Publications by authors named "Akinori Takagane"

Article Synopsis
  • The study aimed to assess the effectiveness of an antiadhesion membrane in preventing postoperative small bowel obstruction (SBO) in patients undergoing open gastrectomy for gastric cancer, following prior evidence of its use in other surgeries. !* -
  • Out of 1204 participants in the JCOG1001 trial, 1200 were analyzed, identifying that factors like total gastrectomy and significant blood loss heightened the risk of SBO, but the antiadhesion membrane offered no protective benefit against it. !* -
  • The findings concluded that the antiadhesion membrane does not lower the incidence of SBO following open gastrectomy in gastric cancer patients, indicating it should not be used for SBO prevention in this surgical context
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Background: REGATTA trial failed to demonstrate the survival benefit of reduction gastrectomy in patients with advanced gastric cancer with a single non-curable factor. However, a significant interaction was found between the treatment effect and tumor location in the subset analysis. Additionally, the treatment effect appeared to be different between Japan and Korea.

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  • This study aimed to compare the quality of life (QOL) after surgery using two methods: esophagogastrostomy (PGEG) and double tract (PGDT) after proximal gastrectomy, assessed through the Postgastrectomy Syndrome Assessment Scale (PGSAS)-45.
  • The research included 300 patients from the PGEG group and 172 from the PGDT group, measuring outcomes like symptoms, meal quality, ability to work, body weight, and daily life satisfaction.
  • Results showed that PGDT had better constipation and diarrhea scores, along with less dissatisfaction in daily life for various stomach sizes, indicating it may be a superior option compared to PGEG for improving postoperative quality of life.
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Article Synopsis
  • Current evidence is limited regarding laparoscopic gastrectomy's effectiveness in treating locally advanced gastric cancer, particularly with follow-up predominantly around 3 years; more data is needed to confirm its noninferiority.* -
  • A randomized trial compared 5-year survival rates between laparoscopy-assisted distal gastrectomy (LADG) and open distal gastrectomy (ODG), involving 502 patients from 37 Japanese institutions, with results assessed via interim and final analyses through various years.* -
  • No significant differences in severe postoperative complications were noted between ODG (4.7%) and LADG (3.5%), and the average follow-up duration for patients was about 67.9 months.*
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Background: Recently, there has been an increase in the number of reports of needle tract seeding (NTS) of tumor cells after a biopsy as one of the adverse events related to endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). In most of the previously reported cases of NTS in pancreatic cancer, distal pancreatectomy was performed as the initial surgery, following which metachronous metastasis was discovered in the gastric wall, whose localization matched the puncture route of the EUS-FNA. We report a case of early metastasis from pancreatic cancer in the gastric wall, which was postulated to be caused by NTS.

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Objective: Dihydropyrimidine dehydrogenase (DPYD) genotype is closely associated with fluoropyrimidine (FP)-induced toxicities in Caucasian population and European Medicines Agency now recommends DPYD genotype-based FP dosing strategy.

Patients And Methods: The current study aimed to investigate their impact on FP-related toxicities in an Asian population using genome-wide association study (GWAS) data set from 1364 patients with colon cancer.

Results: Among 82 variants registered in the Clinical Pharmacogenetics Implementation Consortium, 74 DPYD variants were directly genotyped in GWAS cohort; however, only 7 nonsynonymous DPYD variants (CPIC variants) were identified and none of the four recurrent DPYD variants (DPYD*2A, c.

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Purpose: The phase III ACHIEVE trial conducted in Japan was one of six prospective studies included in the International Duration Evaluation of Adjuvant Therapy collaboration, which explored whether 3 months of adjuvant fluorouracil, leucovorin, and oxaliplatin (FOLFOX) or capecitabine and oxaliplatin (CAPOX) therapy would be noninferior to 6 months of treatment in patients with curatively resected stage III colon cancer. We report the final analyses of survival and long-term safety.

Patients And Methods: Eligible patients were randomly assigned (1:1) to either 3 or 6 months of adjuvant chemotherapy (modified [m]FOLFOX6 or CAPOX, as selected by the treating physician).

