記述言語：日本語  

A 64-year-old woman was diagnosed with Stage IV gastric cancer with lymph node and multiple liver metastases. She was treated with 6 courses of chemotherapy, in 3-week courses, with capecitabine (1,000 mg/m/(2)) plus cisplatin(80 mg/m(2)) administered for 2 weeks, followed by a drug-free week. She underwent curative total gastrectomy with D2 lymph node dissection and reconstruction by using the Roux-en-Y method. The postoperative pathological findings revealed a T3 (SE), N1M1, Stage II B tumor; the tumor was determined to be Grade 1b owing to the chemotherapeutic effect. Postoperatively, only S-1 therapy was administered, because of the development of Grade 3 hand-foot syndrome. The patient is alive 1 year and 8 months after the initial gastrectomy.

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

Spontaneous rupture of the esophagus, which occurs as a result of a sudden increase in the intra-esophageal pressure, is a life-threatening disease that requires urgent treatment. We herein report a case of spontaneous rupture of the esophagus that was successfully treated with primary closure and drainage under video-assisted thoracoscopic surgery. A 52-year-old woman presented at the emergency department with a classic history of acute epigastric pain after an episode of vomiting. A thoracic CT scan revealed mediastinal emphysema and bilateral hydrothorax. Spontaneous rupture of the esophagus was confirmed on esophagography, which demonstrated evidence of an area of perforation measuring 20 mm in the left wall of the lower esophagus. We conducted emergency surgery within 12 hours after onset, followed by thoracoscopic drainage and primary closure. No omental patches were used because the level of contamination was considered to be low. The patient demonstrated a good recovery and was discharged on the 23rd postoperative day.

DOI： 10.5833/jjgs.2014.0136

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

We report a case of gastric carcinoma with metastasis to the liver responding to surgery and chemotherapy. The patient was a 74-year-old man with gastric cancer, clinically diagnosed as P0H0M0T3N0. We initially planned to perform an open distal gastrectomy. However, intraoperative findings revealed metastatic tumors in the liver. Therefore, the patient underwent a D1 distal gastrectomy. After surgery, the patient received the following chemotherapy regimens: 1 course of S-1 and 8 courses of a S-1 and cisplatin (CDDP) combination. After 8 courses of S-1 plus CDDP treatment, liver metastases could not be detected by computed tomography (CT), magnetic resonance imaging (MRI), or positron emission tomography (PET). The patient was assessed to have a clinical complete response. Fifty months after surgery, the patient is alive without recurrence.

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記述言語：英語   出版者・発行元：SPRINGER  

To clarify factors related to vitamin E malabsorption after gastric surgery, we evaluated serum vitamin E levels in patients who had undergone gastrectomy for gastric cancer.
We studied 39 patients (26 men, 13 women; mean age, 61.7 years) who underwent gastrectomy for early gastric cancer. Surgical procedures included 24 subtotal gastrectomies and 15 total gastrectomies. We measured serum levels of vitamin E before and 3, 6, 9, and 12 months after gastrectomy. A level of less than 0.75 mg/dl was defined as a low vitamin E level.
Serum vitamin E levels decreased to less than 0.75 mg/dl in 6 (15.4 %) of the 39 patients within 6 months after gastrectomy and in 7 (17.9 %) of the 39 patients within 1 year after gastrectomy. The proportion of patients with a low serum vitamin E level was significantly higher in the total gastrectomy group (p = 0.002). A low vitamin E level was significantly associated with a low total cholesterol level. Total cholesterol levels in low vitamin E levels patients were lower than normal vitamin E levels patients. None of the patients with a low vitamin E level had neuropathy.
The type of operation performed (total vs. subtotal gastrectomy) may be the major cause of vitamin E malabsorption after gastrectomy for gastric cancer. Vitamin E deficiency probably begins within 6 months after gastrectomy for gastric cancer.

DOI： 10.1007/s00268-014-2515-1

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記述言語：英語   出版者・発行元：SPRINGER  

Laparoscopy-assisted distal gastrectomy (LADG) for gastric cancer may prevent the development of an impaired nutritional status due to reduced surgical stress compared with open distal gastrectomy (ODG).
This study was performed as an exploratory analysis of a phase III trial comparing LADG and ODG for stage I gastric cancer during the period between May and December of 2011. All patients received the same perioperative care via fast-track surgery. The level of surgical stress was evaluated based on the white blood cell count and the interleukin-6 (IL-6) level. The nutritional status was measured according to the total body weight, amount of lean body mass, lymphocyte count, and prealbumin level.
Twenty-six patients were randomized to receive ODG (13 patients) or LADG (13 patients). The baseline characteristics and surgical outcomes were similar between the two groups. The median IL-6 level increased from 0.8 to 36.3 pg/dl in the ODG group and from 1.5 to 53.3 pg/dl in the LADG group. The median amount of lean body mass decreased from 48.3 to 46.8 kg in the ODG group and from 46.6 to 46.0 kg in the LADG group. There are no significant differences between two groups.
The level of surgical stress and the nutritional status were found to be similar between the ODG and LADG groups in a randomized comparison using the same perioperative care of fast-track surgery.

DOI： 10.1245/s10434-014-3509-9

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記述言語：英語   出版者・発行元：BAISHIDENG PUBLISHING GROUP INC  

AIM: To identify the subset of patients with stage IB gastric cancer with an unfavorable prognosis.
METHODS: Overall survival (OS) rates were examined in 103 patients with stage IB (T1N1M0 and T2N0M0) gastric cancer between January 2000 and December 2011. Univariate and multivariate analyses were performed to identify risk factors using a Cox proportional hazards model.
RESULTS: The OS rates of patients with T1N1 and T2N0 cancer were 89.2% and 94.1% at 5-years, respectively. Both univariate and multivariate analyses demonstrated that tumor location was the only significant prognostic factor. The OS rate was 81.8% at 5-years when the tumor was located in the upper third of the stomach and was 95.5% at 5-years when the tumor was located in the middle or lower third of the stomach (P = 0.0093).
CONCLUSION: These data may suggest that tumor location is associated with survival in patients with stage IB gastric cancer. (C) 2014 Baishideng Publishing Group Inc. All rights reserved.

DOI： 10.3748/wjg.v20.i21.6580

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記述言語：英語   出版者・発行元：BIOMED CENTRAL LTD  

Background: Ensuring an adequate blood supply is essential to the safe performance of an anastomosis during esophagectomy and the prevention of anastomotic leakage. Recently, indocyanine green (ICG) fluorescence imaging has been used to visualize the blood supply when anastomosis is performed in vascular surgery. We used ICG fluorescence imaging to visualize the blood supply for reconstruction during esophagectomy.
Methods: Since January 2009, we have performed ICG fluorescence imaging in 33 patients with thoracic esophageal cancer who underwent thoracic esophagectomy. After pulling up the reconstructed stomach, 2.5 mg of ICG was injected as a bolus. ICG fluorescence imaging was performed with a near-infrared camera, and the images were recorded.
Results: ICG fluorescence was easily detected in all patients 1 min after injection. Vascular networks were well visualized in the gastric wall and omentum. The blood supply route was located in the greater omentum beside the splenic hilum in 22 (66.7%) of the 33 patients.
Conclusions: ICG fluorescence can be used to evaluate the blood supply to the reconstructed stomach in patients undergoing esophagectomy for esophageal cancer. On ICG fluorescence imaging, the splenic hiatal vessels were the major blood supply for the anastomosis in most patients.

DOI： 10.1186/1471-2342-14-18

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記述言語：英語  

Background: We thought that using electrocautery for hemostasis caused recurrent laryngeal nerve palsy. We reflected the prolonged use of electrocautery and employed NU-KNIT® to achieve hemostasis nearby the recurrent laryngeal nerve. We assessed that using NU-KNIT® hemostasis prevented or not postoperative recurrent laryngeal nerve palsy, retrospectively. The present study was evaluated to compare using electrocautery hemostasis with using NU-KNIT® hemostasis during lymphadenectomy along recurrent laryngeal nerve. The variables compared were morbidity rate of recurrent laryngeal nerve palsy, operation time, and blood loss. Results: We use NU-KNIT® to achieve hemostasis without strong compression. This group is named group N. On the other hand, we use electrocautery to achieve hemostasis. This group is named group E. Complication rate of recurrent laryngeal nerve palsy was higher in group E (55.6%) than group N (5.3%) (p = 0.007). Conclusions: Even hemostasis using NU-KNIT® was slightly more time-consuming than using electrocautery, we concluded that it would be useful to prevent recurrent laryngeal nerve palsy. © 2014 Rino et al.; licensee BioMed Central Ltd.

DOI： 10.1186/1756-0500-7-127

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記述言語：英語   出版者・発行元：BIOMED CENTRAL LTD  

Background: This randomized Phase III trial will evaluate whether the methylene blue-assisted technique is efficient for harvesting lymph nodes after radical surgery for gastric cancer.
Methods/design: Patients that undergo distal or total gastrectomy with radical nodal dissection will be randomly assigned to Group A: the standard group, the lymph nodes (LNs) will be harvested from the fresh specimen immediately after surgery, or Group B: the methylene blue-assisted group, where the LNs will be harvested from specimens fixed with 10% buffered formalin with methylene blue for 48 hours after surgery. The primary endpoint is the ratio of the number of the harvested LNs per time (minute). The secondary endpoint is the number of harvested LNs. A 25% reduction in the ratio of harvested lymph-node/time (minute) was determined to be necessary for this test treatment, considering the balance between the cost and benefit. Retrospective data was used to estimate the ratio of the number of the harvested LNs per time (minute) to be 40/30 minutes in Group A. A 25% risk reduction and a rate of 40/22.5 minutes is expected in Group B. Therefore, the sample size required ensuring a two-sided alpha error of 5% and statistical power of 80% is 52 patients, with 26 patients per arm. The number of patients to be accrued was set at 60 in total, due to the likelihood of enrolling ineligible patients.

DOI： 10.1186/1471-2407-14-155

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記述言語：英語   出版者・発行元：SPRINGER  

A number of studies have evaluated the effects of subcutaneous drainage during digestive surgery. All of the previous studies assessed the usefulness of active-suctioning drain, including two randomized controlled studies which found no benefit for the placement of active-suctioning drains in digestive surgery. The utility of passive drainage has not been evaluated previously. The purpose of this study was to evaluate the efficacy of subcutaneous passive drainage system for preventing surgical site infections during major colorectal surgery.
A total of 263 patients who underwent major colorectal surgery were enrolled in this study. Patients were randomly assigned to receive subcutaneous passive drainage or no drainage. The primary outcome measured was the incidence of superficial surgical site infections. The secondary outcomes measured were the development of hematomas, seromas, and wound dehiscence.
Finally, a total of 246 patients (124 underwent passive drainage, and 122 underwent no drainage) were included in the analysis after randomization. There was a significant difference in the incidence of superficial surgical site infections between patients assigned to the passive drainage and no drainage groups (3.2 % vs 9.8 %, respectively, P = 0.041). There were no cases that developed a hematoma, seroma, or wound dehiscence in either group. A subgroup analysis revealed that male gender, age a parts per thousand yen75 years, diabetes mellitus, American Society of Anesthesiologists (ASA) status a parts per thousand yen2, blood loss a parts per thousand yen100 ml, and open access were factors that were associated with a beneficial effect of subcutaneous passive drainage.
Subcutaneous passive drainage provides benefits over no drainage in patients undergoing major colorectal surgery.

DOI： 10.1007/s00384-013-1810-x

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記述言語：英語   出版者・発行元：SPANDIDOS PUBL LTD  

Checkpoint with fork-head associated and ring finger (CHFR) is a mitotic checkpoint gene with tumor-suppressor functions. Previous studies have described the hypermethylation of the CpG island in the promoter region as a key mechanism involved in silencing tumor suppressor genes. The epigenetic alterations regulating CHFR expression and the clinical significance of CHFR downregulation remain unclear. A total of 40 patients with esophageal squamous cell carcinoma who underwent primary resection were enrolled in this study. CHFR mRNA expression was quantified, followed by an evaluation of the methylation status using methylation-specific polymerase chain reaction (MSP) techniques in 29 patients. The correlation between CHFR expression and MSP status was then analyzed. In addition, the significance of CHFR expression was determined, with respect to clinicopathological features and overall survival. Aberrant hypermethylation of the CHFR gene was observed in 13 of 29 primary esophageal cancers. The CHFR expression levels of the methylated status samples was significantly lower than that of the unmethylated status samples (P=0.014). CHFR expression levels did not exhibit clinical significance with respect to the patient characteristics or overall survival. Hypermethylation of the CHFR gene is a common event in the development of primary esophageal cancer. CpG island hypermethylation of the promoter region in the CHFR gene is a key mechanism involved in silencing the CHFR gene in patients with esophageal cancer.

