Papers by Hayato Kurihara
British journal of cancer, Jan 15, 2002
The present study aimed at investigating whether in gastric cancer patients stage migration occur... more The present study aimed at investigating whether in gastric cancer patients stage migration occurs with extension of lymphadenectomy, when node metastases are staged according to the new pN classification (UICC 1997). The investigation involved 921 patients, who underwent R0 gastric resection for gastric cancer between 1988 and 1998 in three different Italian centres: Verona (n=236), Forlì (n=409), Siena (n=276). The relation among lymphadenectomy and pN category was assessed by Kendall's partial rank-order correlation coefficient, controlling for depth of tumour invasion. A direct evaluation of the Will Rogers phenomenon was accomplished in the Verona series, by comparing the number of positive nodes actually observed with the number of positive nodes which would have been retrieved by a less extended lymphadenectomy (D1). The number of positive nodes increased remarkably with the enlargement of lymphadenectomy, especially in pT2 patients (from 2.2+/-3.9 in D1 to 3.9+/-5.0 in D...
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Chirurgia italiana
The actual benefit of extended lymphadenectomy in terms of survival in the surgical treatment of ... more The actual benefit of extended lymphadenectomy in terms of survival in the surgical treatment of gastric cancer is still a debated issue. The aim of this non-randomized prospective multicentre study was to evaluate long-term survival in a group of patients with involvement of the second level lymph nodes, which would not have been removed with a limited lymphadenectomy. From 1991 to 1997, 451 patients with primary gastric cancer underwent curative resection with extended lymphadenectomy in three italian surgical departments. Lymph node stations were removed and classified according to the rules of the Japanese Research Society for Gastric Cancer; in all cases, retrieval of the lymph nodes was performed by the surgeon on the fresh specimen. Metastases to lymph node stations 7-12 were found in 126 patients out of 451 (27.9%). A mean number of 13 +/- 9 positive lymph nodes (range: 1-42) was found in these cases. Lymph node stations 7 and 8 showed the highest incidence of metastases (61...
Hepato-gastroenterology
Repeat hepatectomy is the most effective treatment for recurrent colorectal liver metastases. We ... more Repeat hepatectomy is the most effective treatment for recurrent colorectal liver metastases. We aim to assess how repeated liver resections increase survival, without unacceptable surgical risk. Between December 1992 and December 1998, among 19 patients, 5 underwent secondary resection of recurrent metastatic disease. Following the primary liver surgery, three patients had systemic chemotherapy with 5-fluorouracil and two locoregional chemotherapy via Port-a-cath in the gastroduodenal artery. We evaluated survival and we compared time of surgery, duration of Pringle maneuver, blood losses and postoperative stay in the hospital between first and second liver surgery. Perioperative mortality at second liver resection was nil; morbidity minor; mean duration of surgery 320 vs. 260 min; Pringle maneuver 35 vs. 25 min; blood losses 1300 vs. 650 mL; postoperative stay 12.6 vs. 11.5 days. Mean total survival from time of colon resection was 50 months. As an interesting secondary finding, w...
World Journal of Surgery, 2008
Purpose Resection line infiltration (RLI) after surgical treatment represents an unfavorable prog... more Purpose Resection line infiltration (RLI) after surgical treatment represents an unfavorable prognostic factor in advanced gastric cancer. We performed a retrospective analysis of 89 patients with resection line involvement who did not undergo reoperation.
Techniques in Coloproctology, 1999
We report the case of a 46-year-old male with a 24-year history of ulcerative colitis who underwe... more We report the case of a 46-year-old male with a 24-year history of ulcerative colitis who underwent proctocolectomy and ileal S-pouch-anal anastomosis. Six months after surgery the patient complained of increased daytime bowel frequency; pouchoscopy revealed severe pouchitis. Because of the failure of conventional treatments, the patient underwent a cycle of cyclosporin A (CsA) enemas. The therapy consisted of one enema each day for 5 weeks (35 administrations). The patient was submitted to a total of five pouchoscopies, the first before the beginning of the enemas cycle and the last one 2 months after the end of the treatment. Endoscopy showed a remarkable improvement at day 10, but these findings were not confirmed later. Biopsies showed a marked improvement at 10 days, but at later stages a reappearance of crypt abscesses with an increasing number of inflammatory infiltrates. In spite of the grim picture at endoscopy and histology, the patient felt better and noted a progressive reduction of the bowel movements and cessation of mucous and bloody discharge. At present, he reports six bowel movements per day and no bleeding.
