Publications by authors named "Masanori Tokunaga"

Article Synopsis
  • Histone lactylation is a new epigenetic modification driven by lactate from glycolysis, which is often heightened in cancer, notably gastric cancer (GC), and is linked to poorer patient outcomes.
  • In GC, increased levels of histone H3K18 lactylation correlate with worse prognosis, while SIRT1 plays a key role in regulating these levels by either promoting or diminishing H3K18la depending on its expression.
  • Targeting the interplay between SIRT1, the lncRNA H19, and glycolysis presents a promising therapeutic approach for GC, showing significant anti-cancer effects while minimizing harm to normal cells.
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Aim: To evaluate whether the use of a laxative with reduced patient burden in oral antibiotics and mechanical bowel preparation (OAMBP) could prevent surgical site infection (SSI) in left-sided colon and rectal cancers.

Methods: This multicenter, non-blinded, randomized, non-inferiority trial included patients who underwent elective colorectal surgery for colorectal cancer in a university and community hospital in Japan from April 1, 2021 to March 31, 2023. We compared conventional OAMBP (polyethylene glycol, metronidazole, and kanamycin) (cOAMBP group) with modified OAMBP (sodium picosulfate hydrate, metronidazole, and kanamycin) (mOAMBP group).

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Objective: Despite being reported safety, the advantages of transanal minimally invasive proctocolectomy (TAMIP) are controversial, and comparative studies on postoperative defecation function between ileal pouch-anal anastomosis (IPAA) using laparoscopic transanal manipulation (TAMIP-IPAA) and without this technique (traditional IPAA) are lacking. This study analyzed TAMIP's impact on short-term and postoperative defecation function in patients with ulcerative colitis (UC) to evaluate its safety and feasibility.

Methods: Inclusion criteria comprised patients with UC undergoing minimally invasive proctocolectomy at our hospital from May 2014 to May 2023.

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Purpose: The incidence of esophagogastric junction (EGJ) adenocarcinoma has increased worldwide. As the EGJ is located at the boundary between the thoracic and abdominal cavities, the optimal surgical approach is a subject of debate and estimation of the esophageal invasion length (EIL) is an important factor in its selection.

Methods: Data from our in-house database were extracted for consecutive patients with Siewert type I, II and III EGJ adenocarcinoma (EIL ≤ 4 cm), who underwent transhiatal or transthoracic surgical resection between 2010 and 2016.

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Article Synopsis
  • Total gastrectomy with splenic hilar nodal dissection is a common procedure for treating resectable scirrhous gastric cancer (GC), but the necessity of splenectomy specifically for antral-type GC is uncertain.
  • A study at the National Cancer Center Hospital analyzed patients with type IV GC from 2000 to 2018, focusing on those who underwent total gastrectomy with splenectomy and achieved successful tumor resections.
  • Results showed no metastasis to the splenic hilar nodes in patients with antral-type GC, suggesting that splenectomy may not be needed for this subtype, while it was common in body-type GC cases.
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Article Synopsis
  • Robotic surgery may be less safe without contact-force feedback as it can lead to excessive force on tissues, prompting this study to assess its benefits.
  • Both junior and senior surgeons used a robotic system with feedback to perform tasks that tested their ability to gauge tissue stiffness and apply a designated compression force.
  • Results showed that with feedback, surgeons applied less force and made more accurate adjustments to the designated force, especially among junior surgeons, highlighting the advantage of contact-force feedback in robotic surgery.
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Background: During esophagectomy, evaluation of blood supply to the gastric tube is critically important to estimate and avoid anastomotic complications. This retrospective study investigated the relationship between indocyanine green (ICG) fluorescence angiography during esophagectomy and postoperative endoscopy findings, especially mucosal color change.

Methods: This study retrospectively collected data from 86 patients who underwent subtotal esophagectomy and reconstruction using a gastric tube for esophageal cancer at the Tokyo Medical and Dental University between 2017 and 2020.

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Gastric cancer is one of the most common cancers worldwide, and new therapeutic strategies are urgently needed. Ferroptosis is an intracellular iron-dependent cell death induced by the accumulation of lipid peroxidation, a mechanism different from conventional apoptosis and necrosis. Therefore, induction of ferroptosis is expected to be a new therapeutic strategy.

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Purpose: This study examined the impact of the COVID-19 pandemic on the number of colorectal cancer surgeries performed in Japan.

Methods: We selected patients who underwent colorectal cancer surgeries between January, 2017 and December, 2020 from the Diagnosis Procedure Combination database. The COVID-19 pandemic was divided into three waves.

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Article Synopsis
  • The study evaluates the effectiveness of intraoperative nerve monitoring (IONM) during minimally invasive esophagectomy (MIE) for esophageal cancer, focusing on its impact on recurrent laryngeal nerve (RLN) palsy.
  • Analysis of data from over 4,800 patients revealed that those who underwent surgery with IONM experienced significantly lower rates of postoperative RLN palsy and respiratory complications compared to those without IONM.
  • Though IONM resulted in longer anesthesia times, it potentially shortened hospital stays, indicating its benefits in reducing specific complications related to esophageal cancer surgery.
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Background: This study assessed the potential advantages of robotic-assisted Stapled ileal pouch-anal anastomosis (Ro Stapled-IPAA) in ulcerative colitis (UC) compared to conventional laparoscopic surgery (Lap), with a focus on short-term outcomes and postoperative defecatory function, an aspect not previously explored.