DOI： 10.3892/ol.2013.1677

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記述言語：英語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：SPRINGER  

Adjuvant chemotherapy aims to eradicate micrometastatic tumor cells before and after curative surgery. Many Phase III trials have been conducted to study the efficacy of postoperative adjuvant chemotherapy; however, most trials have failed to show any survival benefit because of their low statistical power and/or poor patient compliance. Since 2000, two pivotal Phase III trials, the ACTS-GC and the CLASSIC, have demonstrated the efficacy of postoperative adjuvant chemotherapy following D2 gastrectomy. Although treatment with S-1 for 1 year or combination therapy with capecitabine and oxaliplatin for 6 months is effective, more intensive chemotherapy is necessary to further improve the survival rates. In Europe, two Phase III trials, the MAGIC and the FNCLCC/FFCD, have produced results that strongly suggest that neoadjuvant chemotherapy is beneficial. The advantages of neoadjuvant chemotherapy include a high rate of R0 resection, tumor regression, high compliance and the avoidance of unnecessary surgery. The disadvantage of neoadjuvant chemotherapy is over-diagnosis. In Japan, the Japan Clinical Oncology Group has conducted several clinical trials using neoadjuvant chemotherapy to target extensive nodal disease and/or scirrhous carcinomas. The optimal courses and regimens of neoadjuvant chemotherapy should, therefore, be clarified in the future.

DOI： 10.1007/s00595-013-0529-1

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記述言語：英語   掲載種別：書評論文，書評，文献紹介等   出版者・発行元：BIOMED CENTRAL LTD  

We report a case of perivascular epithelioid cell tumor arising in the rectum of a 55-year-old woman. The tumor was treated by transanal endoscopic microsurgery. After 1 year follow-up, the patient is alive with no radiologic or endoscopic evidence of recurrence. Perivascular epithelioid cell tumor is a rare mesenchymal tumor characterized by co-expression of melanocytic and smooth muscle markers. This rare tumor can arise in various organs, including the falciform ligament, uterus, uterine cervix, liver, kidney, lung, breast, cardiac septum, pancreas, prostate, thigh, and gastrointestinal tract. Perivascular epithelioid cell tumor of the gastrointestinal tract is very rare, with only 23 previously reported cases. We review the literature on perivascular epithelioid cell tumors arising in the gastrointestinal tract.

DOI： 10.1186/1477-7819-12-12

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記述言語：英語  

OBJECTIVE: The purpose of this study was to clarify the priority of nodal dissection in Siewert types II and III adenocarcinoma of the esophagogastric junction (AEG). METHODS: The priority of nodal dissection was evaluated based on the therapeutic value index calculated by multiplying of the frequency of metastasis to each station and the 5-year survival rate of patients with metastasis to that station. RESULTS: A total of 176 patients (95 type II and 81 type III) were examined. Among the lymph nodes that had a metastatic incidence exceeding 10 %, the stations showing the first to fourth highest index were the paracardial and lesser curvature nodes (Nos. 1, 2, and 3) and the node at the root of the left gastric artery (No. 7) in the total cohort, as well as in each type. The next station was the lower thoracic paraesophageal lymph node (No. 110), followed by the nodes along the proximal splenic artery (No. 11p) in type II, whereas it was the nodes along the proximal splenic artery (No. 11p) followed by the para-aortic nodes (No. 16a2), the nodes at the celiac artery (No. 9), and the nodes around the splenic hilum (No. 10) in type III. CONCLUSIONS: These results suggest that the highest priority nodal stations to be dissected were the paracardial and lesser curvature nodes (Nos. 1, 2, and 3) and the nodes at the root of the left gastric artery (No. 7), regardless of the Siewert subtype, but the subsequent priority was different depending on the subtype.

DOI： 10.1245/s10434-013-3036-0

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記述言語：英語   出版者・発行元：SPRINGER  

The trastuzumab for Gastric Cancer study newly defined tumors that were positive for human epidermal receptor-2 (Her-2) and created a Her-2-oriented treatment strategy that is also applicable in the adjuvant setting for stage 2/3 cancers. However, there is currently no information available on the rate of Her-2 positivity and the relapse-free survival (RFS) stratified by Her-2 status in stage 2/3 patients.
The Her-2 status, defined by the current standard method, was examined in 100 gastric cancer patients who underwent curative D2 surgery, who were pathologically diagnosed with stage 2/3 cancer, and received adjuvant S-1 chemotherapy between June 2002 and December 2011.
Ten of the 100 patients were Her-2 positive. Her-2-positive status was more frequently seen in tumors with a differentiated histology. The 5-year RFS rate was 56.3 % in Her-2-positive cases, and 48.8 % in Her-2 negative cases, which was not significantly different (P = 0.786).
The Her-2-positive rate for stage 2/3 gastric cancer patients was low, at only 10 %. Although the RFS was not significantly different based on the Her-2 status, the low positive rate made interpretation difficult. A multi-center study with a large sample size is necessary to clarify the prognostic impact of Her-2 in stage 2/3 gastric cancer patients.

DOI： 10.1007/s00595-013-0544-2

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記述言語：英語   出版者・発行元：WILEY-BLACKWELL  

PurposeSecreted protein acidic and rich in cysteine (SPARC) is one of the first known matricellular proteins that modulates interactions between cells and extracellular matrix. Recent studies investigated the clinical significance of SPARC gene expression in the development, progression, and metastasis of cancer. The present study examined the relations of the relative expression of the SPARC gene to clinicopathological factors and overall survival in patients with gastric cancer.
MethodsWe studied surgical specimens of cancer tissue and adjacent normal mucosa obtained from 227 patients with previously untreated gastric cancer. The relative expression levels of SPARC mRNA in cancer tissue and in adjacent normal mucosa were measured by quantitative real-time, reverse-transcription polymerase chain reaction.
ResultsThe relative expression level of the SPARC gene was higher in cancer tissue than in adjacent normal mucosa. High expression levels of the SPARC gene were related to serosal invasion (P=0.046). Overall survival at 5 years differed significantly between patients with high SPARC gene expression and those with low expression (P=0.006).
ConclusionsOverexpression of the SPARC gene may be a useful independent predictor of outcomes in patients with gastric cancer. J. Surg. Oncol. 2013; 108:364-368. (c) 2013 Wiley Periodicals, Inc.

DOI： 10.1002/jso.23425

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記述言語：日本語  

PURPOSE: The aim of this study was to clarify the human epidermal growth factor receptor 2( HER2) positivity, clinicopathological characteristics, and survival of patients with recurrent HER2-positive gastric cancer who received S-1 adjuvant chemotherapy. METHODS: Thirty-eight patients with recurrent gastric cancer who underwent curative D2 surgery and received S-1 adjuvant chemotherapy between June 2002 and December 2011 were examined. HER2 positivity was determined as defined in the ToGA study. RESULTS: The positivity score was assessed by immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) as follows: IHC 0 in 27 patients, IHC 1+in 4, IHC 2+/FISH-in 3, IHC 2+/FISH+in 1, and IHC 3+in 3. The HER2 positivity rate was 10.5% (4/38). HER2-positive recurrent gastric cancer was characterized by a differentiated histological feature and frequent blood vessel invasion. However, the recurrence and survival rates were not significantly different between the HER2-negative and HER2-positive tumors. CONCLUSIONS: The HER2 positivity rate after S-1 adjuvant chemotherapy did not differ significantly between patients with recurrent gastric cancer and those with primary Stage II/III gastric cancer, suggesting that S-1 adjuvant chemotherapy was equally effective, regardless of HER2 status.

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記述言語：日本語  

BACKGROUND: Eicosapentaenoic acid-enriched oral nutritional supplements (Prosure®; Abbott Japan, Tokyo, Japan) may attenuate surgical stress and catabolism after gastric cancer surgery. The present study aimed to evaluate the effects of Prosure® on body weight loss( BWL) and compliance with S-1 adjuvant chemotherapy after gastrectomy. PATIENTS AND METHODS: Patients who underwent curative total gastrectomy for gastric cancer were selected to undergo adjuvant S-1 chemotherapy at Kanagawa Cancer Center between December 2010 and October 2011. The patients received a normal postgastrectomy diet and two 240 mL packs of Prosure® for 21 postoperative days. BWL was defined as %BWL and calculated as %BWL=(preoperative body weight-1-month postoperative body weight)×100/preoperative body weight. Time to S-1 treatment failure was calculated. RESULTS: Five patients were enrolled in this study. The median age was 62.0 years. One patient was male, and 4 were female. The 1-month postoperative BWL was 92.1%. Compared to our previous report, a 20% risk reduction was observed in this study (Prosure® group vs control group, 92.1% vs 89.7%). Moreover, all the patients continued with the S-1 adjuvant chemotherapy for longer than 6 months. CONCLUSION: Prosure® may inhibit BWL at 1 month after gastrectomy. Moreover, Prosure® improved the patients' compliance with the adjuvant chemotherapy after gastrectomy.

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記述言語：日本語  

PURPOSE: The aim of this study was to evaluate the safety and feasibility of gastrectomy after neoadjuvant chemotherapy in patients with gastric cancer. PATIENTS AND METHODS: Forty-five patients received neoadjuvant chemotherapy and curative gastrectomy between December 2002 and May 2011. Surgical complications were evaluated according to the Clavien- Dindo classification. RESULT: The median age of the patients was 63 years. Twenty-three patients received a PTX and CDDP regimen, 20 received an S-1 and CDDP regimen, 1 received an S-1 regimen, and 1 received an CPT-11 and CDDP regimen as neoadjuvant chemotherapy. Distal gastrectomy was performed in 6 patients, and total gastrectomy was performed in 39 patients. The median operation time was 268 minutes, and the median blood loss was 249.5 mL. Complications more severe than grade 2 were observed in 10 patients: anatomic bleeding( grade 3a) was observed in 2 patients; abdominal abscess( grade 2), in 1 patient; and pancreatic fistula( grade 2), in 7 patients. No surgical mortality was observed. DISCUSSION: The results of our study suggest that gastrectomy after neoadjuvant chemotherapy for the treatment of patients with gastric cancer is safe and feasible.

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記述言語：日本語  

Owing to its less invasiveness, endoscopic stent placement is a potential treatment option for gastric cancer patients with gastric outlet obstruction( GOO). We compared the clinical outcomes of stent placement with gastrojejunostomy( GJ) bypass in terms of postoperative oral intake status, duration of oral intake, and overall survival. Thirty-eight patients who had unresectable gastric cancer with GOO were enrolled in this study. The stent placement group was divided into 2 subgroups: group P comprising 9 patients who received palliative treatment; and group A comprising 12 patients who received aggressive chemotherapy. Stent placement was performed for almost all the patients who had massive peritoneal metastasis and poor performance status. Improvement in oral intake was achieved in 19( 90.5%) of 21 patients after stent placement. Moreover, oral intake improved significantly in patients who underwent chemotherapy after stent placement. The median duration of oral intake and median overall survival was shorter in group P (1.8 and 2.8 months, respectively) and group A (3.2 and 4.8 months, respectively) than in group GJ( 11.8 and 12.7 months, respectively). In conclusion, endoscopic stent placement is effective in improving the oral intake status; however, it may be insufficient to improve the duration of oral intake. Thus, further studies are needed to clarify the clinical benefit of stent placement.

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記述言語：英語  

Laparoscopic esophagojejunostomy using a circular stapler is associated with technical difficulties in the purse-string sutures used to insert the anvil head and in obtaining an adequate visual field to prevent rolling the mesentery and the wall of the jejunum on the mesenteric side into the anastomosis. To overcome these difficulties, we used the EndoStitch to create the purse-string suture and the ENDOCAMELEON to create the visual field to stretch the jejunum. After resecting the esophagus, purse-string sutures were placed using the EndoStitch. A total of five to six needle deliveries were performed. Next, the anvil head was inserted into the esophagus. The main unit of the EEA was inserted from the end of the resected jejunum. Then, the scope was changed to the ENDOCAMELEON. The main unit was slowly moved toward the anvil head. After making sure that the mesentery and the wall of the jejunum on the mesenteric side were not rolled into the anastomosis under the visual field created by the ENDOCAMELEON, the main unit was then fired. Thereafter, esophagojejunostomy was successfully completed. This technique was applied in 20 patients between April 2010 and May 2012. Laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer was completed in all 20 patients. No case required conversion to open surgery. Neither anastomotic leakage nor stenosis was observed. This method is simple and useful for laparoscopic esophagojejunostomy after total gastrectomy for gastric cancer.

DOI： 10.1007/s10120-012-0211-0

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記述言語：英語   出版者・発行元：SPRINGER  

We report a case of gallbladder hernia into the lesser sac through the foramen of Winslow. The patient was a 90-year-old woman, admitted to hospital with obstructive jaundice. Computed tomography (CT) showed a left-deviated and remarkably enlarged gallbladder dragging the liver, and a dilated intrahepatic bile duct. The deviated gallbladder was thought to compress the common bile duct, causing the obstruction. Laparoscopic examination revealed gallbladder herniation into the lesser sac without a floating gallbladder; thus, we performed laparoscopic cholecystectomy. Herniation of the gallbladder is the rarest of all internal hernias and most reported cases have involved a floating gallbladder. The case we report here is therefore considered especially unusual.

DOI： 10.1007/s00595-012-0478-0

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We report a curative resection of a case with advanced gastric cancer responding remarkably well to combination chemotherapy of docetaxel, cisplatin and S-1. The patient was a 71-year-old man with gastric cancer of Borrmann type 3 accompanied with N3. Staging laparoscopy revealed peritoneal dissemination. He was administered docetaxel intravenously at 40 mg/m2 on day 1, cisplatin intravenously at 60 mg/m2 on day 1, and S-1 orally at 80 mg/m2 on days 1 to 14. This treatment was repeated every 28 days as one course. According to gastroscope and CT findings, a significant tumor reduction was obtained after 4 courses. After 6 courses, a CT scan revealed partial response of the lymph node metastasis, and the serum CEA value was normalized. Curative total gastrectomy was performed. The histological effect of the primary lesion was judged to be grade 2. Combination chemotherapy of S-1, cisplatin and docetaxel can be effective and feasible for advanced gastric cancer.

