscopic esophagectomy after triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil for advanced esophageal squamous cell carcinoma.

Akiyama Y, Iwaya T, Endo F, Chiba T, Takahara T, Otsuka K, Nitta H, Koeda K, Mizuno M, Kimura Y, Sasaki A

Surgical endoscopy 32 ( 1 ) 391 - 399 2018年01月 [査読有り] [国際誌]

BACKGROUND: Preoperative chemotherapy with cisplatin and 5-fluorouracil (CF) has become the standard treatment for resectable stage II/III thoracic esophageal carcinoma in Japan. Recently, preoperative triplet chemotherapy with docetaxel, cisplatin, and 5-fluorouracil (DCF) has been reported to be effective for locally advanced esophageal cancer. Thoracoscopic esophagectomy (TE) has been increasingly accepted worldwide for the treatment of esophageal cancer. We conducted a retrospective study to evaluate the safety and outcomes of TE after DCF therapy for patients with advanced esophageal cancer. METHODS: The medical records of 63 consecutive patients with esophageal squamous cell carcinoma who underwent thoracoscopic surgery after chemotherapy were reviewed. Thirty-four patients received neoadjuvant chemotherapy with CF, and 29 received DCF as first-line chemotherapy. RESULTS: The clinical T stage was significantly higher in the DCF group than in the CF group (p < 0.0001), including 17 patients with T4. Lymph node metastasis was more frequent in the DCF group (p = 0.0005), and the clinical stage of the tumor was significantly higher in the DCF group than in the CF group (p = 0.0001). No significant difference existed between the two groups in operation time for the thoracic procedure (DCF 277.2 min vs. CF 302 min). Blood loss during the thoracic procedure was less in the DCF group than in the CF group (DCF 46.9 mL vs. CF 88.8 mL; p = 0.0056). No significant differences existed between the two groups in postoperative morbidity (DCF 34.5% vs. CF 47%) or mortality (DCF 0% vs. CF 2.9%) rates. CONCLUSIONS: Our study suggests that TE after DCF therapy for advanced esophageal cancer is as safe as TE after CF therapy.

DOI PubMed

Establishment of a method for calculating standard splenic volume and its use in the evaluation of functional hepatic reserve

Seika Nakamura, Takeshi Takahara, Yasushi Hasegawa, Hirokatsu Katagiri, Shouji Kanno, Yuji Akiyama, Takeshi Iwaya, Hiroyuki Nitta, Kouki Otsuka, Keisuke Koeda, Akira Sasaki

Biomedical Research (India) ( Scientific Publishers of India ) 29 ( 7 ) 1459 - 1464 2018年

Background and aim: To objectively assess splenic volume preoperatively, the Standard Splenic Volume (SSV) was calculated for each patient. Whether it could be used to evaluate the functional hepatic reserve less invasively before major hepatectomy was then examined. Patients and methods: SSV was calculated for 70 patients who had undergone surgery, excluding liver surgery, for benign disease or early-stage cancer. The postoperative clinical courses of 63 patients who had undergone a sectionectomy or hemihepatectomy were then retrospectively investigated by comparing the preoperative splenic volume with each patient’s SSV. Results: The following equation was obtained: SSV (cm3)=177.7 × Body Surface Area (BSA)-179.9. None of the patients in the preoperative Splenic Volume (SV)/SSV< 1.1 group had total Bilirubin (T-Bil) levels ≥ 1.2 mg/dl in late postoperative period. In contrast, nine (30%) of the patients in the preoperative SV/SSV ≥ 1.1 group (n=30) had T-Bil levels ≥ 1.2 mg/dl in late postoperative period. Conclusion: By comparing the preoperative SV and SSV of patients, objective assessments of the patients’ preoperative portal venous pressure were obtained noninvasively. We believe that this ratio may provide useful information for evaluating functional hepatic reserve at the time of initial surgery for diseases that may require repeat hepatectomies or multidisciplinary treatment.

DOI

Effectiveness of intervention with a perioperative multidisciplinary support team for radical esophagectomy.

