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国立がん研究センター 東病院

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Department of Gastric Surgery

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Takahiro Kinoshita,  Masahiro Yura, Mitsumasa Yoshida, Takafumi Okayama, Takumi Habu, Hiromi Nagata, Masaru Komatsu, Daiki Terajima, Junichi Sano, and Kiyotaka Mochizuki (as of April 2023)

Information

Introduction

Our department currently consists of ten surgeons. Our managing of tumors includes common gastric adenocarcinoma, adenocarcinoma of the esophagogastric junction (AEG: Siewert type II/III), and gastric submucosal tumors (GIST, etc.). Annually, 260-300 patients are operated on either by means of open surgery, laparoscopic or robotic surgery (Table 1). Laparoscopic gastrectomy with radical node dissection was introduced in 2010, and now our department is one of the leading institutions in Japan. Currently, more than 90% of gastrectomy is performed under laparoscopy or by robot (Table 2). The basis of our surgery is radical extirpation of cancer lesions, but at the same time, organ functions and better quality of life (QOL) should be maintained. In addition, we strive to obtain better clinical outcomes for patients with diseases with dismal prognoses (type 4 gastric cancer or with progressive metastasis) by surgery combined with a modern chemotherapy regimen in cooperation with medical oncologists.

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The Team and What We Do

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Usually 10-14 patients are hospitalized and six to eight patients undergo operations per week. A clinical conference of our division is held once a week to decide our treatment strategy. Further, a conference with internal medicine is held every week with doctors of Medical Oncology and Gastrointestinal Endoscopy, discussing the accurate diagnosis of the patients to decide the optimal treatment method. Laparoscopic (robot) surgery covers distal, proximal, pylorus-preserving, and total gastrectomy. D2 dissection can also be done, and its indication is expanding to locally advanced cancer or that after NAC. Recently, due to the progress of chemotherapy regimen, down-staging from cStageIV is sometimes seen. For such patients, we selectively perform conversion surgery to achieve favorable outcomes. For AEGs, the transhiatal approach or thoraco-laparoscopic Ivor-Lewis surgery can be done by minimal invasive means.

Research activities

We aggressively publish our clinical research data in domestic or international congresses. In　addition, we participate in multi-institutional clinical trials conducted by the Japan Clinical　Oncology Group (JCOG) – Gastric Surgery Study Group or other international and domestic organizations, and work as PI for some clinical trials (JCOG1809) (COSMOS-GC regarding liquid biopsy). We started a research of auto intelligence technology relevant with laparoscopic or robot-assisted surgery.

Clinical trials

The ongoing list of multi-institutional clinical trials we participate in is shown as below.

1) JCOG1809 Single-arm phase II trial to evaluate safety of Laparoscopic Total Gastrectomy with Spleen-PReservING splenic hilar dissection for proximal gastric cancer invading the greater curvature (LTG-SPRING-PII)

2) JCOG1507 A phase III trial to confirm S-1 adjuvant chemotherapy for pathological stage II/III vulnerable elderly gastric cancer patients who underwent gastric resection (BIRDIE)

2) JCOG1509 Phase III trial to evaluate the efficacy of neoadjuvant chemotherapy with S-1 plus oxaliplatin followed by D2 gastrectomy with adjuvant S-1 in locally advanced gastric cancer (NAGISA trial)

4) JCOG1711 Randomised controlled phase III trial to evaluate Omentum preserving gastrectomy for patients with ADvanced Gastric Cancer　(ROAD-GC)

4) JCOG1907 Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-2N0-2 Gastric Cancer patients (MONA-LISA Study)

5) An open label phase 2 study to evaluate the safety and efficacy of lenvatinib with pembrolizumab in the neoadjuvant / adjuvant treatment for patients with gastric cancer (EPOC2001)

