Language：English   Publisher：(一社)日本癌治療学会  

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Perioperative adjuvant treatment and complete resection is the standard treatment for resectable pancreatic cancer and systemic chemotherapy is standard treatment for unresectable pancreatic cancer. To improve the survival of patients with pancreatic cancer, it is necessary to identify promising biomarkers to optimize the treatment. The availability of biomarkers may allow patients to receive a more aggressive or less toxic treatment. Recent studies showed that the inflammatory and nutritional status perioperatively and/or during chemotherapy affect short and long-term oncological outcomes in pancreatic cancer. Introduction of inflammatory and nutritional status evaluation in pancreatic cancer treatment might improve the postoperative surgical complications or chemotherapy-induced adverse events. However, to introduce these various nutritional and inflammation assessment tools in daily clinical practice, it is necessary to understand the characteristics of each nutrition and inflammation assessment tool. This review summarizes the background, current status, and future perspectives of nutrition and inflammation assessment tools in pancreatic cancer treatment.

DOI： 10.21873/anticanres.16572

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BACKGROUND/AIM: Mucinous gastric carcinoma (MGC) has a poor prognosis. Due to the differences in clinicopathology factors between MGC and non-MGC (NMGC), it is difficult to compare them. In this study, we compared the clinicopathological characteristics and prognosis of MGC and NMGC patients. PATIENTS AND METHODS: For gastric carcinoma (GC), 3,042 gastrectomy patients were included in the study and divided into the MGC (n=86) and NMGC (n=2,956) groups. The characteristics and prognoses of patients in both groups were compared before and after (both groups, n=86) propensity score matching. RESULTS: Significant differences were observed in the tumor location (upper) (MGC group: 28.0% vs. NMGC group: 24.7%, p=0.003), tumor diameter (median) [65 mm (8-200 mm) vs. 40 mm (2-75 mm), p<0.001], lymph node metastasis (70.9% vs. 37.3%, p<0.001), venous invasion (57.0% vs. 40.4%, p<0.001), and lymphatic invasion (62.8% vs. 34.9%, p<0.001) before propensity score matching. The 5-year overall survival (OS) (70.9% vs. 76.2%, p=0.006) and cancer-specific survival (CSS) (75.5% vs. 82.4%, p=0.014) rates were significantly lower in the MGC group. After propensity score matching, there were no significant differences in either the 5-year OS (70.9% vs. 73.7%, p=0.230) or CSS (75.5% vs. 75.7%, p=0.587) rates. In addition, no substantial difference was observed in either of the recurrence forms. CONCLUSION: MGC is rare and usually diagnosed at a more advanced stage. However, MGC and NMGC have similar prognoses.

DOI： 10.21873/anticanres.16456

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BACKGROUND/AIM: Patients are at-risk for vitamin B12 deficiency after total gastrectomy due to a lack of intrinsic factors. The aim of the study was to clarify the clinical course and risk factors for vitamin B12 deficiency after total gastrectomy for gastric cancer patients. PATIENTS AND METHODS: Patients who underwent curative resection for gastric cancer were selected from the medical records of the Yokohama City University from 2000 to 2020. A logistic regression analysis was performed to identify risk factors for vitamin B12 deficiency. RESULTS: We evaluated 47 patients. The median serum vitamin B12 levels before surgery were 359 pg/ml, while those at 3, 6, 9, and 12 months after surgery these were 255 pg/ml, 197.5 pg/ml, 195 pg/ml, and 206 pg/ml, respectively. Univariate analyses to identify factors associated with vitamin B12 deficiency at 6 months after surgery showed that the occurrence of postoperative complications was a significant risk factor (OR=6.347, 95%CI=1.607-25.774, p=0.009), while adjuvant chemotherapy was a marginally significantly risk factor (OR=3.562, 95%CI=0.877-14.477, p=0.076). CONCLUSION: Almost half of the patients were diagnosed with vitamin B12 deficiency at 6 months after total gastrectomy for gastric cancer. In addition, the occurrence of postoperative complications and adjuvant chemotherapy were risk factors for vitamin B12 deficiency at 6 months after surgery.