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記述言語：日本語  

We report a curative resection of a case with advanced gastric cancer responding remarkably well to combination chemotherapy of docetaxel, cisplatin and S-1. The patient was a 71-year-old man with gastric cancer of Borrmann type 3 accompanied with N3. Staging laparoscopy revealed peritoneal dissemination. He was administered docetaxel intravenously at 40mg/ m2 on day 1, cisplatin intravenously at 60 mg/m2 on day 1, and S-1 orally at 80 mg/m2 on days 1 to 14. This treatment was repeated every 28 days as one course. According to gastroscope and CT findings, a significant tumor reduction was obtained after 4 courses. After 6 courses, a CT scan revealed partial response of the lymph node metastasis, and the serum CEA value was normalized. Curative total gastrectomy was performed. The histological effect of the primary lesion was judged to be grade 2. Combination chemotherapy of S-1, cisplatin and docetaxel can be effective and feasible for advanced gastric cancer.

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記述言語：英語  

BACKGROUND AND OBJECTIVES: We clarified the impact of omentectomy for advanced gastric cancer on patient survival from the surgical results of a high-volume center in Japan. METHODS: Patients who received curative gastrectomy were divided into two groups based on whether they underwent omentectomy. The propensity score-matching method was used to assemble a well-balanced cohort, and relapse-free survival and the pattern of recurrence were compared. RESULTS: For this study, 330 patients who fulfilled the inclusion criteria participated and were divided into two groups: group R, patients who received omentectomy, and group P, patients who received omentum-preserving gastrectomy. After performing score-matching, 196 patients were selected. The 3- and 5-year relapse-free survival rates were 72.9% (95% confidence interval, 64.1-81.7) and 66.2% (56.6-75.8%) in group R, and 76.7% (67.9-81.2) and 67.3% (55.1-79.5) in group P, which were not significantly different (P = 0.750). Regarding sites of relapses, no differences were observed between the groups (P = 0.863). CONCLUSIONS: In this series, omentum-preserving gastrectomy for advanced gastric cancer did not increase the peritoneal relapse rate or affect patient survival compared to conventional gastrectomy. The non-inferiority of the omission of omentectomy should be evaluated by a randomized controlled trial.

DOI： 10.1007/s10120-012-0198-6

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記述言語：英語   出版者・発行元：INT COLLEGE OF SURGEONS  

Situs inversus totalis (SIT) is a congenital condition in which there is complete right to left reversal of the thoracic and abdominal organs. This report describes laparoscopy-assisted distal gastrectomy (LADG) for an early gastric cancer patient with SIT. The preoperative diagnosis was c-stage IA (cT1a cN0 cH0 cP0 cM0). LADG with D1+ dissection and Billroth-I reconstruction was successfully performed by standing at the opposite position. The operating time was 234 minutes and blood loss was 5 mL. Although a mechanical obstruction occurred after surgery, the patient recovered after reoperation with Roux-en-Y bypass.

DOI： 10.9738/INTSURG-D-13-00054.1

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記述言語：英語   出版者・発行元：ELSEVIER SCI LTD  

Background: We evaluated the methylation patterns of histone H3 lysine 27 (H3K27), H3 lysine 36 (H3K36) and the expression of H3K27 methylase EZH2 in patients with colorectal carcinomas with metachronous liver metastasis to search for biomarkers identifying these patients.
Methods: Double 2-mm core tissue microarrays were made from 54 paraffin-embedded samples of primary colorectal adenocarcinomas and corresponding liver metastases and examined using an immunohistochemical analysis of dimethylation and trimethylation in H3K27, H3K36 and EZH2. Positive tumor cell staining for each histone modification (H-score) was used to classify patients into low- and high-staining groups, which were then examined to identify any correlations between the clinicopathological parameters and the clinical outcomes.
Results: The H-scores of H3K27me2 were lower in the liver metastases than in the corresponding primary tumors, while the H-scores of H3K36me2 were higher in the liver metastases than in the corresponding primary tumors (P < 0.001). H3K27me2 in the primary tumors correlated with tumor size (P = 0.016), H3K36me2 in the primary tumors correlated with histological type (P = 0.038), and H3K36me3 in the primary tumors correlated with lymph node metastasis (P = 0.017). In addition, lower levels of H3K27me2 in the primary tumors correlated with poorer survival rates (P = 0.039). The multivariate survival analysis showed that the H3K27me2 status is an independent prognostic factor for colorectal cancer patients (P = 0.047).
Conclusions: Our findings suggest that the methylation level of H3K27me2 detected with immunohistochemistry may be an independent prognostic factor for metachronous liver metastasis of colorectal carcinomas. (C) 2013 Elsevier Ltd. All rights reserved.

DOI： 10.1016/j.ejso.2013.02.023

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記述言語：英語   出版者・発行元：SPRINGER  

Multidetector-row CT (MDCT) may provide accurate preoperative staging of resectable gastric cancer. However, the standard methods and criteria to diagnose the T and N stages to select the patients who are good candidates for neoadjuvant chemotherapy have not been established yet.
The aim of this prospective study was to evaluate the accuracy of MDCT to diagnose the serosal invasion and nodal metastases of gastric cancer. Patients who had gastric adenocarcinoma underwent MDCT scanning using a standardized method. The T and N stage were diagnosed by prespecified criteria. The analyses were performed in the patients who had cN0-2 and M0 tumors and underwent curative gastrectomy as a primary treatment. The accuracy was calculated by comparing the results of MDCT with the histopathological findings.
A total of 315 patients were analyzed. The overall diagnostic accuracy (95 % confidence interval) of T staging was 71.4 % (225 of 315, 66.2-76.1). The accuracy, sensitivity, and specificity for serosal invasion were 85.7 % (81.4-89.1), 54.5 % (42.6-66.0), and 94.0 % (90.3-96.3), respectively. The false-positive rate for serosal invasion was 6.0 % (2.9-7.7). The overall diagnostic accuracy of N staging was 75.9 % (239 of 315, 70.9-80.3). The accuracy, sensitivity, and specificity for nodal metastases were 81.3 % (76.6-85.2), 46.4 % (36.8-56.3), and 96.8 % (93.5-98.4), respectively. The false-positive rate for nodal metastases was 3.2 % (1.6-6.5 %).
These results suggest that MDCT provides an accurate diagnosis with high specificity and a low false-positive rate and can be used to select the patients who are candidates for preoperative chemotherapy.

DOI： 10.1245/s10434-012-2817-1

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記述言語：英語   出版者・発行元：SPRINGER  

Compliance of S-1 adjuvant chemotherapy is not high. The aim of the present study is to clarify risk factors for continuation of S-1 after gastrectomy.
This retrospective study selected patients who underwent curative D2 surgery for gastric cancer, were diagnosed with stage 2/3 disease, creatinine clearance more than 60 ml/min, and received adjuvant S-1 at our institution between June of 2002 and December of 2011. Time to S-1 treatment failure (TTF) was calculated.
A total of 103 patients were selected for the present study. When TTF curve stratified by each clinical factor was compared by the log-rank test, body weight loss (BWL) of 15 % was regarded as a critical point. Both univariate and multivariate Cox proportional hazard analyses demonstrated that BWL was the significant independent risk factor. Moreover, BWL remained a significant factor in both the univariate and multivariate analyses in the subset excluding 8 patients who discontinued S-1 because of recurrence. The 6-month continuation rate was 66.4 % in the patients with BWL < 15 and 36.4 % in patients with BWL a parts per thousand yen 15 % (P = .017).
BWL was the most important risk factor for the compliance of adjuvant chemotherapy with S-1 in the patients with stage 2/3 gastric cancer who underwent D2 gastrectomy. To improve drug compliance that leads to survival, it is a key to maintain body weight before starting S-1 adjuvant. Our study emphasizes the requirement for adequate studies of perioperative nutritional intervention in patients who receive gastrectomy for advanced gastric cancer.

DOI： 10.1245/s10434-012-2776-6

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記述言語：英語   出版者・発行元：SPRINGER  

The aim of this study is to clarify whether TNM-EC or TNM-GC is better for classifying patients with AEG types II/III.
The patients who had AEG types II/III and received D1 or more radical lymphadenectomy were selected. The patients were staged both by seventh edition of TNM-EC and TNM-GC. The distribution of the patients, the hazard ratio (HR) of each stage, and the separation of the survival were compared.
A total of 163 patients were enrolled in this study. TNM-EC and TNM-GC classified 25 (20 and 5) and 32 (20 and 12) patients to stage I (IA and IB), 15 (4 and 11), and 33 (11 and 22) to stage II (IIA and IIB), 88 (24, 3, and 61) and 63 (14, 26, and 23) to stage III (IIIA, IIIB, and IIIC), and 35 and 35 to stage IV, respectively. The distribution of the patients was substantially deviated to stage IIIC in TNM-EC but was almost even in TNM-GC. A stepwise increase of HR was observed in TNM-GC, but not in TNM-EC. The survival curves between stages II and III were significantly separated in TNM-GC (P = 0.019), but not in TNM-EC (P = 0.204). The 5-year survival rates of stages IIIA, IIIB, and IIIC were 69.0, 100, and 38.9 % in TNM-EC and were 52.0, 43.4, and 33.9 % in TNM-GC, respectively.
TNM-GC is better for classifying patients with AEG types II/III than TNM-EC is. These results could impact the next TNM revision for AEG.

DOI： 10.1245/s10434-012-2780-x

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記述言語：英語  

This randomized Phase II trial is being conducted to evaluate the impact of omentectomy for advanced gastric cancer on patient survival. The primary endpoint is the 3-year relapse-free survival rate and the secondary endpoints are 5-year overall survival, intraoperative blood loss, length of the operation and postoperative morbidity (especially postoperative ileus). The planned sample size is 250 patients (125 for complete removal of the omentum and 125 for preservation of the omentum) to determine whether omentum-preserving gastrectomy may be a candidate procedure for a Phase III trial in a randomized Phase II setting.

DOI： 10.1093/jjco/hys208

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記述言語：日本語  

Purpose: We assessed the usefulness of the estimation of physiologic ability and surgical stress (E-PASS) and the revised version of Hasegawa's dementia scale
revised (HDS-R) for predictive value in occurrence of postoperative delirium for elderly patients who had digestive surgical operations. Methods: Seventy-two patients assessed by HDS-R before operation were evaluated by E-PASS. We assessed the preoperative risk score (PRS) before the operation, and surgical stress score (SSS) and comprehensive risk score (CRS) were assessed after the operation. Results: Of all patients, 19.4% (14 patients) developed postoperative delirium. Patients with postoperative delirium were significantly older, with poorer PS (≥2), ASA score (≥3), lower PNI, lower HDS-R score, and higher CRS. Multivariate analysis identified HDS-R and CRS as independent predictors of the occurrence of postoperative delirium (OR 0.77 and 30.3, 95% CI 0.648-0.915 and 1.58-582, P=0.0031 and 0.0237). Of the patients whose HDSR score was 23 or less and CRS score of 0.35 or more, 83.3% developed postoperative delirium. Conclusion: HDSR and E-PASS could be helpful for the prediction of postoperative delirium. © 2013 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.2012.0133

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We report two cases of umbilical urachal remnant which were resolved by radical laparoscopic surgery. A 20-year-old woman (case 1) and an 18-year-old man (case 2) came to our hospital complaining of omphalitis. Enhanced CT showed omphalitis and umbilical urachal remnant. After drainage and antibiotic therapy, we performed laparoscopic surgery using three ports. We poured saline containing 2% indigo carmine into the bladder to visualize the connectiion between the bladder and the urachus, and cut the uracus using Endo GIA blue. We removed the umbilical urachal completely and reconstructed the navel. In both cases postoperative progress was good without any complications and the hospital stays were 5 days (case 1) and 3 days (case 2) after the operation. We believe that radical laparoscopic surgery for umbilical urachal remnant is less invasive and presents fewer difficulties than other methods, and is cosmetic.

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A 57-year-old woman underwent laparoscopic cholecystectomy in June 2006. She was discharged on postoperative day 4 with no complications. But she was rehospitalized on postoperative day 7 for right hypochondrial pain and fever. MRCP indicated the possibility of biliary injury, and emergency surgery was performed on postoperative day 7. A small split was found at the gallbladder fossa and bile was leaking from the split. A simple closure of the split was done and a C-tube was placed in the common bile duct. Bile leakage from the ducts of Luschka was detected by cholangiography from the C-tube on day 7 after closing the split. The leakage was no longer seen on day28 after the closure, and the patient was discharged on day 37 after the closure. The ducts of Luschka are small biliary ducts 1-2 mm in diameter, which usually originate in the right hepatic lobe. These ducts do not drain a particular region of the liver. Most commonly they drain into the right hepatic and common hepatic duct. So when the ducts of Luschka are injured, bile leakage occurs. Because of the limited field of vision, the limited tactile sensation, and the limits of the surgical operation, the frequency of bile duct injury in laparoscopic cholecystectomy is higher than in simple laparotomy cholecystectomy. Bile duct injury causes long-term hospitalization and can have unwanted sequelae. To prevent bile duct injury, it is necessary to master the operation and to take all necessary precautions.

