Yuko Kitagawa

Description:In Japan, the rising incidence of hereditary breast and ovarian cancer syndrome (HBOC) follows partial insurance coverage introduced in 2020. Compared with the general population (~11% lifetime risk), individuals with HBOC face a significantly higher lifetime risk of breast cancer (48%-76%), often presenting at younger ages. BRCA1 mutations are linked to triple-negative breast cancer, whereas BRCA2 mutations typically result in luminal-type disease. Key risk management strategies include surveillance and prophylactic surgery. Annual magnetic resonance imaging and mammography are recommended at younger ages than in the general population, despite concerns regarding contrast agents, radiation exposure, and examination-related burdens. Although risk-reducing mastectomy lowers breast cancer risk by over 90%, it remains underutilized because of cosmetic and psychological considerations. Nipple-sparing or skin-sparing mastectomy combined with immediate or delayed reconstruction offers a balance between risk reduction and postoperative outcomes, although safety and procedure details still warrant careful evaluation. Managing the high breast cancer risk associated with HBOC requires ongoing efforts to refine current strategies while minimizing patient burden.

Description:A program of recruiting families with hereditary pancreatic cancer and hereditary breast and ovarian cancer (HBOC) syndrome as high-risk individuals for pancreatic cancer surveillance using magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) has proven effective, resulting in the improvement of early detection rates and life expectancy. Given this, recent guidelines recommend pancreatic surveillance for patients with familial pancreatic cancer and pathological variants of ten genes, including BRCA1/2. In April 2021, our hospital established the HBOC Center, which is operated by nine departments, including obstetrics and gynecology, breast surgery, pancreatology, urology, medical genetics, dermatology, psychiatry and neurology, and oncology. Currently, MRCP or EUS is performed once or twice a year in 63 cases with pathogenic variants in 54 families. Although 4 cases (6.3%) revealed pancreatic microcysts or branched intraductal papillary mucinous neoplasms, no sign of pancreatic cancer was detected. Since January 2021, the germline BRCA1/2 test for companion diagnosis of pancreatic cancer has been covered by insurance, improving the accessibility of genetic testing among patients with pancreatic cancer. However, the BRCA1/2 positivity rate remains low at 1.3%, and its indication for use is very limited. The implementation of genetic testing, including BRCA1/2 analysis, is necessary for the prevention and early detection of pancreatic cancer in high-risk families.

Description:The rapid worldwide transmission of coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to severe cases of hypoxia, acute respiratory distress syndrome, multi-organ failure, and ultimately death. Small-scale molecular interactions have been analyzed by focusing on several genes/single genes, providing important insights; however, genome-wide multi-omics comprehensive molecular interactions have not yet been well investigated with the exception of GWAS and eQTLm, both of which show genetic risks. From April of 2020 until now, we have created a Japan-wide system, initially named the Japan COVID-19 Task Force. This system has collected more than 6500 COVID-19 patients' peripheral blood and as much associated clinical information as possible from a network of more than 120 hospitals. DNA, RNA, serum, and plasma were extracted and stored in this bank. This study unravels the interplay of inflammatory gene networks that induce different COVID-19 severity levels (mild, moderate, severe, and critical) by using multi-omics data from the Japan COVID-19 Task Force. We analyze RNA and protein expressions to estimate severity-specific inflammation networks that uncover the interplay between RNA and protein networks via ligand-receptor pairs. Our large-scale RNA/protein expression data analysis reveals that the atypical chemokine receptor 2 (ACKR2) acts as a key broker linking RNA and protein inflammation networks to induce COVID-19 critical severity. ACKR2 emerges in RNA and protein inflammation networks, showing active interplay in high-severity cases and weak interactions in mild cases. The results also show severity-specific molecular interactions between interleukin (IL), cytokine receptor activity, cell adhesion, and interactions involving the CC chemokine ligand (CCL) gene family and ACKR2.

Description:Despite advancements in multidisciplinary treatment, esophagectomy remains the primary curative treatment for esophageal cancer. Given that lymph node metastases can spread from the cervical to abdominal regions, three-field lymph node dissection has been established as a standard approach. However, this highly invasive procedure involves multiple anatomical regions-thoracic, abdominal, and cervical-leading to significant surgical burden. To reduce surgical invasiveness, minimally invasive esophagectomy (MIE) has become increasingly common worldwide. With its adoption and advancements in multidisciplinary therapy, discussions have emerged regarding the potential omission of lymph node dissection in selected cases. Since the introduction of robot-assisted minimally invasive esophagectomy (RAMIE) in 2004, this technique has progressively replaced conventional MIE. Robotic systems-equipped with a magnified 3D camera, articulated instruments, and tremor filtering-allow surgeons to perform complex procedures with greater precision than manual techniques. One randomized controlled trial (RCT) has demonstrated fewer postoperative complications with RAMIE compared to open esophagectomy. Additionally, RAMIE has been shown to enable more extensive lymph node dissection around the left recurrent laryngeal nerve than conventional MIE. However, the long-term oncological benefits of RAMIE remain unproven, as no RCTs have definitely confirmed its impact on long-term survival in esophageal cancer patients. Ongoing randomized trials are expected to provide further insights into its prognostic benefits.

Description:Objective: This study aimed to investigate the effects of the coronavirus disease 2019 pandemic on morbidity and mortality after advanced hepatectomy by surgical volume in Japan. Methods: Data from patients who underwent advanced hepatectomy between 2018 and 2022 from the Japanese National Clinical Database were collected. The transition of the number of hepatectomies and changes in risk-adjusted mortality and major complication rates based on the type of institutions certified by the Japan Society of Hepato-Biliary-Pancreatic Surgery were investigated. Results: A total of 33 454 cases were included. The number of advanced hepatectomies gradually decreased, whereas the proportion of hepatectomies performed in certified institutions increased (from 63.4% in 2018 to 71.3% in 2022). Although the major complication rate in institution A was higher than that in institution B or noncertified institutions (16.3% vs. 14.5% vs. 13.5%), the in-hospital mortality rate was consistently favorable in the order of institution A, institution B, and noncertified institutions (1.4% vs. 2.0% vs. 2.8%). The monthly standardized mortality and major complication ratios did not significantly increase mostly throughout the pandemic, regardless of the institution type. Conclusions: The centralization to certified institutions progressed even during the pandemic. Surgical safety after advanced hepatectomy was satisfactorily maintained in any institution.