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Article ; Online: Management of Pouch Neoplasia.

Sugita, Akira / Koganei, Kazutaka / Tatsumi, Kenji

2022 Volume 65, Issue S1, Page(s) S129–S135

Abstract: Background: Pouch neoplasia occurs following ileal pouch-anal anastomosis, with or without mucosectomy in ulcerative colitis and familiar adenomatous polyposis.: Objectives: This study aimed to review available literature and make recommendations ... ...

Abstract	Background: Pouch neoplasia occurs following ileal pouch-anal anastomosis, with or without mucosectomy in ulcerative colitis and familiar adenomatous polyposis. Objectives: This study aimed to review available literature and make recommendations regarding pouch neoplasia. Data sources: Data were collected from specialty hospitals, and a literature review was conducted due to the lack of published large-scale studies. Recommendations for treatment were made based on the literature review and expert opinions. Study selection: Large-scale studies of pouch neoplasia were selected. Intervention: The intervention was studies with details of pouch neoplasia. Main outcome measures: We aimed to identify the management modalities for pouch neoplasia based on the type. Results: Pouch neoplasia can occur in each component of the pouch-afferent limb, pouch body, cuff, and anal transitional zone. In patients with ulcerative colitis, pouch neoplasia is treated because colitis-associated neoplasia comprises a multifocal lesion, which most commonly involves the cuff and anal transitional zone. Close surveillance or endoscopic complete resection is optimal for low-grade dysplasia. For adenocarcinoma, high-grade dysplasia, and low-grade dysplasia with difficult complete resection, pouch excision is recommended. In familiar adenomatous polyposis patients with adenomas of the afferent limb or pouch body, endoscopic resection is optimal. Endoscopic resection is feasible for discrete adenoma in the cuff and anal transitional zone, and surgical excision is optimal for laterally spreading, extensive, large, or flat adenoma. For adenocarcinomas involving any component, pouch excision is recommended. Limitations: Published large-scale studies were lacking because of disease rarity. Conclusion: Pouch neoplasia occurs in each pouch component. In patients with ulcerative colitis, pouch excision is recommended for adenocarcinomas and high-grade dysplasia, whereas endoscopic intervention may be preferable to low-grade dysplasia. In familiar adenomatous polyposis patients, pouch excision is necessary for adenocarcinoma, and endoscopic resection or excisional surgery is optimal for adenoma.
MeSH term(s)	Humans ; Colitis, Ulcerative/complications ; Anastomosis, Surgical/adverse effects ; Anus Neoplasms/pathology ; Proctocolectomy, Restorative/adverse effects ; Adenomatous Polyposis Coli/pathology ; Adenoma/pathology ; Adenocarcinoma/pathology ; Colonic Pouches/adverse effects ; Colonic Pouches/pathology
Language	English
Publishing date	2022-07-21
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	212581-x
ISSN	1530-0358 ; 0012-3706
ISSN (online)	1530-0358
ISSN	0012-3706
DOI	10.1097/DCR.0000000000002552
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Article ; Online: Impact of the body mass index on the retention of the anorectal mucosa after double-stapled ileal pouch-anal anastomosis for ulcerative colitis.

Kimura, Hideaki / Toritani, Kenichiro / Kunisaki, Reiko / Tatsumi, Kenji / Koganei, Kazutaka / Sugita, Akira / Endo, Itaru

BMC gastroenterology

2023 Volume 23, Issue 1, Page(s) 32

Abstract: Background: Double-stapled ileal pouch-anal anastomosis (DS-IPAA) is easy to construct and has a good functional outcome in patients with ulcerative colitis (UC). However, retention of the anorectal mucosa may lead to a subsequent risk of inflammation ... ...