Akiyama Y, Iwaya T, Endo F, Shioi Y, Kumagai M, Takahara T, Otsuka K, Nitta H, Koeda K, Mizuno M, Kimura Y, Suzuki K, Sasaki A

Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer 25 ( 12 ) 3733 - 3739 2017年12月 [査読有り] [国際誌]

PURPOSE: We aimed to evaluate the effectiveness of intervention by a perioperative multidisciplinary support team for radical esophagectomy for esophageal cancer. METHODS: We retrospectively reviewed 85 consecutive patients with esophageal cancer who underwent radical esophagectomy via right thoracotomy or thoracoscopic surgery with gastric tube reconstruction. Twenty-one patients were enrolled in the non-intervention group (group N) from May 2011 to September 2012, 31 patients in the perioperative rehabilitation group (group R) from October 2012 to April 2014, and 33 patients in the multidisciplinary support team group (group S) from May 2014 to September 2015. RESULTS: Morbidity rates were 38, 45.2, and 42.4% for groups N, R, and S, respectively. Although there were no significant differences in the incidence of pneumonia among the groups, the durations of fever and C-reactive protein positivity were shorter in group S. Moreover, postoperative oral intake commenced earlier [5.9 (5-8) days] and postoperative hospital stay was shorter [19.6 (13-29) days] for group S. CONCLUSIONS: The intervention by a perioperative multidisciplinary support team for radical esophagectomy was effective in preventing the progression and prolongation of pneumonia as well as earlier ambulation, oral feeding, and shortening of postoperative hospitalization.

DOI PubMed

[A Case of Para-Aortic Lymph Node Metastasis of Rectal Cancer Successfully Treated Using Multidisciplinary Therapy].

Hatanaka T, Otsuka K, Kimura T, Hakozaki M, Yaegashi M, Kamishima M, Miyake T, Takashimizu K, Sato K, Fujii H, Matsuo T, Takahara T, Akiyama Y, Iwaya T, Nitta H, Koeda K, Mizuno M, Sasaki A

Gan to kagaku ryoho. Cancer & chemotherapy 44 ( 12 ) 1613 - 1616 2017年11月 [査読有り] [国内誌]

A 66-year-old man diagnosed with rectal cancer underwent high anterior resection and received adjuvant chemotherapy (UFT plus UZEL). One year after the surgery, lung and para-aortic lymph node(PLN)metastases were identified. We chose mFOLFOX6 for first-line chemotherapy. After 7 courses, we changed the regimen to sLV5FU2 because of Grade 3 neuropathy. After 5 courses, to treat progressive disease(PD), we changed the regimen to FOLFIRI. Then, the patient had stable disease (SD), and surgical excision was performed for both lung and lymph node recurrence without adjuvant chemotherapy. Six years after the excision, a CT scan revealed PLNagain. We chose FOLFIRI plus cetuximab. After 9 courses, the lymph nodes decreased in size and there was no other recurrence; thus we performed resection. However, a third PLNrecurrence was identified 20 months after the resection. Chemotherapy has continued for 47 courses, and he has maintained SD for more than 2 years.

PubMed

[Fluorescence-Imaging of Nerves - A Novel Trial of Intraoperative Nerve-Preservation].

Endo F, Sugitachi A, Koeda K, Iwaya T, Akiyama Y, Umemura A, Kimura T, Takahara T, Nitta H, Ootsuka K, Mizuno M, Kimura Y, Sasaki A

Gan to kagaku ryoho. Cancer & chemotherapy 44 ( 12 ) 1467 - 1469 2017年11月 [査読有り] [国内誌]

Nerve-preservation technique during surgery is important. Intraoperative nerve injury often causes permanent palsy or numbness and/or neurogenic functional disorders. To evade such intraoperative nerve injuries, we proposed a novel manner to specifically visualize peripheral nerve fibers. Low-toxic agents clinically available, amphotericin B(AmB)or fluorescein isothiocyanate(FITC)were used as neuro-indicators. In in vitro, we used Schwann cells as nerve models to basically confirm these agents effectively functioned as neural markers. In in vivo, we examined whether this novel method was clinically applicable. The Schwann cells reacted with AmB or FITC emitted blue or yellow-green fluorescence in a dark environment. The rat nerve models also fluorescently glimmered in blue-tone when each agent was given. These data suggested that we could clinically discriminate nerve fibers from the surrounding tissues. Our fluorescent-imaging methods warrant further studies for clinical applications.

PubMed

高齢者進行胃癌に対する腹腔鏡下胃切除術の短期成績

肥田圭介, 千葉丈広, 天野怜, 梅邑晃, 馬場誠朗, 秋山有史, 高原武志, 岩谷岳, 新田浩幸, 大塚幸喜, 佐々木章

日本消化器外科学会雑誌 ( (一社)日本消化器外科学会 ) 50 ( Suppl.2 ) 473 - 473 2017年10月

Laparoscopic repair of parahiatal hernia after esophagectomy: a case report.