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We report a rare case of perianal ulcer improved by appropriate treatment. A 73-year-old man was referred to our hospital because of an uncomfortable feeling in the anal region for the previous 6 months. He had a large ulcer extending 8cm behind the anus. Digital examination was normal. We diagnosed this as a perianal ulcer of unknown etioloogy. A biopsy showed inflammatory change. We performed a closure of the ulcer and construction of a stoma. After the operation, the ulcer was changed for the better. We performed anoplasty because of stenosis of the anus. The function of the anus was then restored, so we closed the stoma.

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Purpose: Invasive lobular carcinoma (ILC) is the second most common type of invasive breast cancer' but it is rare in Japan, and the clinicopathological features of ILC have remained unclear. We reviewed them in a single Japanese institute. Methods: The medical records of 551 patients with invasive breast cancer who underwent operation in our department between 1990 and 2008 were reviewed. The clinicopathological features of 21 patients with ILC, their disease-free survival (DFS),and overall survival (OS) were retrospectively investigated and compared with those of 530 patients with invasive ductal carcinoma (IDC). Results: ILC accounted for 3.4% of all invasive breast cancers. There were no differences between the patients with ILC and those with IDC regarding age at diagnosis, tumor size, lymph node involvement, and distant metastasis. ILC patients showed more frequent ER and PgR expression, and less frequent HER2 expression. DFS and OS of ILC patients were similar to those of IDC. Conclusions: The incidence of ILC was relatively low in Japan. There are several clinicopathological characteristics of ILC; however, the prognosis of ILC is not significantly different from that of IDC and thus no differences in the therapeutic management are considered to be necessary.

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Purpose: The usefulness of early oral feeding in operations on the lower digestive tract has been confirmed, but this remains uncertain for cases of the upper digestive tract. The aim of this study was to assess the safety and usefulness of early oral feeding in patients undergoing gastrectomy since 2007. Patients and Methods: We evaluated 219 patients undergoing distal gastrectomy (DG) or total gastrectomy (TG) for gastric cancer from January, 2003, to May, 2011. The number of distal gastrectomies was 146 and of total gastrectomies, 73, counting from July. 2007, for patients undergoing distal gastrectomy, and from August, 2008, for total gastrectomy, According to our schedule, on postoperative day (POD) 1, patients were allowed to drink only water. On POD 2 or 3, oral intake was started. The early oral feeding group comprised 101 patients, and the conventional group, 118. As perioperative results, we retrospectively compared extraneous factors (patient factors, surgical factors, and pathological factors), the occurrence rate of complications and their severity (Clavien-Dindo classification), Hb, Alb, rate of bodyweight change for evaluation of nutrition, peak CRP, and number of inpatient days. Results: No significant differences were noted in patient factors or pathological factors. Among the surgical factors, bleeding was significantly less in the ERAS group than in the conventional group (p<0.05). No significant difference was seen in the incidence of complications. Peak CRP and reduction of Alb one month after the operation were less in the ERAS group than in the conventional group (p<0.05). Conclusion: Early oral feeding after gastrectomy can be carried out safely, and we conclude that it helps to improve the nutritional status.

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記述言語：日本語  

BACKGROUND: Postoperative anastomotic hemorrhage is a relatively rare complication. However, when it does occur, immediate treatment is needed. METHODS: In all, 1,700 patients underwent curative gastrectomy between 2000 and 2010. Anastomotic hemorrhage was observed in 9 patients after surgery. The clinical course of these 9 patients was analyzed. RESULTS: The median age of the patients was 62 years, and all patients were men. Two patients underwent distal gastrectomy, 1 underwent laparoscopic distal gastrectomy, and 6 underwent total gastrectomy. Bleeding occurred as follows: 5 were at gastro- or esophagojejunostomic site, 2 were at gastroduodenostomic site, and 2 were at jejunojejunostomic site. Five patients received conservative treatment and 2 underwent re-operation. Two additional patients achieved complete hemostasis with endoscopic treatment. The patients who received endoscopic treatment were discharged earlier than those who received other treatments. CONCLUSIONS: Endoscopic intervention was useful for the diagnosis and treatment of postoperative anastomotic hemorrhage.

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記述言語：日本語  

We report a case of gastric small cell carcinoma with metastatic liver tumors responding to surgery and chemotherapy. The patient was a 67-year-old man with advanced gastric cancer, clinically diagnosed as P0H1M0CY0T3N1. He was registered in a phase III trial, and was scheduled to undergo gastrectomy and S-1 plus CDDP chemotherapy after surgery. He underwent D1 total gastrectomy and Roux-en-Y reconstruction. Small cell carcinoma of the stomach was diagnosed from the histopathological findings. After surgery, he received the following chemotherapy: 13 courses of CPT-11 plus CDDP chemotherapy, 2 courses of S-1, 5 courses of paclitaxel, and 6 courses of CPT-11. The patient is alive 22 months after his operation. We conclude that the combination of surgery and chemotherapy was effective for small cell carcinoma of the stomach, which was considered to have a poor prognosis.

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記述言語：日本語  

The patient was a 31-year-old man with advanced gastric cancer, clinically diagnosed as ML, Less, Type 3, sig, cT3, cN0, cH0, cP0, cM0, cCY0, cStage IIA. He underwent D2 distal gastrectomy. On microscopic examination, tumor cells were detected in the distal margin of the resected stomach. After surgery, he received 1 course of S-1 followed by chemoradiation therapy(1.8 Gy×25, a total of 45 Gy) with 90 mg/m2 of paclitaxel and 40 mg/m2 of CDDP on days 1, 15, and 29 over 5 weeks. Subsequently, he received 5 cycles of S-1 chemotherapy. To date, no recurrence has been observed 5 years after surgery. This sequential therapy is an option to consider for enabling local and systemic control after gastric cancer surgery.

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記述言語：日本語  

BACKGROUND: Body weight loss is a common outcome in patients with gastric cancer who have undergone gastrectomy. However, the rate of body weight loss after surgery is unknown. METHODS: In this retrospective study, we selected patients who underwent radical gastrectomy for gastric cancer and were diagnosed with Stage II or III disease. Further, we compared the body weight loss after surgery between patients in the surgery alone group and the S-1 adjuvant chemotherapy group. RESULTS: We evaluated 163 patients, of which 81 underwent only surgery, and 82 underwent surgery followed up with S-1 adjuvant chemotherapy. The body weight loss rate at 1, 3, and 6 months in the surgery alone group were 93.1%, 92.9%, and 94.9%, while those in the S-1 adjuvant group were 92.9%, 90.4%,and 91.9%, which was a significant difference. CONCLUSIONS: Body weight loss after gastrectomy was higher in the S-1 adjuvant group than in the surgery alone group. Further, nutritional support is required for these patients to maintain body weight after surgery.

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記述言語：日本語  

A 73-year-old asymptomatic woman was referred to our department because of an abnormal shadow on a chest Xray film. Computed tomography showed a giant solid tumor in the left side of the thoracic cavity and a solid tumor in the stomach. Endoscopic ultrasonography showed that both tumors were connected to the 4th layer of the mucosa. The esophageal tumor was diagnosed by fine-needle aspiration biopsy as esophageal gastrointestinal stromal tumor (GIST). Surgery was performed on a diagnosis of esophageal GIST with gastric gastrointestinal mesenchymal tumor. The esophageal tumor measured 130 mm, and the gastric tumor measured 42 mm. Both tumors were positive for c-KIT. Esophageal GIST and gastric GIST were therefore diagnosed. The esophageal GIST was apparently associated with high-grade malignancy, and gene analysis revealed a mutation in exon11. Postoperative treatment with imatinib was begun, but had to be discontinued because of adverse reactions. The patient visits our hospital every 4 months, and as of 2 years and 3 months after surgery there has been no evidence of recurrence. © 2012 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.45.905

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The patient was a thirty-year-old female. She was diagnosed with left cervical tuberculous lymphadenitis and treated with antituberculous agents for one month, but the lymphadenitis got worse and formed an esophagocutaneous fistula. She was admitted to our hospital in March, 2010. We did drainage and lavage of a fistula and an abcess. Endoscopy and X-ray examination revealed a deep ulcer and a fistula on the left wall of the esophagus. She was administered enteral nutrition and antituberculous agents through a nasogastric tube without oral intake. After two months of conservative therapy, the fistula remained unchanged. Therefore, endoscopic clipping of the fistula was performed. Endoscopy and X-ray examination on the seventh day showed that the fistula was successfully closed. The patient started drinking and eating. Two months after the clipping, the nasogastric tube was removed. Follow-up examinations did not show any esophagocutaneous fistula recurrence. Nine months after the clipping, we stopped the antituberculous agents for her. Endoscopic clipping for esophagocutaneous fistula caused by tuberculous lymphadenitis can shorten the period of fistula closure.

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Back ground/Aimes: The use of adjuvant chemotherapy remains controversial in stage II colon cancer, but some patients at high risk for tumor recurrence are thought to benefit. The aim of this study was to identify clinicopathological features associated with poor outcomes in stage II colon cancer and to define the subgroup of patients at greatest risk. Methodology: From January 1990 through December 2004, a total of 272 patients with stage II colon cancer received curative resection at Kanagawa Cancer Center. The median follow up was 63.3 months. Results: The 5-year disease-free survival was 89.2% in the study group as a whole. Multivariate analysis identified two independent factors that were significantly related to disease-free survival: T4 lesions (p = 0.013) and lymphatic invasion (p = 0.007). The 5-year disease-free survival differed significantly among patients with neither of these poor prognostic factors (94.9%), those with only 1 factor (90.4%), and those with 2 factors (71%, p = 0.0001). Conclusion: Patients with stage II colon cancer who have both T4 lesions and lymphatic invasion are at high risk for recurrence. The use of adjuvant chemotherapy should be considered in this subgroup of patients.

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At Yokohama City U. hospital, following published guidlines for the treatment of acute cholangitis and cholecystitis, we perform early laparoscopic cholecystectomy (LC) for acute cholecystitis. We examined 32 patients who had undergone LC for acute cholecystitis from July 2006 to September 2009. We examined the following parameters: age, gender, time from onset of symptoms to the operation, operation time, blood loss, and postoperative hospital stay. There were 18 patients in the early LC group (Group E, within 72 hours from onset to the operation) and 14 patients in the late LC group (Group L, over 72 hours from onset to the operation). A statistically significant increase in group E was noted in the operation time (p = 0.024). No significant difference was noted in age, gender, blood loss, or post-operative hospital stay. We also classified these 32 cases into severe cases (19), intermediate cases (5), and mild cases (8). The severe cases had significant increase in the time from onset to the operation (p = 0.003) and in the operation time (p = 0.045). Postoperative complications were injury of the cystic duct and intraabodminal abscess. Both cases were in Group L, severe cases. Surgical outcomes of early LC in our institution for acute cholecystectomy were favorable, especially in Group E. The operation in Group L and in severe cases was difficult, so we must deal carefully with such cases.

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According to the guidelines of the Japanese Society of Gastroenterology, when the diagnosis of gastroesophageal reflux disease (GERD) is objectively confirmed, surgical therapy should be considered in individuals for whom medical management has failed. A large body of literature on the laparoscopic surgical treatment of GERD exists. The majority of published studies have demonstrated lower dysphagia rates after Toupet fundoplication and no difference in heartburn control between the Toupet and Nissen procedures at follow up. On the basis of these reports, we selected Toupet fundoplication. This case was a 65-year-old male who complained of heartburn and was diagnosed as having GERD 4years previously, but medical management failed. The postoperative course was uneventful. After Toupet fundoplication, he had no complications of GERD without proton pump inhibitor.

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記述言語：英語   出版者・発行元：LIPPINCOTT WILLIAMS & WILKINS  

DOI： 10.1097/JTO.0b013e3181fb5100

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記述言語：英語  

Background: We developed a skin-level jejunostomy tube (SLJT) procedure for patients undergoing esophagectomy using a skin-level gastrostomy tube (G-tube) (Entristar™; Tyco Healthcare, Mansfield, Mass), in order to improve their nutrition status and quality of life (QOL). We describe the procedure and the adverse effects of SLJT in patients with esophageal cancer (EC).Methods: Over a 24-month period (March 2008 to March 2010), there were 16 patients (mean age: 61.8 years; age range: 49-75 years; 15 men, 1 woman) who had Stage II or III EC. Primary jejunostomy was performed under general anesthesia during esophagectomy. The technical success and the immediate and delayed complications of the procedure were recorded.Jejunostomy techniques: SLJT placement using the G-tube (20Fr) was performed 20 cm from the Treitz ligament on the side opposing the jejunal mesenterium. The internal retention bolster was exteriorized through an incision in the abdominal wall. A single purse string suture using a 4-0 absorbable suture was performed. The internal retention bolster was then inserted into the jejunal lumen via the small incision. The intestine adjacent to the tube was anchored to the peritoneum using a single stitch.Results: The SLJT was successfully inserted in all 16 patients. No early complications were documented. Follow-up for a median of 107 days (range, 26-320 days) revealed leakage to the skin in four patients, including superficial wound infections in two patients. There were no cases of obstruction of the tube or procedure-related death.Conclusions: This SLJT placement technique using the G-tube is a safe procedure in patients with EC and allows the creation of a long-term feeding jejunostomy. © 2011 Rino et al; licensee BioMed Central Ltd.

