Publications by authors named "Naohiro Tomita"

Article Synopsis
  • A new model for predicting germline pathogenic variants (GPVs) of the APC gene in patients with adenomatous polyposis is being developed to aid in clinical diagnosis and management, especially when genetic testing is unavailable.
  • In a study of 162 patients, 55.6% were found to have GPVs of the APC gene, with key predictors identified, including age under 40, 100 or more polyps, fundic gland polyposis, and a family history of colorectal polyposis.
  • The predictive model demonstrated high accuracy (area under the curve of 0.91) and aims to assist both patients and healthcare providers in deciding on the necessity of genetic testing.
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  • The study investigates optimal colonoscopy surveillance intervals for Lynch syndrome cases by analyzing colorectal cancer incidence and precancerous lesions in a multicenter study conducted in Japan.
  • Results show that advanced colorectal cancers are detected more frequently beyond a 2-year interval, with significant differences in detection rates between intervals.
  • The findings suggest that regular colonoscopy surveillance within 2 years is crucial for early detection, with specific risk stratifications for different gene mutations indicating varying risks for subsequent colorectal cancers.
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  • Patients with familial adenomatous polyposis (FAP) face both medical risks and social challenges, particularly related to marriage and childbirth after undergoing colorectal surgery.
  • A study of 161 Japanese patients showed that the overall marriage rate post-surgery (57.8%) was similar to that of the general Japanese population, but those unmarried before surgery had a low marriage rate (16.0%).
  • Factors like younger age and genetic testing significantly increased the likelihood of getting married post-surgery, and 71% of those who married after surgery went on to have successful pregnancies.
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  • Single-incision laparoscopic surgery (SILS) is a less common method compared to multiport laparoscopic surgery (MPLS) for colonic procedures, prompting a systematic review to assess its feasibility, safety, and oncological outcomes.
  • The review analyzed multiple studies (from September to October 2023) that compared SILC with MPLC, focusing on complications and results, finding no significant differences in major outcomes, although SILC had a shorter incision.
  • Despite a gradual increase in SILS cases, its popularity has plateaued in Japan, along with a decline in related research articles, but advances in robotic surgery may revive interest in the technique.
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Purpose: This study evaluated the risk of metachronous colorectal cancer (CRC) after resection of index (first) rectal cancer in patients with Lynch syndrome (LS).

Methods: Clinicopathological data of patients with genetically proven LS were retrospectively analyzed in this multicenter Japanese study. The cumulative incidence of metachronous CRC and the overall survival were compared between patients with index rectal cancer (rectal group) and those with index colon cancer (colon group).

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Background: According to the sixth Gastric Cancer Treatment Guideline, the regimen included nab-paclitaxel(nab-PTX) is a conditional recommendation as second-line treatment for advanced gastric cancer. However, the selection criteria of nab-PTX is not clear.

Method: Questionnaire survey as narrative approach on the problems of paclitaxel premedication, the symptoms due to paclitaxel containing alcohol, and infusion time was conducted for patients who had been treated with paclitaxel.

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Background: The actual situation of oral care and oral troubles for patients with gastric cancer received chemotherapy is not clear.

Methods: Questionnaire survey in the form of oral questions was performed for patients with gastric cancer who received chemotherapy from December 2021 to February 2022. The relevance between the survey results and background factors was examined using the χ2 test.

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Article Synopsis
  • * A colonoscopy revealed ascending colon cancer, specifically adenocarcinoma classified as Group 5, but imaging showed no spread to other areas (no metastases).
  • * The patient underwent laparoscopic surgery (right hemicolectomy and D3 dissection), with post-surgery results indicating stage IIa cancer, and the case is discussed alongside relevant literature on both conditions.
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  • * The study included 52 patients (mean age 75, 28 male and 24 female) who underwent NAC GS, with most having tumors located in the pancreatic head; however, only 2 patients completed full treatment due to necessary dose reductions.
  • * Adverse events were common, with 40.4% of patients experiencing significant neutropenia, but the treatment was generally manageable, resulting in 90.4% of patients undergoing successful R0 resection.
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  • Pancreatoduodenectomy, a surgery for duodenal carcinoma, has high complications in elderly patients, prompting consideration of safer alternatives.
  • An 80-year-old man with advanced duodenal carcinoma chose to avoid surgery due to potential risks, opting for a gastroduodenal bypass and chemotherapy instead.
  • After undergoing 6 courses of the SOX regimen, the patient's tumor was effectively treated, leading to the termination of chemotherapy and 7 months of recurrence-free follow-up.
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  • Patients with familial adenomatous polyposis (FAP) are at a higher risk of gastric neoplasms, including adenomas and cancer, and this study investigates their incidence over time.
  • A cohort of 443 FAP patients was analyzed, revealing that by age 50, 22.8% had gastric adenomas and 7.6% had gastric cancer, with the highest risk for adenomas occurring around age 65.
  • The study suggests that regular monitoring of the upper gastrointestinal tract in older FAP patients could improve early detection of gastric cancer, indicating a need for more frequent check-ups as patients age.
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A 30s female complaining of anal pain and melena was referred to our hospital. The support by adolescent-and-young- adult(AYA)team was initiated after the first encounter. Colonoscopic examination revealed an ulcerated tumor on the anterior wall of anal canal with its anal margin on anal verge and the tumor was diagnosed as an adenocarcinoma.