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Article Synopsis
  • A phase II study was conducted to evaluate the combination of S-1, irinotecan, and bevacizumab (SIRB regimen) as a second-line treatment for specific colorectal cancer patients who had not responded to other therapies.
  • The study involved 17 patients previously treated with oxaliplatin and cetuximab, showing a 6-month progression-free survival rate of 64.7% and a median overall survival of 21.8 months.
  • The results indicated that while there were some grade ≥3 adverse effects in a minority of patients, the SIRB regimen appears to be an effective and safe treatment option for those with resistant metastatic colorectal cancer.
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Purpose: Early management is crucial for acute intestinal blood flow disorders; however, no published study has identified criteria for the time limit for blood flow resumption. This study specifically examines the time factors for avoiding intestinal resection.

Methods: The subjects of this retrospective cohort study were 125 consecutive patients who underwent emergency surgery for a confirmed diagnosis of intestinal strangulation (n = 86), incarceration (n = 27), or volvulus (n = 12), between January 2015 and March 2021.

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Background: During pancreaticoduodenectomy in patients with celiac axis (CA) stenosis due to compression by the median arcuate ligament (MAL), the MAL has to be divided to maintain hepatic blood flow in many cases. However, MAL division often fails, and success can only be determined intraoperatively. To overcome this problem, we performed endovascular CA stenting preoperatively, and thereafter safely performed pancreaticoduodenectomy.

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Introduction: Regorafenib is a multikinase inhibitor approved for the treatment of metastatic colorectal cancer (mCRC). Despite providing a statistically significant survival benefit, a substantial number of patients fail to respond to or continue with treatment, which has resulted in an unmet clinical need for a biomarker of regorafenib efficacy.

Methods: The JACCRO CC-12 study was a prospective, multicenter, single-arm phase II trial designed to evaluate the usefulness of [F]fluorodeoxyglucose positron emission tomography (FDG-PET) as an imaging biomarker of regorafenib in patients with mCRC that progressed after standard chemotherapies.

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Background: Specific treatment strategies are sorely needed for scirrhous-type gastric cancer still, which has poor prognosis. Based on the promising results of our previous phase II study (JCOG0210), we initiated a phase III study to confirm the efficacy of neoadjuvant chemotherapy (NAC) in type 4 or large type 3 gastric cancer.

Methods: Patients aged 20-75 years without a macroscopic unresectable factor as confirmed via staging laparoscopy were randomly assigned to surgery followed by adjuvant chemotherapy with S-1 (Arm A) or NAC (S-1plus cisplatin) followed by D2 gastrectomy plus adjuvant chemotherapy with S-1 (Arm B).

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Grade 3 (G3, poorly differentiated) is an important treatment-decision factor in stage II colon cancer, but no unified diagnostic criteria are established. According to previous studies, an intratumoural poorly differentiated area with no glandular formation (POR) that fills the microscopic field of a ×40 objective lens was an essential factor that defined G3. We aimed to prospectively validate this in a randomized controlled study of adjuvant chemotherapy (SACURA trial).

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Article Synopsis
  • Regorafenib and trifluridine/tipiracil have limited effectiveness as third-line treatments for metastatic colorectal cancer (mCRC), so this study explores an alternative method using irinotecan combined with cetuximab in specific patients.
  • A Phase 2 trial found that 34 mCRC patients responded to this treatment, achieving a 3-month progression-free survival (PFS) rate of 44.1%, with median PFS of 2.4 months and overall survival of 8.2 months.
  • The results suggested that the treatment is safe and potentially effective, particularly for patients with longer intervals between cetuximab treatments, indicating the need for further studies in Phase
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Background: We had previously reported that surgical palliation could maintain quality of life (QOL) while improving solid food intake among patients with malignant gastric outlet obstruction (GOO) caused by advanced gastric cancer. The present study aimed to perform a survival analysis according to the patients' QOL to elucidate its impact on survival.

Methods: Patients with GOO who underwent either palliative gastrectomy or gastrojejunostomy were included in this study.