Abstract	Background: Double-stapled ileal pouch-anal anastomosis (DS-IPAA) is easy to construct and has a good functional outcome in patients with ulcerative colitis (UC). However, retention of the anorectal mucosa may lead to a subsequent risk of inflammation and neoplasia. This study aimed to identify factors associated with the retention of a large amount of anorectal mucosa after DS-IPAA. Methods: The medical records of 163 patients who had undergone one-stage total proctocolectomy and DS-IPAA for UC between 2007 and 2020 were retrospectively reviewed. The patients were divided into two groups according to the length of the retained mucosa. The high anastomosis group was defined as having a retained mucosal length of ≥ 30 mm in the anterior or posterior wall. Clinical factors were compared between the high and low anastomosis groups. Results: The high anastomosis group showed a significantly higher body mass index (BMI) (high vs. low: 23.2 vs. 19.0), longer operation time (304 vs. 263) and greater blood loss (357 vs. 240). In the multivariate analysis, high BMI was the only factor significantly associated with high anastomosis (odds ratio 1.32). There was a positive correlation between BMI and the length of the retained mucosa. Conclusions: In DS-IPAA, BMI showed the strongest association with the retention of a large amount of the anorectal mucosa. In high BMI patients, although the risk of inability of anastomosis is little than that of IPAA with mucosectomy, the possible retention of a large amount of mucosa should be considered.
MeSH term(s)	Humans ; Proctocolectomy, Restorative/adverse effects ; Colitis, Ulcerative/surgery ; Body Mass Index ; Retrospective Studies ; Surgical Stapling/adverse effects ; Anastomosis, Surgical/adverse effects ; Intestinal Mucosa/surgery ; Treatment Outcome ; Colonic Pouches/adverse effects ; Postoperative Complications/etiology ; Postoperative Complications/surgery
Language	English
Publishing date	2023-02-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2041351-8
ISSN	1471-230X ; 1471-230X
ISSN (online)	1471-230X
ISSN	1471-230X
DOI	10.1186/s12876-023-02667-w
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Article: [A case of ulcerative colitis complicated by disseminated intravascular coagulation that improved markedly after surgery].

Tatsuno, Mizuki / Koganei, Kazutaka / Tatsumi, Kenji / Kuroki, Hirosuke / Obara, Nao / Saitoh, Sayumi / Sugita, Akira

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology

2023 Volume 120, Issue 8, Page(s) 680–688

Abstract: A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ...

Abstract	A 57-year-old man presenting with severe ulcerative colitis (UC) complicated by disseminated intravascular coagulation (DIC) was referred to our hospital. Since it was difficult to improve DIC immediately with any medical treatment, total proctocolectomy, ileoanal canal anastomosis, and ileostomy were performed on the patient. Soon after the surgery, his platelet count and coagulability improved, and he recovered from DIC. Thus, when the cause of DIC is probably UC itself, and medical treatment has limited efficacy in improving the DIC, surgery should be performed as soon as possible to eliminate the cause of DIC, considering the general condition of the patient.
MeSH term(s)	Male ; Humans ; Middle Aged ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/surgery ; Disseminated Intravascular Coagulation/complications ; Disseminated Intravascular Coagulation/surgery ; Proctocolectomy, Restorative/adverse effects ; Anastomosis, Surgical/adverse effects
Language	Japanese
Publishing date	2023-04-21
Publishing country	Japan
Document type	Case Reports ; English Abstract ; Journal Article
ZDB-ID	708695-7
ISSN	1349-7693 ; 0446-6586
ISSN (online)	1349-7693
ISSN	0446-6586
DOI	10.11405/nisshoshi.120.680
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Article ; Online: Postoperative results and complications of fecal diversion for anorectal Crohn's disease.

Kuroki, Hirosuke / Sugita, Akira / Koganei, Kazutaka / Tatsumi, Kenji / Nakao, Eiichi / Obara, Nao

Surgery today

2022 Volume 53, Issue 3, Page(s) 386–392

Abstract: Purpose: Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to ... ...