Materials And Methods: Out of a total of 132 patients who underwent proctocolectomy or residual rectal resection, consecutive patients undergoing minimally invasive Stapled-IPAA for UC at our hospital from May 2014 to May 2024 were included. The Ro approach was chosen for individuals with severe colitis extending into the anal canal, deeper rectal cancers (beyond T1), and cases requiring residual rectal resection, taking advantage of its benefits.

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  • The study investigates the importance of reinforcing the duodenal stump to prevent leakage after radical gastrectomy in gastric cancer patients, as the effectiveness of different reinforcement methods was not well understood.
  • Conducted across 57 medical centers in Japan, the research analyzed data from over 16,000 patients from 2012 to 2021 and found that 0.93% experienced duodenal stump leakage, with lower incidence rates linked to reinforcement methods like seromuscular sutures and reinforced staplers.
  • Results highlighted that duodenal stump reinforcement is crucial, as leakage rates were lower in higher-volume hospitals and specific patient demographics were identified as risk factors for leakage-related mortality.
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There is no optimal reconstruction after radical distal esophagectomy for cancers of the esophagogastric junction. We designed a novel reconstruction technique using pedicled ileocolic interposition with intrathoracic anastomosis between the esophagus and the elevated ileum. Two patients underwent the surgery.

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Background/aim: Multiple doses of vaccines against the coronavirus disease (COVID-19) provide patients with cancer the opportunity to continue cancer treatment. This study investigated the safety and efficacy of COVID-19 vaccination in patients with cancer and the optimal timing of vaccination during chemotherapy.

Patients And Methods: A total of 131 patients with gastrointestinal (GI) cancer who received two doses of the COVID-19 vaccine were included in this study.

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Background: Recent studies have revealed that sarcopenia is associated with postoperative complications and poor prognosis. Although neoadjuvant chemotherapy is a promising treatment for gastric cancer, its toxicity may lead to the loss of skeletal muscle mass. This study investigates the changes in skeletal muscle mass during neoadjuvant chemotherapy and its clinical impact on patients with locally advanced gastric cancer.

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Background: This randomized phase II study explored the superiority of trastuzumab plus S-1 plus cisplatin (SP) over SP alone as neoadjuvant chemotherapy (NAC) for HER2-positive resectable gastric cancer with extensive lymph node metastasis.

Methods: Eligible patients with HER2-positive gastric or esophagogastric junction cancer and extensive lymph node metastasis were randomized to receive three or four courses of preoperative chemotherapy with SP (arm A) or SP plus trastuzumab (arm B). Following gastrectomy, adjuvant chemotherapy with S-1 was administered for 1 year in both arms.

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Background: Currently, widely used robotic surgical systems do not provide force feedback. This study aimed to evaluate the impact and benefits of a force feedback function on the suturing procedure.

Methods: Twenty surgeons were recruited and divided into young (Y-group, n = 11) and senior (S-group, n = 9) groups, based on their years of surgical experience.

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Background: The use of robot-assisted surgery for rectal cancer is increasing, but its short-term results remain unclear. We compared the short-term outcomes of robot-assisted and laparoscopic surgery for rectal cancer using a nationwide inpatient database.

Methods: We analyzed patients registered in the Japanese Diagnosis Procedure Combination database who underwent robot-assisted or laparoscopic surgery for rectal cancer from April 2018 to March 2020.

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Treatment strategy for locally advanced gastric cancer differs worldwide. Neoadjuvant chemotherapy (NAC) is considered one of the promising treatment options for locally advanced gastric cancer, even in Japan, and clinical trials have been conducted or are ongoing. A consensus meeting was organized at the 77th general meeting of the Japanese Society of Gastroenterological Surgery in 2022, in which the current status and future prospects of NAC for locally advanced gastric cancer were discussed.

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Article Synopsis
  • Laparoscopic gastrectomy (LG) is a common treatment for early-stage gastric cancer, but it has limitations like motion restriction and spatial perception issues, which robot-assisted gastrectomy (RG) aims to overcome through advanced features.
  • A large-scale randomized phase III study is being conducted in Japan to determine if RG is safer than LG for patients with clinical T1-2N0-2 gastric cancer, enrolling 1,040 participants over five years.
  • The study focuses on various postoperative complications and outcomes, including infection rates and survival, with approval obtained from healthcare authorities and adjustments made to eligibility criteria based on recent findings.
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Increasing evidence based on the safety and benefits of robot-assisted surgery indicates the disadvantage of the lack of tactile feedback. A lack of tactile feedback increases the risk of intraoperative complications, prolongs operative times, and delays the learning curve. A 40-year-old female patient presented to our hospital with a positive fecal occult blood test.

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Introduction: Bacteroides fragilis (B. fragilis) is considered to act in an anti-inflammatory manner on the intestinal tract. On the contrary, enterotoxigenic B.

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Background: In Japan, the transhiatal approach, including lower mediastinal lymph node dissection, is widely performed for Siewert type II esophagogastric junction adenocarcinoma. This procedure is generally performed in a magnified view using laparoscopy or a robotic system, therefore, the microanatomy of the lower mediastinum is important. However, mediastinal microanatomy is still unclear and classification of lower mediastinal lymph nodes is not currently based on fascia or other microanatomical structures.

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