Akiyama Y, Iwaya T, Endo F, Chiba T, Takahara T, Otsuka K, Nitta H, Koeda K, Mizuno M, Kimura Y, Sasaki A

Surgical case reports 3 ( 1 ) 91 - 91 2017年08月 [査読有り] [国際誌]

BACKGROUND: Diaphragmatic hernia is a potential complication of esophagectomy, which usually occurs as a hiatal hernia and more frequently after minimally invasive esophagectomy. Parahiatal hernia is a rare form of diaphragmatic hernia, and to the best of our knowledge, parahiatal hernia after esophagectomy has not been previously reported. Here, we report a case of parahiatal hernia after esophagectomy that was successfully managed laparoscopically. CASE PRESENTATION: A 73-year-old man underwent thoracoscopic esophagectomy for esophageal cancer with gastric tube reconstruction via the posterior mediastinum. Postoperative morbidity was ileus, which required conservative treatment, and intestinal obstruction for which operation with laparotomy was necessary. He was admitted with abdominal pain and vomiting at 15 months after esophagectomy. Abdominal X-ray revealed colon gas in the intrathoracic space. A barium enema examination showed a transverse colon incarcerated in the intrathoracic space. The patient was preoperatively diagnosed with hiatal hernia after esophagectomy, and laparoscopic hernia repair was performed. During the surgery, the hiatus was found to be intact, and the defect was clearly separated from the left crus of the diaphragm. Parahiatal hernia was the operative diagnosis. The incarcerated colon was repositioned in the abdominal cavity, and the defect was repaired using a composite mesh. CONCLUSIONS: Laparoscopic surgery was found to be effective for the diagnosis and repair of parahiatal hernia.

DOI PubMed

Stability of cervical esophagogastrostomy via hand-sewn anastomosis after esophagectomy for esophageal cancer

Yuji Akiyama, T. Iwaya, F. Endo, Y. Shioi, T. Chiba, T. Takahara, K. Otsuka, H. Nitta, K. Koeda, M. Mizuno, Y. Kimura, A. Sasaki

Diseases of the Esophagus ( John Wiley and Sons Inc. ) 30 ( 5 ) 2017年05月 [査読有り]

The aim of the present study is to evaluate the outcome of hand-sewn esophagogastric anastomosis during radical esophagectomy for esophageal cancer. The outcomes of 467 consecutive esophageal cancer patients who underwent cervical esophagogastric anastomosis using interrupted and double-layered sutures after radical esophagectomy via right thoracotomy or thoracoscopic surgery were retrospectively reviewed. Anastomotic leakage, including conduit necrosis, occurred in 11 of 467 patients (2.4%) 7 of 11 (63.6%) cases experienced only minor leakage, whereas the other four (36.4%) patients had major leakage that required surgical or radiologic intervention, including two patients of conduit necrosis. Anastomotic leakages were more frequently observed after retrosternal reconstruction compared with the posterior mediastinal route (P < 0.0001). The median time to healing of leakage was 40 days (range: 14-97 days). Two patients (2/467, 0.4%) died in the hospital due to sepsis caused by the leakage and conduit necrosis. Twelve patients (2.6%) developed anastomotic stenosis, which was improved by dilatation in all patients. Hand-sewn cervical esophagogastric anastomosis is a stable and highly safe method of radical esophagectomy for esophageal cancer.

DOI PubMed

特異な経過で発見されたintraductal tubulopapillary neoplasmの1例

梅邑晃, 新田浩幸, 高原武志, 長谷川康, 眞壁健二, 岩谷岳, 秋山有史, 大塚幸喜, 肥田圭介, 佐々木章

日本外科系連合学会誌 ( 日本外科系連合学会 ) 42 ( 3 ) 587 - 587 2017年05月

切除不能進行・再発胃癌二次治療に対するラムシルマブの有用性

千葉丈広, 肥田圭介, 天野怜, 瀬川武紀, 西成悠, 高原武志, 秋山有史, 岩谷岳, 西塚哲, 木村祐輔, 大塚幸喜, 新田浩幸, 水野大, 佐々木章

日本外科学会定期学術集会抄録集 ( (一社)日本外科学会 ) 117回 PS - 3 2017年04月

食道扁平上皮癌治療経過における血液腫瘍マーカーの有用性の検討

遠藤史隆, 岩谷岳, 秋山有史, 塩井義裕, 天野総, 高原武志, 西塚哲, 新田浩幸, 大塚幸喜, 肥田圭介, 水野大, 木村祐輔, 佐々木章

日本外科学会定期学術集会抄録集 ( (一社)日本外科学会 ) 117回 PS - 8 2017年04月

Target sequenceによる食道癌変異遺伝子同定効率に関する検討

岩谷岳, 遠藤史隆, 西塚哲, 秋山有史, 塩井義裕, 高原武志, 大塚幸喜, 新田浩幸, 肥田圭介, 水野大, 佐々木章

日本外科学会定期学術集会抄録集 ( (一社)日本外科学会 ) 117回 SF - 5 2017年04月

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