Abstract	Purpose: Fecal diversion is a less-invasive technique that can alleviate symptoms in patients with refractory anorectal Crohn's disease. However, complications, including recurrence of residual anorectal Crohn's disease, may develop. We aimed to evaluate the postoperative results and complications associated with fecal diversion in patients with refractory anorectal Crohn's disease. Methods: We enrolled 1218 Crohn's disease patients who underwent laparotomy at our institute. We retrospectively analyzed the clinical features of 174 patients who underwent fecal diversion for refractory anorectal Crohn's disease, complications of the diverted colorectum, and the incidence and risk factors for proctectomy after fecal diversion. Results: After fecal diversion, 74% of patients showed improved symptoms. However, bowel continuity restoration was successful in four patients (2.2%), and anorectal Crohn's disease recurred in all patients. Seventeen patients developed cancer with a poor prognosis. The rate of conversion to proctectomy after fecal diversion was 41.3%, and the risk factors included rectal involvement (p = 0.02), loop-type stoma (p < 0.01), and the absence of treatment with biologics after fecal diversion (p = 0.03). Conclusion: Fecal diversion for refractory anorectal Crohn's disease can improve clinical symptoms. Patients with rectal involvement or loop-type stoma have a greater risk of requiring proctectomy following fecal diversion. The administration of biologic may decrease the rate of proctectomy.
MeSH term(s)	Humans ; Crohn Disease/surgery ; Crohn Disease/complications ; Anus Diseases/complications ; Anus Diseases/surgery ; Retrospective Studies ; Surgical Stomas/adverse effects ; Ileostomy/methods ; Postoperative Complications/epidemiology ; Postoperative Complications/etiology ; Postoperative Complications/surgery
Language	English
Publishing date	2022-07-22
Publishing country	Japan
Document type	Journal Article
ZDB-ID	1115435-4
ISSN	1436-2813 ; 0941-1291
ISSN (online)	1436-2813
ISSN	0941-1291
DOI	10.1007/s00595-022-02556-x
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Article: [A case of a patient with Crohn's disease who had vaginal delivery after abdominoperineal resection for severe anorectal complications].

Obara, Nao / Koganei, Kazutaka / Tatsumi, Kenji / Futatsuki, Ryo / Kuroki, Hirosuke / Nakao, Eiichi / Sugita, Akira

Nihon Shokakibyo Gakkai zasshi = The Japanese journal of gastro-enterology

2021 Volume 118, Issue 11, Page(s) 1079–1084

Abstract: We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent ... ...

Abstract	We report the case of a young female patient with Crohn's disease case who had vaginal delivery after abdominoperineal resection for severe perianal disease. The patient had Crohn's disease with anorectal complications for 13 years and underwent abdominoperineal resection for anorectal stenosis, complex anal fistula, and rectovaginal fistula in her early twenties. Seven years later, she got pregnant and gave birth to a healthy boy by vaginal delivery. No recurrence of Crohn's disease was observed during the perinatal period. There is no curative treatment for severe anorectal complications, which may be necessary for young patients to undergo abdominoperineal resection. Further studies are needed to determine the effects of Crohn's disease with anorectal complications on pregnancy and childbirth in affected patients.
MeSH term(s)	Crohn Disease/complications ; Crohn Disease/surgery ; Delivery, Obstetric ; Female ; Humans ; Male ; Pregnancy ; Proctectomy ; Rectal Fistula ; Recurrence ; Treatment Outcome
Language	Japanese
Publishing date	2021-11-10
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	708695-7
ISSN	1349-7693 ; 0446-6586
ISSN (online)	1349-7693
ISSN	0446-6586
DOI	10.11405/nisshoshi.118.1079
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Article ; Online: Subtotal colectomy for refractory ulcerative colitis with COVID-19 infection; a first case report in Japan.

Obara, Nao / Koganei, Kazutaka / Tatsumi, Kenji / Futatsuki, Ryo / Kuroki, Hirosuke / Nakao, Eiichi / Sugita, Akira

Clinical journal of gastroenterology

2021 Volume 14, Issue 5, Page(s) 1437–1442

Abstract: We report a 60-year-old male who was transferred to our hospital for the operation because of refractory ulcerative colitis (UC). He was diagnosed to be infected with COVID-19 for SARS-CoV-2 PCR test positive at the time of transfer. We determined ... ...