6) An open label phase 2 study to evaluate the efficacy and safety of trastuzumab deruxtecan (T-DXd) in the neoadjuvant treatment for patients with HER2 positive gastric and gastroesophageal junction adenocarcinoma (EPOC2003)

7) Multiomics data cancer diagnostics therapies (TITANIA Study)

8) Conquer Solid Malignancies by blood screening –gastric cancer- 01 (COSMOS-GC)

9) Development of a Clinical Decision Support System (CDSS) with Artificial Intelligence for Gastric and Esophageal Adenocarcinomas (Ask Bob Study)

10) The HOLD Study– StomacH Cancer Elective Surgery MOrbidity and Mortality at 90-Day / The OUTLIVE Study - Oesophageal and JUncTional Cancer ELectIVE Surgery Morbidity and Mortality at 90-Day: A TUGS Multinational Audit

11) The UGIRA International Registry for Robot-Assisted Minimally Invasive Gastrectomy (RAMIG) for gastric cancer

12) The UGIRA International Registry for Robot-Assisted Minimally Invasive Esophagectomy (RAMIE)

Academia / Training

Resident doctors are trained to be specialized surgical oncologists with sufficient techniques and knowledge. Nowadays, opportunities to perform robotic/laparoscopic/open surgery are simultaneously given to them. We also place importance on the education of surgeons of other institutions.  We are endorsed as a domestic official certified institution for surgery observation of robotic gastrectomy.

Observership Visits for International Doctors

We always welcome doctors from overseas to share our expertise with the international gastric surgical oncology community. Since 2014, we have hosted more than 100 observership visitors from 20 countries and regions.

In 2020-2022, we could not accept foreign doctors due to COVID-19 pandemic, but we have resumed our surgery observership program and many candidates hope to visit our department.

 

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Future prospects

We will keep striving to obtain better survival outcomes for the patients with far advanced diseases; for multidisciplinary therapy (chemotherapy, molecular-target agents or immune check-point inhibitor), collaborating with medical oncologists is essential. Additionally, we will continue to develop less-invasive as well as high-quality surgical methods (laparoscopic or robotic surgery), to improve patients' QOL and realize complete cures. It is also our obligation to expand our knowledge and experience globally as one of the main countries in terms of gastric cancer occurrence.