Scandinavian Journal of Gastroenterology, 2003
The test and treat strategy for Helicobacter pylori infection has raised some concern since young... more The test and treat strategy for Helicobacter pylori infection has raised some concern since young gastric cancer patients may have no alarm symptoms. In this study the frequency of alarm symptoms was assessed in a series of young gastric cancer patients, as well as the impact of absence of alarm symptoms on delay in diagnosis and stage of gastric cancer at diagnosis and survival. A retrospective study was carried out on 92 gastric cancer patients < or = 45 years of age identified from databases in four hospitals between January 1985 and December 2001. Characteristics analysed included duration and features of dyspeptic symptoms, presence of alarm symptoms, time interval from the onset of symptoms to diagnosis, pTNM stage and survival. Of the 92 patients, 54 (58.7%) presented uncomplicated dyspepsia and 38 (41.3%) alarm symptoms. In those with uncomplicated dyspepsia, epigastric pain was the most common complaint (64.1%) followed by vomiting (30.4%), heartburn and nausea. Weight loss was the most common alarm symptom (30.4%), followed by anorexia (10.9%), dysphagia or anaemia (7.6%). The mean delay from first symptoms to final diagnosis was 16.8 +/- 13.9 weeks in patients with alarm symptoms and 29.3 +/- 39.9 weeks in patients without alarm symptoms (P:ns). Patients without alarm symptoms showed significantly less aggressive gastric cancer compared to patients with alarm symptoms in relation to TNM stage and survival (cumulative 5-year survival rate: 76% versus 49% P: 0.01). The survival rate, at 5 years, of patients without alarm symptoms, and with a history of dyspepsia of more than 24 weeks, was higher than that in patients with early diagnosis (93.4% versus 66.5%: P: 0.05). A large proportion of young gastric cancer patients present without alarm symptoms. Despite the delay in diagnosis, these patients have a better outcome than those with alarm symptoms. Thus the delay in diagnosis of patients without alarm symptoms does not affect survival.
Digestive and Liver Disease, 2000
and aims. Since the initial description in 1978, several modifications of restorative proctocolec... more and aims. Since the initial description in 1978, several modifications of restorative proctocolectomy with ileal-pouch-anal-anastomosis (IPAA), for the surgical management of ulcerative colitis (UC), have occurred. Aim of this study is to evaluate safety and efficacy of our IPAA procedure. Patients and Methods. From January 1993 to lune 1999 we treated 44 patients for UC; 33 underwent IPAA. We always performed an S-pouch with mucosectomy and hand-sewn IAA introducing several modifications in the originally described S-pouch. The central loop of the pouch is sutured on ik antimesenteric site with the mesenteric sides of the lateral loops and the length of the limbs is no longer than 9 cm. This shape increases pouch capacitance and allows a better set in lower pelvis. In order to avoid outlet obstruction due to chinking of the pouch, we limit the length of the efferent limb to two cm with preservation of the mesorectum. Mucosectomy stark just few millimetres below the dentate line and is extended for two cm along the anal canal; the IPAA is fashioned by a hand-sewn suture. Results and conclusions. We had no perioperatlve mortality with a low complication rate (12%). The patients referred good continence and an average of 4 bowel movements a day. Various pouch configurations with either two (I), three (5) or four (W) loops have been described; criteria used in choosing a pouch design include the ease of construction, the expected pouch capacity and compliance, ease of evacuation and the Occurrence of complication aRer construction. A controversial technical aspect regards mucosectomy with a
Digestive and Liver Disease, 2002