Abstract	We report a 60-year-old male who was transferred to our hospital for the operation because of refractory ulcerative colitis (UC). He was diagnosed to be infected with COVID-19 for SARS-CoV-2 PCR test positive at the time of transfer. We determined emergency operation because his general condition was poor such as malnutrition and ADL decline due to exacerbation of UC and air embolization by central venous catheter removal. He underwent subtotal colectomy with a sigmoid mucous fistula and ileostomy. He was well postoperatively. This is a first case report in Japan who underwent an operation for UC with COVID-19 infection.
MeSH term(s)	COVID-19 ; Colectomy ; Colitis, Ulcerative/complications ; Colitis, Ulcerative/surgery ; Humans ; Japan ; Male ; Middle Aged ; SARS-CoV-2
Language	English
Publishing date	2021-07-02
Publishing country	Japan
Document type	Case Reports ; Journal Article
ZDB-ID	2429411-1
ISSN	1865-7265 ; 1865-7257
ISSN (online)	1865-7265
ISSN	1865-7257
DOI	10.1007/s12328-021-01472-w
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Article ; Online: Long-term survival differences between sevoflurane and propofol use in general anesthesia for gynecologic cancer surgery.

Takeyama, Eriko / Miyo, Masaaki / Matsumoto, Hisanori / Tatsumi, Kenji / Amano, Eizo / Hirao, Motohiro / Shibuya, Hiromi

Journal of anesthesia

2021 Volume 35, Issue 4, Page(s) 495–504

Abstract: Background: This study aimed to evaluate the influence of anesthetic management with propofol or sevoflurane on the prognosis of patients undergoing gynecologic cancer surgery.: Methods: This retrospective cohort study included patients who underwent ...

Abstract	Background: This study aimed to evaluate the influence of anesthetic management with propofol or sevoflurane on the prognosis of patients undergoing gynecologic cancer surgery. Methods: This retrospective cohort study included patients who underwent gynecologic cancer (cervical, endometrial, and ovarian cancer) surgery between 2006 and 2018 at the National Hospital Organization Osaka National Hospital. Patients were grouped according to anesthesia type for maintenance of anesthesia: propofol or sevoflurane. After propensity score matching, Kaplan-Meier survival curves were constructed for overall survival, cancer-specific survival, and recurrence-free survival. Univariate and multivariate cox regression models were used to compare hazard ratios for recurrence-free survival. Results: A total of 193 patients with propofol and 94 with sevoflurane anesthesia were eligible for analysis. After propensity score matching, 94 patients remained in each group. The sevoflurane group showed significantly lower survival rates than the propofol group with respect to 10-year overall survival (89.3% vs. 71.6%; p = 0.007), 10-year cancer-specific survival (91.0% vs 80.2%; p = 0.039), and 10-year recurrence-free survival (85.6% vs. 67.7%; p = 0.008). Sevoflurane anesthesia was identified as an independent risk factor for recurrence-free survival. Furthermore, distant recurrence was significantly more frequent in the sevoflurane group than in the propofol group (p < 0.001). Conclusion: In patients undergoing gynecologic cancer surgery, sevoflurane anesthesia was associated with worse overall, cancer-specific, and recurrence-free survival than propofol anesthesia.
MeSH term(s)	Anesthesia, General/adverse effects ; Anesthetics, Inhalation ; Anesthetics, Intravenous ; Female ; Humans ; Methyl Ethers ; Neoplasms ; Propofol ; Retrospective Studies ; Sevoflurane
Chemical Substances	Anesthetics, Inhalation ; Anesthetics, Intravenous ; Methyl Ethers ; Sevoflurane (38LVP0K73A) ; Propofol (YI7VU623SF)
Language	English
Publishing date	2021-05-19
Publishing country	Japan
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	1107821-2
ISSN	1438-8359 ; 0913-8668
ISSN (online)	1438-8359
ISSN	0913-8668
DOI	10.1007/s00540-021-02941-9
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Article: Surgical treatment for Crohn's disease.

Koganei, Kazutaka / Tatsumi, Kenji / Futatsuki, Ryo

Nihon rinsho. Japanese journal of clinical medicine

2018 Volume 75, Issue 3, Page(s) 426–432

Abstract: Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenosis with obstruction, internal and ... ...