DOI： 10.1186/1471-230X-11-8

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

We report a case of small-cell carcinoma (SCC) of the gastric tube, which is rare. A 67-year-old man underwent subtotal esophagectomy and retromediastinal reconstruction using a gastric tube for moderately differentiated esophageal carcinoma (depth sm, NO, MO, stage I) in October 1995. Six years and 9 months after esophagectomy, endoscopy showed a type 2 gastric tube tumor and biopsy showed poorly differentiated adenocarcinoma, necessitating total gastric tube resection. Chromogranin A, NCAM and synaptophysin were positive in immunohistology, yielding a final diagnosis of small-cell gastric tube carcinoma. Despite chemotheraphy for liver metastasis, the man died of hepatic failure 11 months after gastric tube resection. Only one case of gastric tube SCC has been reported in Japan to our knowledge. © 2011 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.44.23

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Since we introduced laparoscopy-assisted gastrectomy (LAG) for early gastric cancer in 2000, and 102 cases were performed in this decade. The purpose of this study was to assess the feasibility of LAG for early gastric cancer. Laparoscopy-assisted distal gastrectomy (LADG) was performed in 72 cases of the 102 cases. Blood loss, operating time, mortality, morbidity, number of lymph nodes retrieved and postoperative hospital stays were recorded for this study. The learning curve was assessed by correlating the number of cases with blood loss or operating time. Negative correlations were shown, and we speculated that a stable procedure was obtained in about 30 cases. After achieving a stable procedure, the median operating time in LADG was 338 minutes, blood loss was 121ml, and the number of lymph nodes retrieved was 28. Compared with open distal gastrectomy (ODG), LADG needed more operating time, bud caused less blood loss. The median postoperative hospital stay was 9 days, and the incidence of complications was 2 cases, 4. 5 percent. There was no case of needing to convert to laparotomy. No recurrence was observed. LADG could be performed safely in our institute. LADG is a time-consuming procedure but is less invasive than laparotomy.

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Fifty three patients under 40 years old with gastric cancer in patients were clinicopathologically evaluated in comparison with 795 middle-aged (40-75 years old) patients and 128 elderly aged (older than 75) patients between January 1976 and December 2000. The incidence of gastric cancer in the young patient group was 5.4% of all patients and the proportion of females was relatively higher in this group. There was significant difference in cancer location, macroscopic and histological type, and peritoneal dissemination detected during operation. However, no significant difference was seen in depth of invasion, degree of nodal metastasis, stage or conclusive curability. Although gastric cancer in all stages with curative resection showed favorable prognosis for the young groups compared with the other groups, no intergroup difference was noted for advanced cases or cases with poorly differentiated histology. Consequently an extended radical operation and chemotherapy would be necessary to obtain more favorable clinical outcomes in advanced cases in the young, because they have fewer coexisting disorders.

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記述言語：英語   出版者・発行元：SPRINGER  

Paraneoplastic neurological syndromes (PNSs) are a heterogeneous group of neurological disorders caused by immune-mediated mechanisms. The incidence of PNS is much less than 1% for solid tumors, except for small-cell lung cancer and thymoma. We report a rare case of gastric cancer that presented with primary clinical findings of PNS. The patient was a 63-year-old woman who was admitted for worsening neuropathy. Laboratory and neurological tests excluded a nutritional deficit, diabetes mellitus, and connective tissue disease as causes of her neuropathy. Computed tomography (CT) of the abdomen, positron emission tomography (PET)-CT, and endoscopy of the stomach revealed gastric cancer with lymph node swelling. Distal gastrectomy was performed and pathological and immunohistochemical examinations indicated endocrine cell carcinoma. The gastrectomy stopped the exacerbation of her symptoms and recurrence was not observed, but the neurological disorders were irreversible. This case suggests that early diagnosis of the primary tumor is required to improve the outcome in patients with PNS.

DOI： 10.1007/s10120-010-0563-2

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Purpose: As a project of the Kanagawa Colorectal Cancer Study Group, we performed this study to analyze the efficacy and the safety of modified FOLFIRI (irinotecan: 150 mg/m2) therapy for Japanese patients with metastatic colorectal cancer. Patients and Methods : We treated PS 0-1 Japanese patients with measurable or assessable colorectal cancer who either had not received preliminary treatment, or were postoperative with metastasis and had undergone radiation therapy or adjuvant chemotherapy before more than four weeks, and further had provided written acceptance of our proposed procedures. Twenty patients received modified FOLFIRI therapy as a 2-hour infusion of CPT-11 150 mg/m2 and I-LV 200 mg/m2 followed by a bolus 5-FU 400 mg/m2 and 46-hour infusion 5-FU 2, 400 mg/m2. Tumor response was assessed by RECIST and toxicity by NCI-CTC. Results : Thirty males and seven females underwent an average 10 courses of treatment. This therapy achieved a 50% response rate, 80% disease-control rate, and 316±40days PHS. Regarding hematological toxicity, 11 patients (55%) experienced leukemia, which developed to grade 3/4 in 5 (25%) of them. Twelve patients (65%) experienced neutropenia, which developed to grade 3/4 in 10 (50%) of them. Digestive toxicity was observed in 16 patients (80%), which developed to grade 3/4 in only one patient (5%) with gastric ulcer. Six patients (30%) experienced alopecia, which was grade 1/2 only. Conclusion : This clinical study was safely carried out. The efficacy was as good as in previous reports using a regular dose of CPT-11.

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

Purpose: As a project of the Kanagawa Colorectal Cancer Study Group, we performed this study to analyze the efficacy and the safety of modified FOLFIRI (irinotecan: 150 mg/m2) therapy for Japanese patients with metastatic colorectal cancer. Patients and Methods : We treated PS 0-1 Japanese patients with measurable or assessable colorectal cancer who either had not received preliminary treatment, or were postoperative with metastasis and had undergone radiation therapy or adjuvant chemotherapy before more than four weeks, and further had provided written acceptance of our proposed procedures. Twenty patients received modified FOLFIRI therapy as a 2-hour infusion of CPT-11 150 mg/m2 and I-LV 200 mg/m2 followed by a bolus 5-FU 400 mg/m2 and 46-hour infusion 5-FU 2, 400 mg/m2. Tumor response was assessed by RECIST and toxicity by NCI-CTC. Results : Thirty males and seven females underwent an average 10 courses of treatment. This therapy achieved a 50% response rate, 80% disease-control rate, and 316±40days PHS. Regarding hematological toxicity, 11 patients (55%) experienced leukemia, which developed to grade 3/4 in 5 (25%) of them. Twelve patients (65%) experienced neutropenia, which developed to grade 3/4 in 10 (50%) of them. Digestive toxicity was observed in 16 patients (80%), which developed to grade 3/4 in only one patient (5%) with gastric ulcer. Six patients (30%) experienced alopecia, which was grade 1/2 only. Conclusion : This clinical study was safely carried out. The efficacy was as good as in previous reports using a regular dose of CPT-11.

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記述言語：英語   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: We investigated whether or not there are cancer cells in the blue node (BN) and the sentinel lymphaticus (SL), which is detected using sentinel node biopsy (SNB).
Methodology: Patent blue (1%) is injected submucosally into 4 to 5 different sites at 1mL per site around the primary tumor. Blue-stained lymphatics and lymph nodes can be seen by turning over the greater omentum and lesser omentum extraperitoneally. If blue nodes or lymphaticus are found, biopsy is performed at this point. The study was conducted in 14 patients (11 males and 3 females, mean age 65.7 y/o) with a preoperative diagnosis of T1 tumor invasion and NO that there is no lymph node metastasis. Informed consent was obtained from the patients for SNB after patent blue staining and investigation of CEAmRNA and CK20mRNA.
Results: Of the 14 patients in whom BN and SL were identified, 1 (7.1%) had positive CEAmRNA and positive CK20mRNA of SL.
Conclusion: Our present study shows the possibility for the existence of cancer cells in the lymphaticus from the tumor to BN. We should avoid the cut of lymphaticus when we perform gastrectomy.

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記述言語：英語   出版者・発行元：SPRINGER TOKYO  

In this report, we describe our traction suture technique of the pericardium for suspension of the heart without hemodynamic instability to obtain excellent exposure in the abdominal-transhiatal approach (TH). Our technique is an application of deep pericardium stitches for off-pump coronary artery bypass surgery. In detail, the left hepatic lobe is detached at its triangular ligament from the diaphragm and is deflected to the right. Then, the tendinous portion of the diaphragm arching over the esophagus is incised upward in the midline until the pericardium is exposed. Pericardial fatty tissue was dissected. Three U-shaped sutures reinforced with a felt pledget are placed on the posterior aspect of the pericardium and diaphragm. A 15 Fr. flexible catheter is placed over both ends of the suture to avoid damage of the adjacent organs. Finally, the sutures are fixed to the drape of anterior wall of the patient to maintain good exposure.

DOI： 10.1007/s10388-009-0215-y

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Background: We have previousy reported on a Phase II study of S-1 monotherapy as a first line, combination therapy of S-1 plus cisplatin as a second line, and weekly paclitaxel monotherapy as a third line therapy in patients with advanced gastric carcinomas. The median survival time (MST) of patients over the whole course of treatment was not previously calculated because 12 out of 19 patients had not yet succumbed. Since then, we have calculated the MST for this study and herein report our findings. Patients and Methods: Between 2002 and 2005, 19 patients were enrolled in this study. Chemotherapy consisted of either 60 mg/m2 of S-1 for 4 weeks at 6-week intervals, a combination of 60 mg/m2 S-1 for 3 weeks and 60 mg/m2 cisplatin on day 8 at 5-week intervals, or 60 mg/m2 paclitaxel at days 1, 8, and 15, at 4-week intervals. The regimens were repeated until the occurrence of unacceptable toxicities, disease progression, or patient noncompliance. The primary end point was the overall survival. Results: The median survival time was 774 days. The response rates were 33.3% (3/9), 12.5% (1/8), and 0% (0/4) after the first, second, and third line chemotherapies, respectively. The major adverse hematological toxicity was leukopenia, which reached grades 3-4 in all lines of chemotherapy investigated. In addition, the major adverse non-hematological toxicity was anorexia, which reached grade 3-4 in second line chemotherapy, and no deaths were attributable to the adverse effects of the drugs. Conclusion: This sequential therapy was an effective treatment for advanced gastric cancer with acceptable toxic side-effects. We considered this therapy to be effective because of the smooth transition to the next regimen. © the author(s), publisher and licensee Libertas Academica Ltd.

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

Both gastric cancer recurrence over 10 years after initial surgery and umbilical metastasis known as Sister Mary Joseph's nodule are rare. We report an unusual case of umbilical gastric cancer metastasis over 10 years after surgery. A 50-year-old woman who underwent total gastrectomy (curativity B) in June 1996 was diagnosed postoperatively as pathological StagelllA (poorly differentiated adenocarcinoma (por2), T3 (SE), Nl, HO, P0, MO). Adjuvant chemotherapy with UFT was administered for five years without evident recurrence. After reporting left back pain and an umbilical tumor in August 2006, she was found in computed tomography (CT) to have left hydronephrosis and a 1.2cm umbilical tumor. Based on the diagnosis of peritoneal dissemination and umbilical gastric cancer metastasis, she was treated with TS-1 and cisplatin (CDDP) combined chemotherapy. Hydronephrosis disappeared after one course, but the umbilical tumor grew and paclitaxel was ineffective. The woman died in September 2001. © 2010 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.43.1218

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The purpose of the present study was to clarify the risk factors of failure of the clinical pathway for colon cancer. A total of 255 patients were evaluated in this study. We examined the relation to failure of clinical pathway of the factors of preoperation, intraoperation and postoperation. In these patients, the clinical pathway failed in 36(14.1%) patients developed to failure of clinical pathway. Multivariate analysis identified a body temperature of 37. 5°C or higher on 4 days after operation as an independent risk factor of failure of the clinical pathway. In conclusion, this risk factor should be considered as a critical indicator of failure of the clinical pathway.

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記述言語：英語   出版者・発行元：SPRINGER  

Risk factors and treatment strategy in younger patients with papillary thyroid carcinoma are still controversial.
We reviewed 120 consecutive papillary thyroid carcinoma patients younger than 20 years who underwent initial surgery between 1977 and 2004 (14 male and 106 female subjects; mean age, 16.3 years; mean follow-up, 11.6 years). Outcomes were evaluated initially, and risk factors for disease-free survival (DFS) were analyzed statistically. Cox proportional multivariate analysis revealed that initial nodal manifestation (P < .001, hazard ratio 2.97) was the most statistically significant risk factor for DFS. The outcomes were then compared between four subgroups on the basis of the initial nodal manifestation and node dissection: 17 patients in group A (no lymphadenopathy, no or only prophylactic central dissection), 30 patients in group B (no lymphadenopathy, prophylactic modified neck dissection, MND), 46 patients in group C (nonpalpable lymphadenopathy detected by radiological or operative findings, therapeutic MND), and 27 patients in group D (palpable lymphadenopathy, therapeutic MND).
Subtotal/total thyroidectomy and radioactive iodine therapy were performed for 47.1 and 0% in group A, 33.3 and 0% in group B, 43.4 and 10.9% in group C, and 85.1 and 48.1% in group D, respectively. In groups A, B, C, and D, 0%, 3.3%, 28.3%, and 48.1% developed recurrence, respectively (P < .001). DFS Kaplan-Meier curves differed significantly among the four subgroups (P < .0005).
Initial nodal manifestation is useful to predict DFS in younger papillary thyroid carcinoma patients. Our findings will be beneficial to determine the treatment strategy. Conservative therapy is considered acceptable for patients without risk factors.