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Article Synopsis
  • * In a study of 451 FAP patients, 59% had duodenal polyps and 18% had ampullary polyps; duodenal cancer incidence was 4.7% and ampullary cancer was 18% in those with respective polyps.
  • * The study suggests that patients with duodenal polyps require regular endoscopic monitoring, especially those with intermediate- or profuse-type APC variants, due to the high rate of progression of these polyps.*
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Cowden syndrome (CS)/ hamartoma tumor syndrome (PHTS) is a rare autosomal dominantly inherited condition caused by germline pathogenesis. It is associated with multiple hamartomatous lesions occurring in various organs and tissues, including the gastrointestinal tract, skin, mucous membranes, breast, thyroid, endometrium, and brain. Macrocephaly or multiple characteristic mucocutaneous lesions commonly develop in individuals in their 20s.

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Linear IgA disease (LAD) is a rare autoimmune bullous disease characterized by IgA deposition in the basement membrane zone (BMZ). A 66-year-old male was treated for myelodysplastic syndrome at our hospital for 5 years, during which his condition remained stable. He visited our department because of erythema with itching, which appeared 1 year ago and gradually exacerbated with the development of blisters and erosions.

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Article Synopsis
  • The study addresses the challenges of managing colorectal polyp burden in patients with familial adenomatous polyposis (FAP) and explores the potential of tailoring management strategies based on genetic types (genotypes).
  • Using data from a Japanese multicenter study, the research evaluates the risk of colorectal cancer (CRC) associated with two different genotype groups: Genotype-1 and Genotype-2.
  • Findings indicate patients with Genotype-1 have a significantly lower risk of advanced CRC compared to Genotype-2, suggesting the need for genotype-specific approaches in clinical management, which require further validation through future studies.
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  • The study focused on patients in Japan with Lynch syndrome (LS) who have first colon cancer (fCC) to assess the risk of developing metachronous colorectal cancer (mCRC) and the extent of colectomy needed.
  • Researchers analyzed data from 142 patients, noting that the cumulative incidence of mCRC increased significantly over time, especially in those with left-sided colon cancers compared to right-sided ones.
  • The findings suggest that while extending surgical procedures could lower mCRC risks, it’s crucial to weigh this against the overall survival rates and the actual mCRC risks when considering treatment plans.
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Aim: To establish a new Japanese classification of synchronous peritoneal metastases from colorectal cancer.

Methods: This multi-institutional, prospective, observational study enrolled patients who underwent surgery for colorectal cancer with synchronous peritoneal metastases. Overall survival rates were compared according to the various models using objective indicators.

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Background: Recent developments in the field of companion diagnosis and molecular-targeting therapeutic agents have helped in developing treatments targeting human epidermal growth factor receptor 2 (HER2) in gastric cancer (GC) and esophagogastric junction cancer (EGJC), and the importance of accurate diagnosis of HER2 expression is increasing. However, the HER2-positivity rate significantly differs among reports in GC and EGJC, and factors that affect HER2-positivity require elucidation.

Methods: The present study retrospectively examined factors related to HER2-positivity in a single institution, including age, sex, body mass index, the American Society of Anesthesiologists physical status, tumor information, and surgery information, including time to specimen processing.

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Background: A molecular budding signature (MBS), which consists of seven tumor budding-related genes, was recently presented as a prominent prognostic indicator in colon cancer (CC) using microarray data acquired from frozen specimens. This study aimed to confirm the predictive power of MBS for recurrence risk based on formalin-fixed, paraffin-embedded (FFPE) materials.

Methods: This research utilized the same microarray data from a prior multicenter study using FFPE whole tissue sections, which retrospectively reviewed 232 stage II CC patients without adjuvant chemotherapy and 302 stage III CC patients with adjuvant chemotherapy.

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For nearly half a century, desmoid tumor (DT) has been considered a major complication that occurs in approximately 10%-25% of familial adenomatous polyposis (FAP) patients. It is also the leading cause of death in patients undergoing colectomy. We believe that the mortality rate is improving due to the understanding of the natural history of DT and recent advances in medical treatment.

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Article Synopsis
  • Juvenile polyposis syndrome (JPS) is a rare condition characterized by multiple benign polyps in the gastrointestinal tract, with most cases being inherited, while some occur sporadically.
  • The syndrome can lead to complications like gastrointestinal issues and increased risk of gastric cancer, especially in cases associated with specific genetic variants.
  • A committee in Japan developed clinical guidelines for the diagnosis and management of JPS to ensure better care for patients, incorporating a structured approach to recommendations based on evidence.
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Background: Peutz-Jeghers syndrome (PJS) is a rare disease characterized by the presence of hamartomatous polyposis throughout the gastrointestinal tract, except for the esophagus, along with characteristic mucocutaneous pigmentation. It is caused by germline pathogenic variants of the STK11 gene, which exhibit an autosomal dominant mode of inheritance. Some patients with PJS develop gastrointestinal lesions in childhood and require continuous medical care until adulthood and sometimes have serious complications that significantly reduce their quality of life.

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A 60s male, who had laparoscopic ileocecal resection for ascending colon cancer 2 years ago, had enhanced computed tomography(CT)for follow-up and a 12-mm nodule in Douglas' pouch adjacent to right seminal vesicle and rectum was found. 18F-fluorodeoxyglucose(FDG)-positron emission tomography CT revealed abnormal accumulation of 18F-FDG only to the lesion(standardized uptake value max 2.60)and the diagnosis of peritoneal recurrence of ascending colon cancer was made.

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The patient was a 78-year-old man. After 4 courses of GEM plus nab-PTX therapy for multiple recurrent liver metastases after pancreatic body cancer surgery, the patient was aware of general malaise and edema of the extremities. Blood tests showed pancytopenia, and he was admitted to the hospital with a diagnosis of chemotherapy-induced pancytopenia.

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