lstlt"t" Nanorde Turn"" Regm Elena, Roma Background The s-yea Sun"a,I "fp*tle"ts wth completely r... more lstlt"t" Nanorde Turn"" Regm Elena, Roma Background The s-yea Sun"a,I "fp*tle"ts wth completely rerened, nods par,trve gastric c*nCer ranges from IS% to 25% We explored the feaslbdq ofa chemoradmtion regime consistmg m a coocomnant hyperfradionated radiotherapy (HR) and fluorouracil protracted venom infwon (5-W PVC! Matmds and methods Fatty patients, operated oftotal or partial gastrectomy and D-2 nodal resection for stage III @SO% cancer, were imdmted with 6 to I5 MV photons by linacs The target included the gas~lc bed, anastomosis, stumps and regional nodes A total dose of 55 Gy was given in 50 fmtion by using 1 1 Gy BID All patients received a concomitant 200 mg/mZ/day 5-F" WI Patients were examined as ~roprammed during follow-w oetiod Disease relaose or progression was dowme& bi biopsy or cytilogy rep&, or clinical wide& of enlarging mass on radiographic or clinical exammation Toxicity was recorded following the RTOG criteria RS"hS Aflec a me&m follow-up of 75 6 months (range 22 tc 136 months), 24 (60%) panems died and 16 (40%) are alive and free of disease The t-yea actotial incidence ofrelapse is WA, 22% and 10% for distant metast~ses, pentooeal sKding and locoregional recuneoces, respectively The S-year actuarial causerpecuic survival is 43% Three sat&s are sorwvinn more than II wars Acute made > 3 t&city consisted of hematolo&c (22 5%) and gas&intestinal to&y (nausea ani vomjt 22 5%. diarrhoea 2 8% and abdominal pain 2 6%) No late toxuty was observed Co"cl"rl"" This regime of concomitant 5.FU PVI and HX is well tolerated and resulted in a successful loco-regional contraI and satwfactory survival 18 P SAFETY. EFFICACY AND LONG TERM PROGNOSIS OF EXTENDED DZ AND D3 LYMPHADENECTOMY FOR GASTRIC CANCER M Cristaldl, H Kurihara, GM Semptetro, V Ptizzo, P Fociaoi. P Danelh, AM Taschlerl Umversiti degli Studi di Mdano, Dlpartimeoto do seienze cliniche Luigi Sacco
Annals of Surgical Oncology, 2002
Background: The survival benefit of extended lymphadenectomy in the surgical treatment of gastric... more Background: The survival benefit of extended lymphadenectomy in the surgical treatment of gastric cancer is still being debated. The aim of this longitudinal multicenter study was to evaluate long-term survival in a group of patients with involvement of second level lymph nodes, which would not have been removed in the case of a limited lymphadenectomy. Results were compared with those in patients with involvement of first level lymph nodes.
World Journal of Surgery, 2006
Resection line involvement has been indicated as an important prognostic factor for gastric cance... more Resection line involvement has been indicated as an important prognostic factor for gastric cancer. Its late detection renders the choice of treatment difficult for surgeons. We describe the multicenter experience of a group of 11 patients with early gastric carcinoma (EGC) and positive resection confirmed at histological examination who did not undergo surgical retreatment for reasons of associated disease, surgical considerations on duodenal stump, or patient refusal. The gastric margin was involved in 4 patients, and 7 patients had duodenal resection line involvement. No surgical complications or postoperative deaths were observed. Five and 8-year survival was 100% and 86%, respectively. The only patient who relapsed did not have lymph node involvement and died from liver metastases, without local recurrence. It is sometimes difficult to accurately define the resection line in gastric cancer surgery, especially in the early stages of disease, but because of the strongly negative prognostic value of an infiltrated margin, frozen sections are recommended if neoplastic invasion is suspected and a new resection is always recommended if possible. Nevertheless, the good prognosis of resected EGC patients with resection line involvement must be considered before submitting patients with associated diseases to radical surgical retreatment.
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Papers by Hayato Kurihara