DOI： 10.1245/s10434-009-0673-4

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記述言語：英語   出版者・発行元：BIOMED CENTRAL LTD  

Herein, we report two extremely rare cases of differentiated thyroid carcinoma (DTC) with extended tumor thrombus or mediastinum lymph node metastasis (LNM) involving the superior vena cava (SVC), causing SVC syndrome. Both of these patients were successfully treated with radical resection and reconstruction of the SVC using autologous tissue instead of an expanded polytetrafluoroethylene (ePTFE) graft. The left brachiocephalic vein was used to reconstruct the SVC in a papillary thyroid carcinoma patient with mediastinum LNM and a pericardial patch was used in a follicular thyroid carcinoma patient with tumor thrombus. Our search of the English-language literature found sporadic reports of SVC resection with reconstruction by vascular graft (ePTFE), interposed between the brachiocephalic vein and the right atrium. However, SVC reconstruction using autologous tissue in thyroid carcinoma has not been reported to date. To our knowledge, this is the first report describing such an unusual technique in DTC patients.

DOI： 10.1186/1477-7819-7-75

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記述言語：英語   出版者・発行元：The Japanese Society for Lymphoreticular Tissue Research  

There are several reports describing [18F] fluorodeoxyglucose positron emission tomography (FDG-PET) findings in patients with lymphomatoid granulomatosis (LYG). We report a case of grade I LYG that showed increased uptake of FDG. The patient was a 63-year-old Japanese male who underwent an FDG-PET/computed tomography (CT) scan in screening for a malignant lesion. Increased uptake of FDG [maximum standard uptake value (SUV(max)), 3.7] was observed in the right hilar region in FDG-PET and enhanced CT revealed a round, abnormal mass that also showed increased FDG uptake. The patient had no previous symptoms. A tumor biopsy was performed and the histological diagnosis was grade I LYG. Therefore, increased SUV(max) in FDG-PET might be useful for diagnosing of LYG.

DOI： 10.3960/jslrt.49.39

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記述言語：英語  

Introduction. The distant metastases from differentiated thyroid carcinomas are often untreatable. In particular, bone metastasis is significantly related to poor prognosis since radioactive iodine therapy is generally less effective. Therefore, surgical resection is considered one of the treatments for patients with bone metastases. We report chest wall resection and reconstruction using titanium micromesh covered with polypropylene mesh (Marlex mesh) for metastatic rib bones as a result of follicular thyroid carcinoma. Case presentation. A 51-year-old man was referred to our institution with a painful chest wall tumor. He presented with a 15 × 10 cm bony swelling on the left chest wall and multiple small lung nodules from follicular thyroid carcinoma. Completion total thyroidectomy, chest wall resection and reconstruction using titanium micromesh covered with Marlex mesh were performed. There were no critical complications associated with surgical treatments and tumor pain disappeared during the postoperative period. Then, he received radioactive iodine therapy and the uptake of radioactive iodine was well observed in bilateral lung fields. Conclusion. Reconstruction using titanium micromesh covered with Marlex mesh is possible for repairing the wide chest wall resection required for thyroid carcinoma metastasis. This technique would help to enhance treatment efficacy in the combination therapy of radioactive iodine and surgery in patients with large thyroid carcinoma metastasis in the chest wall. © 2009 licensee BioMed Central Ltd.

DOI： 10.4076/1752-1947-3-7259

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記述言語：日本語  

In May in 2006, a 48-year-old man admitted to our hospital for the treatment of tuberculosis and AIDS. Three weeks before the admission, he had been undergone emergency ileo-cecal resection due to the tubercular perforations of ileum and peritonitis. The double stomas of jejunum and ascending colon had made and been separated each other. When oral intake was started, a lot of intestinal juice was discharged from the stoma Because of low level of white blood cell, the anastomosis between jejunum and ascending colon was suspended for a while. In March in 2007, magnetic compression anastomosis using Yamanouchi's method was performed for care of the dehydration and renal function due to a lot of jeunal juice discharge. With radiography, two magnets were placed in the jeunum and ascending colon through the stomas severally, and attached the walls of the intestines. Eight days after the maneuver, the anastomosis was completed without complication. Two months later, with general anestasia, the stomas were closed.

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

We report a rare case of gastrointestinal stromal tumor (GIST) arising from cecal intussusception. A 61-year-old man admitted for abdominal pain and a jelly-like stool was found in ultrasonography and computed tomography to have intussusception caused by a protruding tumor of the right colon. Colonoscopy showed a hard spherical mass with erosion in the cecum. Benign tissue found in a tumor biopsy necessitated laparoscopy-assisted iliocecal resection. Histopathologically, H&amp
E staining showed fascicular proliferation of spindle cells that, together with positive immunological staining for c-kit and CD34, yielded a diagnosis of uncommitted GIST. © 2009 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.42.100

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

In May 2006, a 79-year-old man underwent left colectomy and D2 lymphadenectomy for descending colon cancer (fStage II, Cur A). No adjuvant chemotherapy was done. Eighteen months after surgery, the serum tumor marker level was increased (CA19-9 526 U/mL), and multiple liver metastases (H2) and peritoneal dissemination were detected using abdominal CT. He was treated with S-1 plus CPT-11 therapy, because mFOLFOX6 as a standard chemotherapy for advanced colorectal cancer was rejected. After 4 courses, tumor markers normalized and abdominal CT revealed a partial response. At present, progression-free survival (PFS) is 240 days. In our case, this regimen was found to be convenient and safe in an outpatient compared with FOLFIRI and FOLFOX. This case suggested that S-1 plus CPT-11 therapy could well be a promising systemic chemotherapy for patients with advanced colorectal cancer.

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

In May 2006, a 79-year-old man underwent left colectomy and D2 lymphadenectomy for descending colon cancer (fStage II, Cur A). No adjuvant chemotherapy was done. Eighteen months after surgery, the serum tumor marker level was increased (CA19-9 526 U/mL), and multiple liver metastases (H2) and peritoneal dissemination were detected using abdominal CT. He was treated with S-1 plus CPT-11 therapy, because mFOLFOX6 as a standard chemotherapy for advanced colorectal cancer was rejected. After 4 courses, tumor markers normalized and abdominal CT revealed a partial response. At present, progression-free survival (PFS) is 240 days. In our case, this regimen was found to be convenient and safe in an outpatient compared with FOLFIRI and FOLFOX. This case suggested that S-1 plus CPT-11 therapy could well be a promising systemic chemotherapy for patients with advanced colorectal cancer.

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

S-1/CDDP combination chemotherapy is conducted in many institutions, but most patients are hospitalized at the time of CDDP administration. We performed S-1/CDDP combination chemotherapy in 15 patients with advanced gastric cancer, and CDDP was administered in the outpatient department for 8 outpatients out of the 15 patients without renal failure or dysfunction. If outpatient chemotherapy can safely perform a regimen based on evidence, it brings about improvement in the QOL of the patient, and there are considerable advantages for economical care delivery. S-1/CDDP combination chemotherapy for outpatients was regarded as feasibile with appropriate patient guidance.

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記述言語：日本語   出版者・発行元：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

S-1/CDDP combination chemotherapy is conducted in many institutions, but most patients are hospitalized at the time of CDDP administration. We performed S-1/CDDP combination chemotherapy in 15 patients with advanced gastric cancer, and CDDP was administered in the outpatient department for 8 outpatients out of the 15 patients without renal failure or dysfunction. If outpatient chemotherapy can safely perform a regimen based on evidence, it brings about improvement in the QOL of the patient, and there are considerable advantages for economical care delivery. S-1/CDDP combination chemotherapy for outpatients was regarded as feasibile with appropriate patient guidance.

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記述言語：日本語  

In May in 2006, a 48-year-old man admitted to our hospital for the treatment of tuberculosis and AIDS. Three weeks before the admission, he had been undergone emergency ileo-cecal resection due to the tubercular perforations of ileum and peritonitis. The double stomas of jejunum and ascending colon had made and been separated each other. When oral intake was started, a lot of intestinal juice was discharged from the stoma Because of low level of white blood cell, the anastomosis between jejunum and ascending colon was suspended for a while. In March in 2007, magnetic compression anastomosis using Yamanouchi's method was performed for care of the dehydration and renal function due to a lot of jeunal juice discharge. With radiography, two magnets were placed in the jeunum and ascending colon through the stomas severally, and attached the walls of the intestines. Eight days after the maneuver, the anastomosis was completed without complication. Two months later, with general anestasia, the stomas were closed.

DOI： 10.11405/nisshoshi.106.85

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Pancreatic metastasis from renal cell carcinoma is rare. We report here a case of pancreas tail metastases of renal cell carcinoma with a discussion of the literature. A 53-year-old Japanese man had undergone right radical nephrectomy because of renal cell carcinoma (clear cell type, T2, N0, M0, V1a) in 1995. In 2003, lung metastases were detected by computed tomography (CT) in segments 3 and 6 of the right lung. In 2006, CT showed slightly enlarging lung metastasis in S3 and a new lesion located at the splenic hilum. We diagnosed lymph node metastasis at the splenic hilum. Pancreas tail resection and splenectomy were performed in September, 2006. Another tumor was detected in the pancreas tail intraoperatively. Pathological examination revealed that both tumors were pancreas metastases of renal cell carcinoma. Our patient is still alive with stable lung metastases and has had no other recurrence for 24 months after the operation.

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記述言語：日本語   出版者・発行元：一般財団法人 日本消化器病学会  

An 83-year-old man was admitted to our hospital with jaundice. At the age of 79, he had undergone distal gastrectomy with Roux-Y reconstruction and cholecystectomy due to early gastric cancer and gall bladder carcinoma. CT and MRI revealed severe dilatation from the common bile duct (CBD) to the intra-hepatic bile duct. Blood tests showed high serum levels of bilirubin and CA19-9. Cytology of the bile juice was Class V. Percutaneous transhepatic bile duct drainage was performed. Curative surgical resection was not indicated due to his age and general condition. Neither percutaneous nor endscopical fistulization were successful. Finally magnetic compression anastomosis was performed. Under general anesthesia, the first magnet was placed in the CBD through a cutaneous fistula. The second one was placed in the duodenum through the jejunum. The two magnets attached the walls of the CBD and duodenum. Three weeks after the maneuver, the anastomosis was completed with only a slight fever.

DOI： 10.11405/nisshoshi.105.1523

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An 80-year-old man with no history of thoracic radiotherapy nor interstitial pneumonia was administered S-1 for gastric cancer in June 2007. Twenty-two days after starting S-1, he had dyspnea, and X-rays showed reticular shadows in both lung fields, yielding a diagnosis of interstitial pneumonia. Drug lymphocyte stimulating test (DLST) was positive against S-1. The total dose of S-1 was 2,200 mg to the symptom onset. We immediately started steroid pulse therapy after emergency hospitalization, and it revealed improved condition and he was able to leave the hospital. S-1 administration is becoming frequent because RCTs supported the efficacy of S-1 for gastric cancer. Interstitial pneumonia as a side effect of S-1 is not frequent, but it is necessary to pay attention to dyspnea throughout the duration of administration.

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記述言語：英語   出版者・発行元：SPRINGER  

Adrenocortical carcinoma (ACC) in childhood is rare: in 2002, only three new cases were reported in Japan. Although there is no established therapeutic management system, margin-free complete surgical excision of the tumor is very important to a satisfactory outcome. We report a case of ACC with bilateral pulmonary metastasis in a 10-year-old boy. Preoperative chest computed tomography (CT) showed pulmonary metastasis with near-water density. The patient was treated successfully with complete surgical resection of the primary tumor and adjuvant chemotherapy, including mitotane. After bilateral lung surgery for the metastatic lesions, the plasma dehydroepiandrosterone sulfate level became negative.

DOI： 10.1007/s00595-008-3788-5

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記述言語：英語   出版者・発行元：SPRINGER  

Lung cancer associated with Sweet's syndrome is extremely rare. There are only seven reports of such cases. As far as could be determined from a comprehensive search, there is no reported operative case of lung cancer with this syndrome in the world literature. A 75-year-old Japanese man was diagnosed as having Sweet's syndrome. A chest computed tomography (CT) scan to screen for malignant lesions associated with this syndrome revealed an abnormal shadow in the lung. Although [F-18]2-fluoro-2-deoxy-D-glucose positron emission tomography showed no abnormal uptake, lung cancer was most strongly suspected by chest CT. His erythema improved rapidly with steroid therapy and he underwent a segmentectomy (S-6) of the right lower lobe. A pathological examination revealed lung adenocarcinoma (pT1N0M0: Stage Ia). The patient was discharged from the hospital without any worsening of Sweet's syndrome. We herein report a first operative case of an early stage lung adenocarcinoma with this syndrome.