Abstract	Surgery has important role in the management for Crohn's disease, although medical treatment had been developed in recent years. Surgical indications are as follows, massive bleeding, perforation, cancer, abscess, stenosis with obstruction, internal and external fistulas, severe anorectal disease, and medical failure. The principle of surgery is a minimal resection of intestine responsible for uncontrolled symptoms and repair of involved organs such as intestine, urinary bladder and abdominal wall. Strictureplasties are an effective alternative for stenosis which preserve the intestine. Seton treatment is often employed for complex perianal fistula. Surgery relieves the refractory symptoms well and should be employed at optimal time for the patients with severe symptoms which impaired their quality of lives.
MeSH term(s)	Crohn Disease/surgery ; Digestive System Surgical Procedures ; Humans
Language	Japanese
Publishing date	2018-12-19
Publishing country	Japan
Document type	Journal Article
ZDB-ID	390903-7
ISSN	0047-1852
ISSN	0047-1852
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Article: [A case of ulcerative colitis complicated by internal fistula between the transverse colon and stomach].

Nakao, Eiichi / Tatsumi, Kenji / Kuroki, Hirosuke / Futatsuki, Ryo / Koganei, Kazutaka / Sugita, Akira

Nihon Shokakibyo Gakkai zasshi The Japanese journal of gastro-enterology

2020 Volume 117, Issue 7, Page(s) 619–625

Abstract: A case of ulcerative colitis (UC) with an internal fistula was reported;the patient, a 42-year-old male, was admitted to the hospital with a diagnosis of refractory UC. The preoperative examination revealed an internal fistula between the transverse ... ...

Abstract	A case of ulcerative colitis (UC) with an internal fistula was reported;the patient, a 42-year-old male, was admitted to the hospital with a diagnosis of refractory UC. The preoperative examination revealed an internal fistula between the transverse colon and the stomach. UC was diagnosed preoperatively with an internal fistula, but the possibility of Crohn's disease could not be ruled out at that time. The patient underwent subtotal colectomy with end ileostomy, sigmoid colon mucous fistula, and partial gastrectomy. UC was diagnosed histopathologically, and an ileal pouch-anal anastomosis was performed. An internal fistula can complicate UC;a split surgery is recommended with the possibility of Crohn's disease in the patient.
MeSH term(s)	Adult ; Colitis, Ulcerative ; Colon, Transverse ; Fistula ; Humans ; Male ; Proctocolectomy, Restorative ; Stomach ; Treatment Outcome
Language	Japanese
Publishing date	2020-06-19
Publishing country	Japan
Document type	Journal Article
ZDB-ID	708695-7
ISSN	1349-7693 ; 0446-6586
ISSN (online)	1349-7693
ISSN	0446-6586
DOI	10.11405/nisshoshi.117.619
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Article: Epidemiology of colitis complicating cancer-postoperative cancer in ulcerative colitis and anorectal cancer in Crohn's disease.

Sugita, Akira / Koganei, Kazutaka / Tatsumi, Kenji / Futatsuki, Ryo / Kuroki, Hirosuke

Nihon rinsho. Japanese journal of clinical medicine

2018 Volume 74, Issue 11, Page(s) 1796–1801

Abstract: Colitis complicating inflammatory bowel disease is gradually increasing in Japan. Although the postoperative cancer in ulcerative colitis is rare, careful postoperative follow up is nec- essary. Anorectal cancer including cancer of anal fistulae in Crohn' ...

Abstract	Colitis complicating inflammatory bowel disease is gradually increasing in Japan. Although the postoperative cancer in ulcerative colitis is rare, careful postoperative follow up is nec- essary. Anorectal cancer including cancer of anal fistulae in Crohn's disease is the most common cancer in Japan and our original cancer surveillance program in which biopsy for anorectal lesion is performed for longstanding anal lesion (more than 10 years) is suggested to be effective for the detection of early cancer.
MeSH term(s)	Colitis, Ulcerative/epidemiology ; Colitis, Ulcerative/etiology ; Colonic Neoplasms/complications ; Colonic Neoplasms/surgery ; Crohn Disease/complications ; Early Detection of Cancer ; Humans
Language	Japanese
Publishing date	2018-12-14
Publishing country	Japan
Document type	Journal Article
ZDB-ID	390903-7
ISSN	0047-1852
ISSN	0047-1852
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