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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, Takumi Habu, Hiromi Nagata, Masaru Komatsu, Junichi Sano, Daiki Terajima, , Ayumi Umemiya, and Erika Yamada (as of April 2024)

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.

Table 1. Number of patients (in 2023)
Total 248(54)
Gastric Cancer (with neo adjuvant chemotherapy) 217(54)
GIST 21
Others 5
Table 2. Type of procedure (in 2023)
Robotic Surgery (with neo adjuvant chemotherapy) 141(44）
Distal Gastrectomy 91(24)
Pylorus-preserving Gastrectomy 0
Proximal Gastrectomy 29(8)
Total Gastrectomy 21(12)
Laparoscopic Gastrectomy (with neo adjuvant chemotherapy) 68(4)
Distal Gastrectomy 60(3)
Pylorus-preserving Gastrectomy 1(0)
Proximal Gastrectomy 4(0)
Total Gastrectomy 3(1)
Open Surgery (with neo adjuvant chemotherapy) 8(6)
Distal Gastrectomy 5(3)
Pylorus-preserving Gastrectomy 0
Proximal Gastrectomy 1(1)
Total Gastrectomy 2(2)
Others 51
Staging laparoscopy 41
Bypass, etc 10

 




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 neo adjuvant chemotherapy (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) 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)

3) 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) JCOG2204 A randomized phase II study to compare the pathological responses of neoadjuvant chemotherapy for type 4 or large type 3 gastric cancer: 5-FU, Oxaliplatin and Docetaxel (FLOT) versus Docetaxel, Oxaliplatin and S-1(DOS)

6) 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)

7) 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)

8) Multiomics data cancer diagnostics therapies (TITANIA Study)

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

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

11) 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

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

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

14) A Study on the Learning Curve of the Multi-Jointed Articulating Laparoscopic Instrument (ArtiSential)

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, Kitaguchi D, Yura M, Takeshita N, Yoshida M, Yamaguchi M, Kondo H, Kinoshita T, Ito M. Automatic surgical phase recognition-based skill assessment in laparoscopic distal gastrectomy using multicenter videos. Gastric Cancer. 2024 Jan;27(1):187-196
  2. Kunisaki C, Katai H, Sakuramoto S, Mizusawa J, Katayama H, Kadoya S, Yamada T, Kinoshita T, Yoshikawa T, Terashima M on behalf of the Stomach Cancer Study Group of Japan Clinical Oncology Group. A nonrandomized controlled trial long-term outcomes of LATG/LAPG for cStage I gastric cancer: JCOG1401. Gastric Cancer. 2024 Jan;27(1):164-175
  3. Tokunaga M, Machida N, Mizusawa J, Ito S, Yabusaki H, Hirao M, Watanabe M, Imamura H, Kinoshita T, Yasuda T, Hihara J, Fukuda H, Yoshikawa T, Boku N, Terashima M. Early endpoints of a randomized phase II trial of preoperative chemotherapy with S-1/CDDP with or without trastuzumab followed by surgery for HER2-positive resectable gastric or esophagogastric junction adenocarcinoma with extensive lymph node metastasis: Japan Clinical Oncology Group study JCOG1301C (Trigger Study). Gastric Cancer. 2024 Jan;27(1):580-589
  4. Honda M, Ri M, Kinoshita T, Kawakubo H, Aizawa M, Bamba T, Matsuda S, Kawamura H, Yoshida M, Nunobe S. Comparison of the survival outcomes between retro-colic and ante-colic Roux-en-Y reconstruction after gastrectomy for gastric cancer. Ann Gastroenterol Surg. 2024;8(3):443-449
  5. Kinoshita T, Komatsu M. Artificial intelligence in surgery and its potential for gastric cancer. J Gastric Cancer. 2023;23(3):400-409
  6. Cas dJ, Cianchi F, Kinoshita T, Kingma F, Piccoli M, Dubecz A, Kouwenhoven E, Det Mv, Mala T, Coratti A, Ubiali P, Turner P, Kish P, Borghi F, Immanuel A, Nilsson M, Rouvelas PI, Hӧlzen JP, Rouanet P, Saint-Marc O, Dussart D, Patriti A, Bazzocchi F, Etten Bv, Haveman JW, DePrizio M, Sabino F, Viola M, Berlth F, Grimminger PP, Roviello F, Hillegersberg Rv, Ruurda J; UGIRA collaborative group. surgical techniques and related perioperative outcomes after Robot-assisted Minimally Invasive Gastrectomy (RAMIG):Results from the prospective multicenter international ugira gastric registry. Ann Surg. 3 November 2023. Epub Ahead of Print doi: 10.1097/SLA.0000000000006147
  7. Makuuchi R, Terashima M, Terada M, Mizusawa J, Kita R, Tokunaga M, Omori T, Ojima T, Ehara K, Watanabe M, Yanagimoto Y, Nunobe S, Kinoshita T, Ito S, Nishida Y, Hihara J, Boku N, Kurokawa Y, Yoshikawa T, the Stomach Cancer Study Group of Japan Clinical Oncology Group. Randomized controlled phase III trial to investigate superiority of robot-assisted gastrectomy over laparoscopic gastrectomy for clinical stage T1-4aN0-3 gastric cancer patients (JCOG1907, MONA LISA study): A study protocol. BMC Cancer. 17 October 2023. Published Online. doi:10.1186/s12885-023-11481-2
  8. Mitsui T, Mori A, Takamatsu T, Kadota T, Sato K, Fukushima R, Okubo K, Umezawa M, Takemura H, Yokota H, Kuwata T, Kinoshita T, Ikematsu H, Yano T, Maeda S, and Soga K. Evaluating the identification of the extent of gastric cancer by over-1000 nm near-infrared hyperspectral imaging using surgical specimens. J. Biomed. Opt. 22 August 2023, Published Online. doi:10.1117/1.JBO.28.8.086001
  9. 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.
  10. 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
  11. 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
  12. 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時53分-62, 2023
  13. 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
  14. 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時53分3-540, 2023
  15. 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
  16. 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
  17. 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
  18. 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
  19. 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
  20. 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時36分6-374, 2022
  21. 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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