DOI： 10.1007/s00595-007-3683-5

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We report a patient with primary lung adenocarcinoma who had Ewing's sarcoma and was successfully treated with ifosfamide. A 56-year-old Japanese man was referred to the Orthopedic Department of our hospital with a complaint of pain on his hip, ischuria, and dyschezia (vesicorectal disorder). MRI showed a mass in the sacrum. Open biopsy revealed Ewing's sarcoma (T2N0M0G4, Stage II B). Chest CT to screen showed an abnormal shadow in the left pulmonary lower lobe (S10). Bronchoscopic examination revealed primary lung adenocarcinoma(cT2N0M0, Stage I B). Because of a severe hip pain, treatment for Ewing's sarcoma by high-dose ifosfamide (day 1: 4 g/m2/day --> day 2-7: 2 g/m2/day: total 14 g/m2) was given in one course before lung surgery. The lung adenocarcinoma became small, the reduction ratio of the tumor was 26.5% and the tumor changed into a cavity. No serious adverse effect was observed.

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© 2008 Libertas Academica Ltd. All rights reserved. Background: We conducted a pilot phase II study to evaluate the efficacy and safety of S-1 as a first-line, S-1 plus cisplatin as a second-line, and weekly paclitaxel as a third-line therapy for advanced gastric cancer. Patients and methods: Between 2002 and 2005, 19 patients were enrolled in this study. Chemotherapy consisted of either 60 mg/m2 of S-1 for 4 weeks at 6 weeks interval, a combination of 60 mg/m2 S-1 for 3 weeks and 60 mg/m2 cisplatin on day 8 at 5 weeks interval, or 60 mg/m2 paclitaxel at day 1, 8, 15, at 4 weeks interval. The regimen was repeated until the occurrence of unacceptable toxicities, disease progression, or patient refusal. The primary end point was the overall survival. Results: The response rates were 33.3%, 12.5%, and 0% after the first, second, and third line chemotherapy, respectively. The mean overall survival time was 994 days. The median survival time could not be calculated because 12 out of 19 patients were still alive when the study was concluded. Regarding hematological toxicity, the major adverse effect was leukopenia, which reached grades 3–4 in all lines of chemotherapy investigated. In addition, regarding non-hematological toxicities, the major adverse effect was anorexia, which reached grade 3–4 in the second line chemotherapy, and no deaths were attributable to the adverse effects of the drugs. Conclusion: This sequential therapy was an effective treatment for advanced gastric cancer with acceptable toxic side-effects. We considered this sequential therapy to be effective because of the smooth switch to the next regimen.

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We report a case of long-term survival of 5 years after operation and chemotherapy for type 4 gastric cancer with peritoneal dissemination. A 41-year-old woman underwent total gastrectomy for type 4 gastric cancer with peritoneal dissemination and pancreas invasion. After operation, chemotherapy with S-1 plus PSK therapy, S-1 plus CDDP, and S-1 plus DOC was performed. The regimen of S-1 plus CDDP included S-1 on day 1-5, 8-12, 15-19, 22-26 and 2 weeks rest and PSK daily. After S-1 plus PSK therapy(34th course), peritoneal recurrence caused ileus, so a right hemicolonectomy was performed. Now the patient is undergoing weekly paclitaxel. The S-1 plus PSK therapy is able to prolong time to progression and has fewer adverse effects.

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This study was designed to analyze clinicopathological features of upper gastric cancer with lymph node metastasis at the splenic hilum (lymph node No. 10). Subjects were 269 patients undergoing splenectomy for advanced upper gastric cancer at the hospital from 1976 to 2003. Lymph node No.10 metastasis (Group A) was observed in 40 patients, and 229 patients had no metastasis in lymph node No.10 (Group B). There were significant differences in location (greater curvature), microscopic appearance (poor, signet ring cells, mucinous), macroscopic appearance (TypeS, Type4), and depth of tumor invasion (T3, T4). In a multivariate analysis, depth of tumor invasion and microscopic appearance were important predictors of Group A, and No.1, 2, 4sa, 4d lymph node metastasis was a strong predictor of Group A. The 5-year survival rate of Group A was significantly lower than that of Group B. In this study, if the lesion location, depth of tumor invasion, microscopic and macroscopic appearance is in the low risk group of lymph node No.10 metastasis, splenectomy for lymph node No. 10 dissection can be avoided in advanced upper gastric cancer.

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記述言語：英語   出版者・発行元：SPRINGER  

Background. We previously reported that the administration of 1 alpha hydroxy vitamin D3 was effective for treating post-gastrectomy bone disorders. Accordingly, we performed the present study to obtain evidence supporting the effectiveness of 1 alpha hydroxy vitamin D3 in post-gastrectomy patients.
Methods. The study involved 22 outpatients who had undergone gastrectomy for gastric cancer and had not been treated with 1 alpha hydroxy vitamin D3 or calcium. They comprised 17 men and 5 women, with a mean age of 61.9 years. Laboratory tests were performed to examine the following parameters: 1,25(OH)(2) vitamin D3; 25(OH) vitamin D3; 24,25(OH)(2) vitamin D3; ionized calcium; calcium; phosphorus; alkaline phosphatase; N-parathyroid hormone; and osteocalcin.
Results. The level of 1,25(OH)(2) vitamin D3, the most active of the vitamin D metabolites, was found to be normal in all of the patients. In contrast, the level of 25(OH) vitamin D3, which shows weak activity, was below the normal range in 7 of the 22 patients (31.8%). The mean serum level of 25( OH) vitamin D3 was significantly lower in patients at 1 year or more postoperatively than the level in those at less than 1 year postoperatively (P = 0.041), as well as being significantly lower in patients who had received total gastrectomy than in patients who underwent other gastrectomy procedures. The level of 24,25(OH)(2) vitamin D3, a metabolite of 25(OH) vitamin D3 that shows weak activity, was below the normal range in 19 of the 22 patients (86.4%). On multivariate analyses, factors associated with the change in vitamin D metabolites did not remain.
Conclusion. The patients showed a decrease of 25(OH) vitamin D3 and 24,25(OH)(2) vitamin D3, which are metabolites that show weak activity. This suggests that a homeostatic response maintains the normal level of 1,25(OH)(2) vitamin D3, which is important for calcium regulation. Thus, it was suggested that gastrectomy had a moderate influence on the metabolism of vitamin D. However we could not detect any factor associated with the decrease of 25(OH) vitamin D3 and 24,25(OH)(2) vitamin D3.

DOI： 10.1007/s10120-007-0439-2

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記述言語：日本語   出版者・発行元：南江堂  

A 6-year-old girl who had been diagnosed as hyper immunoglobulin-E syndrome, was admitted to the department of pediatrics of our institute in May 2006, because of pulmonary aspergillosis. The chest X-ray showed bilateral cavities with niveau and fungus ball in the left middle lung field. In spite of medical treatment by antibiotics and antimycotics, the lesions did not improve. Therefore, bilateral lobectomy was done. After surgery, she needed re-operation twice, because of prolonged air leakage. There are few reports of lung surgery for the patient with the hyper immunoglobulin-E syndrome, and we present our case and review previous 2 case reports in the Japanese literature.

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記述言語：英語   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

Background/Aims: In order to clarify vitamin E malabsorption after gastric surgery, we evaluated serum vitamin E level and neurological consequences in patients who had undergone gastrectomy for gastric cancer.
Methodology: We studied forty-eight patients (30 men, 18 women) with a mean age of 68.0 years, who had previously undergone gastrectomy for gastric cancer and had no evidence of recurrence. The types of operation consisted of subtotal gastrectomy in 26 patients and total gastrectomy in 22 patients. We measured postoperative body weight, white blood cells, red blood cells, hemoglobin, hematocrit, platelets, and serum levels of vitamins E, vitamin 1312, folic acid, total cholesterol, triglycerides, total protein, and albumin.
Results: Serum vitamin E level was decreased in 7 (14.6%) of the 48 patients. The occurrence of low vitamin E level was significantly more frequent in the total gastrectomy group than in the subtotal gastrectomy group. In relation to reconstruction procedures, the incidence of low vitamin E level was significantly higher in patients without food passage through the duodenum. The low vitamin E level was significantly associated with low total cholesterol level. The incidence of neuropathy was significantly higher in patients with low vitamin E level.
Conclusions: We assume that vitamin E deficiency more likely occurs after the reconstruction procedure in which food does not pass through the duodenum. Transport disturbance with loss of passage through the duodenum consequently may be the major cause of malabsorption. Differential diagnosis of neurological symptoms in post-gastrectomy patients should include hypovitammosis E.

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記述言語：英語   出版者・発行元：PROFESSOR D A SPANDIDOS  

The cytotoxic effect of trastuzumab in combination with oral fluoropyrimidine S-1 on human epidermal growth factor receptor 2 (HER2)-overexpressing human pancreatic cancer cell line TRG in vitro and in vivo was investigated. HER2 expression in TRG was analyzed by RT-PCR and flow cytometry. For in vitro experiments, 5-fluorouracil (5-FU) was used instead of S-1. In vivo studies were conducted with TRG xenografts in athymic mice. Trastuzumab (10 mg/kg) was administered intraperitoneally once a week for 4 weeks. S-1 (10 mg/kg) was administered orally 5 days a week for 4 weeks. The results showed that TRG cells were positive for HER2 mRNA and overexpressed HER2 protein. Either trastuzumab or 5-FU concentration-dependently inhibited the growth of TRG cells. The combination of trastuzumab and 5-FU resulted in a significant inhibition of growth of TRG cells compared to either agent alone (P<0.001). Incubation of TRG cells with peripheral blood mononuclear cells after treatment with trastuzumab enhanced the antiproliferative effect of trastuzumab, which could be the result of antibody-dependent cellular cytotoxicity. The combination of trastuzumab and S-1 resulted in a significant reduction in xenograft volume compared to each agent alone (P<0.0001). In conclusion, this study showed that combination therapy with trastuzumab and S-1 may be effective for HER2-overexpressing pancreatic cancer patients.

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We treated two patients in whom irinotecan (CPT-11)+cisplatin (CDDP) and irradiation showed efficacy against brain metastases of gastric cancer. CPT-11 and CDDP were administered on days 1 and 15 of a 28-day cycle at 60 mg/m(2) and 30 mg/m(2), respectively. The first patient was a 63-year-old man,who complained of headache and weakness. In March 2003, he was diagnosed as having Stage IV gastric cancer with peritoneal dissemination (T3, Nx, P1) and underwent total gastrectomy with D1 dissection. Chemotherapy with S-1 was continued after surgery. Two years and two months later, a metastatic tumor was found in the upper lobe of the right lung. The protocol was changed to S-1+CDDP, but progression of his disease occurred. The weekly paclitaxel (PTX) therapy was tried instead. Seven months later, he developed headache and weakness, and multiple brain metastases were diagnosed by CT scanning. We performed total brain irradiation (30 Gy) and started CPT-11+CDDP therapy, which was continued on a fortnightly basis at 60 mg/m(2) and 30 mg/m(2), respectively. The brain metastases regressed (PR), and this therapy led to a marked improvement in his quality of life. The second patient was a 78-year-old man, who complained of weakness of the lower extremities and dizziness. In November 2003, he was diagnosed as having stage IB gastric cancer (T2 (ss), N0, P0), and underwent total gastrectomy and splenectomy with D2 dissection. One year and four months later, local recurrence at the anastomosis was detected, as well as a metastatic tumor in the right lung. S-1, S-1+CDDP, and weekly PTX therapy were all tried. One year later, the patient was admitted with weakness and dizziness,and brain metastases were detected by CT scanning. We then performed Cyber Knife treatment and administered CPT-11+CDDP. As a result, his brain metastases partially regressed (PR).

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Esophageal carcinoma within a diverticulum is very rare, and only 49 cases have been reported in Japan. A 58-year-old man with vomiting was found by esophagogram to have diverticulum of the lower thoracic esophagus. Endoscopy showed a reddish and irregular depressed lesion not dyed by lugol solution in the diverticulum. A biopsy specimen showed squamous cell carcinoma that had invaded the mucosal layer. A diverticulectomy through esophageal hiatus with midline incision was performed. The resected specimen showed a slightly depressed type carcinoma (0 - II c). A pathological examination revealed a moderately differentiated squamous cell carcinoma with invasion of m2. Five years after the diverticulectomy, the patient is well without recurrence or metastasis. Generally, the prognosis for esophageal carcinomas of the diverticulum is poor because of the ease of invasion through the thin wall. Therefore, a patient with an esophageal diverticulum should be checked with esophagogram, esophagoscopy, and biopsy, considering the possibility of development of carcinoma.