Latest journals

  1. Komatsu M, Kinoshita T, Akimoto E, Yoshida M, Nagata H, Habu T, Okayama T, Yura M. Advantages of robotic gastrectomy for overweight patients with gastric cancer: a comparison study of robotic gastrectomy and conventional laparoscopic gastrectomy. Surg Today, 2023 Apr 6. doi: 10.1007/s00595-023-02681-1. Online ahead of print.
  2. Akimoto E, Kinoshita T, Sato R, Yura M, Harada J, Yoshida M, Okayama T, Takabe Y, Tanaka Y, Tomi Y, Habu T. Impact of postoperative intra-abdominal infectious complications on survival outcomes in patients with gastric cancer who underwent laparoscopic surgery. Surgical endoscopy, 37:382-390, 2023
  3. Kanda M, Terashima M, Kinoshita T, Yabusaki H, Tokunaga M, Kodera Y. A multi-institutional study to evaluate the feasibility of next-generation sequencing and genomic analysis using formalin-fixed, paraffin-embedded biopsies of gastric cancer. Gastric cancer, 26:108-115, 2023
  4. Kinoshita T, Akimoto E, Yura M, Yoshida M. Survival outcomes of laparoscopic versus open total gastrectomy with nodal dissection for gastric cancer in a high-volume Japanese center: A propensity score-matched analysis. Annals of gastroenterological surgery, 7:53-62, 2023
  5. Yamaguchi T, Takashima A, Nagashima K, Kumagai K, Yamada T, Terashima M, Yabusaki H, Nishikawa K, Tanabe K, Yunome G, Kawachi Y, Yamada T, Fukagawa T, Kinoshita T, Watanabe M, Ishiyama K, Inoue K, Boku N. Evaluating the efficacy of post-operative chemotherapy after curative resection of stage IV gastric cancer with synchronous oligo metastasis: a multicenter retrospective study. Gastric cancer, 26:307-316, 2023
  6. Habu T, Kumanishi R, Ogata T, Fujisawa T, Mishima S, Kotani D, Kadowaki S, Nakamura M, Hojo H, Fujiwara H, Kumagai S, Koyama S, Fujita T, Kinoshita T, Nishikawa H, Yano T, Tajika M, Muro K, Mitsunaga S, Kojima T, Bando H. Complete response to definitive chemoradiotherapy in unresectable locally advanced esophageal squamous cell carcinoma. Esophagus, 20:533-540, 2023
  7. Sakashita S, Sakamoto N, Kojima M, Taki T, Miyazaki S, Minakata N, Sasabe M, Kinoshita T, Ishii G, Ochiai A. Requirement of image standardization for AI-based macroscopic diagnosis for surgical specimens of gastric cancer. Journal of cancer research and clinical oncology, 2023
  8. Etoh T, Ohyama T, Sakuramoto S, Tsuji T, Lee SW, Yoshida K, Koeda K, Hiki N, Kunisaki C, Tokunaga M, Otsubo D, Takagane A, Misawa K, Kinoshita T, Cho H, Doki Y, Nunobe S, Shiraishi N, Kitano S. Five-Year Survival Outcomes of Laparoscopy-Assisted vs Open Distal Gastrectomy for Advanced Gastric Cancer: The JLSSG0901 Randomized Clinical Trial. JAMA surgery, 158:445-454, 2023
  9. Akimoto E, Kuwata T, Shitara K, Kawazoe A, Sakamoto N, Ishii G, Ochiai A, Kinoshita T. Impact of Programmed Death-Ligand 1 Expression on Mismatch Repair Deficiency and Epstein-Barr Virus Status on Survival Outcomes in Patients with Stage II/III Gastric Cancer After Surgery. Annals of surgical oncology, 2023
  10.  Mizusawa J, Tokunaga M, Machida N, Yabusaki H, Kawabata R, Imamura H, Kinoshita T, Nomura T, Nunobe S, Tsuji K, Katayama H, Fukuda H, Boku N, Yoshikawa T, Terashima M, Stomach Cancer Study Group of the Japan Clinical Oncology Group. Protocol digest of a phase III trial to evaluate the efficacy of preoperative chemotherapy with S-1 plus oxaliplatin followed by D2 gastrectomy with postoperative S-1 in locally advanced gastric cancer: Japan Clinical Oncology Group study JCOG1509 (NAGISA Trial). Japanese Journal of Clinical Oncology, 53:168-173, 2022
  11. Ikematsu H, Ishihara M, Okawa S, Minamide T, Mitsui T, Kuwata T, Ito M, Kinoshita T, Fujita T, Yano T, Omori T, Ozawa S, Murakoshi D, Irisawa K, Ochiai A. Photoacoustic imaging of fresh human surgically and endoscopically resected gastrointestinal specimens. DEN open, 2:e28, 2022
  12. Tanaka Y, Kinoshita T, Akimoto E, Sato R, Yura M, Harada J, Yoshida M, Tomi Y. The impact of hiatal hernia on survival outcomes in patients with gastroesophageal junction adenocarcinoma. Annals of gastroenterological surgery, 6:366-374, 2022
  13. Komatsu M, Kinoshita T, Akimoto E, Yoshida M, Terajima D, Nagata H, Habu T, Okayama T, Takabe Y, Harada J, Yamaguchi M, Yura M. The Significance of Staging Laparoscopy in Detection of Radiologically Occult Peritoneal Carcinomatosis in Gastric Cancer With Gastric Outlet Obstruction: Consideration of The Optimal Treatment Approach. Anticancer research, 42:5571-5578, 2022

     

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