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Article Synopsis
  • Laparoscopy-assisted distal gastrectomy (LADG) is being studied as a potential alternative to open distal gastrectomy (ODG) for treating gastric cancer, as both methods have shown similar survival rates despite LADG's increased technical difficulty.
  • A phase 3 clinical trial involving 921 patients compared the long-term survival outcomes of LADG and ODG, with patients being randomly assigned to one of the two procedures.
  • Results indicated that LADG had a 5-year relapse-free survival rate of 95.1%, slightly better than ODG's 94.0%, confirming that LADG is non-inferior to ODG in terms of survival outcomes.
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Purpose: Adjuvant FOLFOX therapy is an established standard-of-care for resected colon cancer. Peripheral sensory neuropathy (PSN) is regarded as the major toxicity issue related to FOLFOX therapy. There have been a few reports on the recovery status from PSN thereafter.

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Importance: Oxaliplatin-based chemotherapy is associated with debilitating peripheral sensory neuropathy (PSN) for patients with stage III colon cancer.

Objective: To assess disease-free survival (DFS) and long-lasting PSN in patients treated with 3 vs 6 months of adjuvant oxaliplatin-based chemotherapy.

Design, Setting, And Participants: An open-label, multicenter, phase 3 randomized clinical trial of 1313 Asian patients with stage III colon cancer was conducted investigating the noninferiority of 3 vs 6 months of adjuvant oxaliplatin-based chemotherapy.

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Purpose: S-1 is a standard postoperative adjuvant chemotherapy for patients with stage II or III gastric cancer in Asia. Neoadjuvant or perioperative strategies dominate in Western countries, and docetaxel has recently shown significant survival benefits when combined with other standard regimens in advanced cancer and perioperative settings.

Patients And Methods: This randomized phase III study was designed to prove the superiority of postoperative S-1 plus docetaxel over S-1 alone for R0 resection of pathologic stage III gastric cancer.

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Objective: Adjuvant Chemotherapy Trial of TS-1 for Colon Cancer (ACTS-CC), a randomised phase III trial, demonstrated that adjuvant therapy with S-1 for stage III colon cancer was non-inferior in 3-year disease-free survival (DFS) to that of tegafur-uracil plus leucovorin (UFT/LV). We updated DFS and overall survival (OS) and performed T x N subset analysis.

Methods: A total of 1518 patients with curatively resected stage III colon cancer were randomly assigned to receive S-1 (80-120  mg/day on days 1-28 every 42 days, four courses) or UFT/LV (UFT: 300-600  mg/day and LV: 75  mg/day on days 1-28 every 35 days, five courses).

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Background: Few clinical studies have investigated the association between neutrophil-lymphocyte ratio (NLR) and treatment with cetuximab-based chemotherapy in metastatic colorectal cancer (mCRC). The NLR may reflect immune cells modulating specific cytokine signals in the tumor microenvironment; however, which immune-related genes affect the NLR remain unclear.

Patients And Methods: In 77 patients with KRAS exon2 wild-type mCRC from prospective trials of first-line chemotherapy with cetuximab, expression levels of 354 immune-related genes were measured in tissue samples obtained from all patients by the HTG EdgeSeq Oncology Biomarker Panel.

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Article Synopsis
  • FOLFOXIRI combined with bevacizumab is now recognized as a standard first-line treatment for metastatic colorectal cancer (mCRC), especially for patients with RAS mutations.
  • A study involving 64 patients aged 20 to 75 with unresectable RAS mutant tumors showed a high objective response rate of 75.8% and a median progression-free survival of 11.5 months.
  • The treatment was effective but resulted in significant adverse effects, including neutropenia in 54% of patients, indicating its potential as a viable option for mCRC in Japan.
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Background: The International Duration Evaluation of Adjuvant chemotherapy project investigated whether a shorter duration of oxaliplatin-based adjuvant chemotherapy was as effective as 6 months of identical chemotherapy for resected stage III colon cancer. As part of this project, we report safety data from the Japanese ACHIEVE study (JFMC47-1202-C3).

Patients And Methods: ACHIEVE was an open-label, multicentre trial randomising patients with stage III colon cancer to receive 3 m or 6 m of mFOLFOX6/CAPOX after surgery.

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Background: FOLFOXIRI is now regarded as the chemotherapy regimen that offers the best platform for the treatment of colorectal cancer. However, the safety and efficacy of FOLFOXIRI + panitumumab has not been demonstrated. We conducted a phase I study to determine the recommended dose of FOLFOXIRI + panitumumab as first-line treatment for RAS wild-type metastatic colorectal cancer (mCRC).

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