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記述言語：英語   出版者・発行元：H G E UPDATE MEDICAL PUBLISHING S A  

In this study, we performed laparoscopy-assisted distal gastrectomy (LADG) and lymph node dissection with an incision of 3cm aiming at radical cure and low invasiveness. We introduce and discuss this technique of minilaparotomy and recommend a device for anastomosis.
In LADG, a skin incision of 5cm or greater is made in order to pull out the stomach in other institutes. Whether function is distinctly better after laparoscopy-assisted surgery than after abdominal section has not been elucidated so far, so we should seek an aesthetic advantage. We have used a 3-cm abdominal wound to date. If the wound is smaller than this, the body of the SDH25 cannot be inserted, and currently a wound less than 3cm may thus not be possible. The shaft of the SDH is straight, making it easy to confirm the direction even through a laparoscope. The shaft of the anvil head of the PPCEEA is too long, so that when it is connected with the body through the 3-cm incision, it is necessary to draw it through the remnant stomach to a great extent.

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記述言語：英語   出版者・発行元：KARGER  

Tissue inhibitor of metalloproteinase-1 (TIMP-1) not only inhibits matrix metalloproteinases but also stimulates tumor growth. In this study, long-term follow-up results were analyzed to clarify the prognostic value of plasma TIMP-1. Preoperative plasma TIMP-1 was measured from peripheral blood samples of 87 Japanese patients with colorectal carcinoma. All the patients underwent surgical resection and were followed for 5 years prospectively. The median follow-up period was 70 months (60-79 months). The cutoff value of plasma TIMP-1 was set at 170 ng/ml based on the ROC curve. Sensitivity and specificity to predict 5-year survival was 66.7 and 55.0% with this cutoff value. In univariate analyses for overall survival, lymph node metastasis, serosal invasion, peritoneal metastasis, liver metastasis, metastasis to other distant organs and TIMP-1 were significant. In multivariate analyses, lymph node and liver metastases, metastasis to other distant organs and plasma TIMP-1 were independent prognosticators, but p values of TIMP-1 did not reach statistical significance. Our results suggested that the pre-operative plasma TIMP-1 concentration could be a useful prognosticator of long-term survival in patients with colorectal carcinoma. Copyright (C) 2007 S. Karger AG, Basel.

DOI： 10.1159/000112827

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

Metastasis of breast carcinoma to the gallbladder is very rare, with only 9 cases reported in the global literature from 1985 to 2000. A 53-year-old woman admitted for right upper quadrant pain and fever who had been undergone modified radical mastectomy for left breast cancer in 1985, was diagnosed histologically as having papillotubular carcinoma and invasive lobular carcinoma. After the mastectomy, local and bone metastases were treated with chemoradiation and hormonal therapy. In July 2003, abdominal computed tomography and ultrasonography showed a swollen gallbladder with a thickened wall and no stones. We diagnosed the problem as noncalculous cholecystitis and undertook cholecystectomy. Multiple liver metastases were detected intraoperatively and partial hepatic resection was added. Pathological examination of the specimen showed a tumor morphologically identical to the breast carcinoma for which the patient had undergone right mastectomy 18 years earlier. Of the 10 cases, including ours, 5 were diagnosed preoperatively as gallstones or cholecystitis, but none as gallbladder metastases. Six were histologically diagnosed as lobular carcinoma. Careful preoperative abdominal examinations are thus important for cases with a history of breast carcinoma. ©2007 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.40.56

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

Introduction : We evaluated serum vitamin A and E in patients undergoing gastrectomy for gastric cancer. Patients and Methods : Subjects were 55 patients - 35 men and 20 women with a mean age of 66.7 years - who had undergone gastrectomy for gastric cancer and had no evidence of recurrence. Surgery involved subtotal gastrectomy in 29 and total gastrectomy in 26. We measured postoperative white (WBC) and red blood cell counts, hemoglobin, hematocrit, platelets, and serum levels of vitamins E, vitamin B12, folic acid, total cholesterol, triglycerides, total protein, albumin, and body mass index. Results : Serum vitamin A levels decreased in 1 (1.8%) of the 55 and serum E levels in 12 (21.8%). Low vitamin E was associated significantly with low total cholesterol, low vitamin A, and high WBC count. Low vitamin E was significantly more frequent in the total gastrectomy group than in the subtotal gastrectomy group. In light of reconstruction procedures, the incidence of low vitamin E was significantly higher in patients without food passage through the duodenum. Discussion : While we assume that vitamin E deficiency is more common than thought, further assessment is needed to determine the relationship between gastrectomy for gastric cancer and vitamin A and E levels. ©2007 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.40.1763

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We report here a case of intractable hemorrhage after self-removal of a percutaneous endoscopic gastrostomy (PEG) tube. A 69-year-old woman was an outpatient at the Department of Neuropsychiatry with a diagnosis of progressive supranuclear palsy. Aspiration pneumonitis and difficulty in swallowing required PEG in our department and PEG was done in February, 2001. After PEG there were no complications until a nurse discovered self-removal of the PEG tube 14 days after PEG. Bleeding continued around the fistula of PEG, and staunching with gauze attempted. But the bleeding did not stop and forced an urgent endoscopic inspection and staunching. However, bleeding could not be controlled and an urgent operation was reguired. We understood that the uncontrolled bleeding might be attributable to new growing vasculature in granulation tissue replaced with collagen fiber in the 14 days after PEG, and a PEG tube should be managed very carefully in the early period after PEG.

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記述言語：英語   出版者・発行元：SPRINGER  

Background: Recently, some studies have suggested that sentinel node biopsy also can be applied to gastric cancer. The authors apply sentinel lymph node biopsy in laparoscopy assisted distal gastrectomy to perform it as safe limited surgery. Limited surgery is a procedure in which the extent of lesion resection and lymph node dissection is reduced. The authors demonstrate that intraoperative diagnosis of lymph node metastasis is useful in this respect.
Methods: The study was conducted with 38 patients (29 men and 9 women) who had a preoperative diagnosis of T1 tumor invasion. The patients had a mean age of 66.2 years. Patent blue (1%) was injected submucosally into four or five different sites around the primary tumor at 1 in] per site. Blue-stained lymphatics and lymph nodes could be seen by turning over the greater omentum and the lesser omentum extraperitoneally. If blue nodes were found, biopsy was performed.
Results: The mean number of blue nodes dissected was 2.5 +/- 1.9. Intraoperative identification and biopsy of blue nodes could be performed for 35 (92.1%) of the 38 patients. Of the 35 patients in whom blue nodes were identified, 4 (9.7%) had metastases in blue nodes confirmed by intraoperative frozen-section diagnosis. Intraoperative frozen-section diagnosis was negative for blue node metastasis in 31 patients. Postoperative permanent section diagnosis also showed no evidence of lymph node metastasis in these 31 patients (100% accuracy, 0% false-negative rates).
Conclusion: The reported method allows observation of blue-stained lymphatics up to 2 h after patent blue injection. Sentinel node biopsy was performed in laparoscopy assisted distal gastrectomy, making it technically equivalent to open gastrectomy. Sentinel node biopsy can serve as a method to determine the appropriate use of laparoscopy assisted distal gastrectomy for management of T1 gastric cancer.

DOI： 10.1007/s00464-006-0043-2

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We investigated sixty-nine cases of post-operative infection among 1291 cases of abdominal operation from January 2000 to December 2002, and searched for the risk factors of post-operative infection. Age, intraperitoneal infection, and highly invasive operations were thought to be the risk factors for post-operative infection. In these cases, a method to prevent post-operative infection needs to be established.

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記述言語：英語   出版者・発行元：INT INST ANTICANCER RESEARCH  

Background: To find a way to prevent the development of hepatocellular carcinoma (HCC) from hepatitis C virus-associated liver cirrhosis (HCV-LC), an analysis of the HCV-LC patients who had received reduction therapy of the alanine aminotransferase (ALT) levels was performed. Patients and Methods: Seventy-four consecutive HCV-LC patients of Child Stage A were followed for > 10 years for the development of HCC. They were divided into two groups: in group A, the reduction therapy for the ALT levels was aggressively performed, while in group B, the reduction therapy was not performed aggressively. The patients were subdivided into three sub-groups according to their serum ALT levels. In groups A and B, the high ALT group was comprised, respectively, of nine and five patients whose annual average serum ALT levels were persistently high (>= 80 IU), while the low ALT group was comprised of 19 and 20 patients whose annual average serum ALT levels were persistently low (< 80 IU). The remaining eleven and ten patients had annual average serum ALT levels which fluctuated and were unclassified (unclassified group). Results: In group B, 65.7% of the patients had developed HCC in 13 years, in contrast to only 41.0% of group A (p=0.039). In group A, the median HCC development time was 12.8 years, in contrast to only 3.8 years in group B (p=0.0013). Multivariate analysis demonstrated that the mode of reduction therapy and ALT levels were the significant factors affecting HCC development. Conclusion: The chances of surviving for more than ten years without developing HCC for HCV-LC patients of Child Stage A were far more favorable in group A than group B. These results suggest that aggressive reduction therapy for ALT levels in HCV-LC patients could significantly prevent HCC development.

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記述言語：英語   出版者・発行元：INT INST ANTICANCER RESEARCH  

Background: S-1 is a novel oral fluorouracil antitumor drug that contains a combination of 3 pharmacological agents: tegafur (FT), a 5-fluorouracil (5-FU) prodrug, 5-chloro-2,4-dihydroxypyridine (CDHP), which inhibits the activity of dihydropyrimidine dehydrogenase (DPD), and potassium oxonate (Oxo), which reduces the gastrointestinal toxicity of 5-FU. S-1 and docetaxel have both been identified as effective agents for the treatment of gastric cancer. However, little is known about the effects and/or adverse effects of a combination of these drugs in the treatment of gastric cancer. The aim of this phase I study was to determine the maximum-tolerated dose (MTD) and the recommended dose of docetaxel with a fixed dose of S-1 in patients with advanced or recurrent gastric cancer. Patients and Methods: Patients with metastatic, recurrent, or unresectable gastric cancer received docetaxel at a starting dose of 25 mg/m(2) by i.v. infusion over I h on days 1, 15 and 29, and S-1 at the full dose of 80 mg/m(2) daily for 4 weeks of every 6 weeks. Nine patients were treated with increasing dosages of docetaxel as follows: (docetaxel/S-1, mg/m(2)): 25/80 (level 1), 30180 (level 2) and 35180 (level 3). All cases were assessable for drug safety and 7 were assessable for response. Colony-stimulating factor (CSF) was not used in this study. The adverse effects of treatment were analyzed according to NCI-CTC, version 2 and the response was assessed according to the Japanese Classification of Gastric Cancer, 13th Ed. Results: The MTD was reached at the 35/80 mg/m(2) dose-level in 3 out of 3 patients. These patients experienced some dose-limiting toxicity (DLT) or grade 3 anemia. The reported DLTs included diarrhea, stomatitis and general fatigue. Due to these results, 3 additional patients were not enrolled at this dose-level. No hematological or non-hematological adverse effects (more severe than grade 2) were observed in any of the level 1 or 2 patients. However, among the level 1 patients, 66.7% developed grade 2 leukocytopenia and 33.3% developed grade 2 neutropenia. Among the level 2 patients, 33.3% developed grade 2 appetite loss, diarrhea and general fatigue. Partial responses were achieved in 3 (42.9%) out of the 7 patients with evaluable lesions. These results indicated that the appropriate doses of the 2 drugs in combination therapy are 30 mg/m(2) for docetaxel and 80 mg/m(2) for S-1. Conclusion: The S-1/docetaxel drug combination showed a good safety profile, with diarrhea and general fatigue being common, but manageable, adverse reactions. Moreover, the responses observed in this study suggest that the drug combination shows a high degree of efficacy in patients with advanced and/or recurrent gastric cancer.

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記述言語：日本語   出版者・発行元：Japanese Society of Gastroenterological Surgery  

Adenoendocrine cell carcinoma of the gallbladder is rare and has a dismal prognosis. Only 54 cases were reported in Japan from 1983 to 2004. A 59-year-old man was found to have an elevated lesion of the gallbladder in abdominal ultrasonography. This lesion grew gradually to almost 20mm in diameter as seen in CT and MRI. In laparoscopic cholecystectomy, the intraoperative frozen pathological diagnosis was suspected undifferentiated carcinoma, necessitating lymph node dissection and liver bed resection by open laparotomy. Neither liver metastasis nor peritoneal dissemination was seen. Immunohistochemical studies of tumor cells were positive for NCAM staining. The definitive pathological diagnosis was adenoendocrine cell carcinoma. Postoperatively, chemotherapy with CDDP and VP-16 and radiation therapy were conducted as is done in small cell carcinoma of lung. He has continued disease-free in the 24 months since resection. ©2006 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.39.476

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記述言語：日本語  

A 57-year-old man having undergone total gastrectomy for gastric cancer was admitted to the hospital because of difficulty in swallowing. Endoscopic examination revealed a severe stenosis in the jejunum 5cm distal to the esophago-jejunal anastomosis. With abdominal CT and rectal examination, we made a diagnosis of malignant stenosis due to peritoneal dissemination. We decided to place a covered self-expandable metallic stent. However, the delivery system could not pass through the bend because the jejunum was bent. Then a silk gut tied up to the delivery system was grasped with forceps endoscopically, and the delivery system was led successfully. After placement of the stent, the patient could leave the hospital and take food for 4 months. Against re-stenosis, a stent-in-stent technique was also made. The stent placement for jejunal stenosis is relatively difficult. This technique could apply to these cases, and would improve a quality of life for these patients.

DOI： 10.11280/gee1973b.47.211

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