DOI： 10.21873/anticanres.16207

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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BACKGROUND/AIM: The prognostic nutritional index (PNI) has been reported as an immunonutritional index that can easily evaluate nutritional status and immunocompetence from blood tests. The purpose of this study was to investigate the usefulness of PNI as a prognostic factor in postoperative gastric cancer patients. PATIENTS AND METHODS: In this retrospective cohort study, we evaluated 258 patients with pStage I-III gastric cancer who underwent radical resection at Yokohama City University Hospital, from 2015 to 2021. To examine the association with prognosis, we analyzed clinicopathological factors including PNI (<47/≥47), age (<75/≥75), sex (male/female), depth (pT1/≥pT2), lymph node metastasis (pN+/pN-), lymphatic invasion (ly+/ly-), vascular invasion (v+/v-), histological type (enteric/spread) and postoperative complications. RESULTS: In univariate analysis, PNI (p<0.001), depth of tumor invasion (p<0.001), lymph node involvement (p<0.001), age (p=0.002), lymphatic invasion (p<0.001), vascular invasion (p<0.001), and postoperative complications (p=0.003) were associated with overall survival. In multivariate analysis, PNI (HR=2.100, 95% confidence interval 1.225-3.601, p=0.007), tumor invasion, lymph node metastasis, and postoperative complications were shown as poor prognostic factors for overall survival. CONCLUSION: PNI is an independent prognostic factor for overall and recurrence-free survival in postoperative gastric cancer patients. PNI could be implemented in clinical practice to identify patients at higher risk for poor outcomes.

DOI： 10.21873/invivo.13207

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BACKGROUND/AIM: We investigated the influence of the preoperative Oral Health Assessment Tool (OHAT) score on the outcomes of patients with esophageal cancer after curative surgery. PATIENTS AND METHODS: This study included 90 patients with esophageal cancer who underwent curative surgery and who were screened with the OHAT between 2008 and 2021. The OHAT consists of eight categories with three possible scores. The risk factors for 5-year overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Patients were divided into healthy (n=42) and unhealthy (n=48) groups. The OHAT score was identified as a significant risk factor for postoperative pneumonia (11.9% vs. 43.8%, p=0.001) and postoperative hospital stay (20.5 days vs. 50.1 days, p=0.042). The 5-year OS rate after surgery was 71.2% in the healthy group and 43.2% in the unhealthy group, which was a significant difference (p=0.015). A multivariate analysis showed that a high OHAT score was a significant independent factor for 5-year OS (p=0.034). CONCLUSION: The OHAT score was a useful prognostic marker in patients who underwent curative surgery for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

DOI： 10.21873/invivo.13327

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BACKGROUND/AIM: The platelet-to-lymphocyte ratio (PLR) is a promising prognostic marker in some malignancies. The present study evaluated the clinical impact of the PLR in patients with gastric cancer who underwent curative resection. PATIENTS AND METHODS: This study included 258 patients who underwent curative treatment for gastric cancer between 2005 and 2020. The prognosis and clinicopathological parameters between the high- and low-PLR statuses were analyzed. RESULTS: The overall survival (OS) stratified by each clinical factor was compared using the log-rank test, and a significant difference was observed using a pretreatment PLR of 150. When comparing the patient backgrounds between the high-PLR (PLR≥150) and low-PLR (PLR<150) groups, there were no significant differences between the two groups. The OS rates at 3 and 5 years after surgery were significantly higher at 70.8% and 60.4%, respectively, for the high-PLR group than at 83.6% and 79.7%, respectively, for the low-PLR group. Univariate and multivariate analyses of the OS showed that the PLR was a significant prognostic factor. In addition, when comparing the first recurrence sites, there were significant differences in peritoneal recurrence. CONCLUSION: The PLR is a significant risk factor for gastric cancer, making it a promising prognostic factor for patients with gastric cancer.

DOI： 10.21873/invivo.13379

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Multidisciplinary treatment for esophageal cancer leads to nutritional and inflammatory changes. Recent studies showed that nutritional and inflammatory changes during multidisciplinary treatment affect both short and long-term oncological outcomes in esophageal cancer treatment. Therefore, evaluation of the nutritional and inflammatory status during treatment is necessary in order to optimize and utilize multidisciplinary therapy for esophageal cancer. If patients with esophageal cancer are able to determine their nutritional and inflammatory status, they will be able to select the optimal esophageal cancer, anti-inflammation, and nutritional treatments. Various types of nutrition and inflammation assessment tools have been developed and reported for esophageal cancer, with each tool having its own clinical characteristics, which must be understood before being applied in clinical practice. This review summarizes the background, current status, and future perspectives on the application of nutrition and inflammation assessment tools in esophageal cancer treatment.

DOI： 10.21873/invivo.13051

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BACKGROUND/AIM: When nivolumab is administered as second-line therapy for esophageal cancer, radiotherapy may also be provided in cases either concurrently or sequentially. The aim of this study was to retrospectively examine whether the incidence of adverse events increases in such cases. PATIENTS AND METHODS: Twenty-two esophageal cancer patients [17 males and 5 females; mean age 71 years (range=58-87 years)] treated with nivolumab were included. Patients were divided into two treatment groups: nivolumab alone (N group) (12 patients) and nivolumab combined with radiotherapy (R group) (10 patients). All patients had squamous cell carcinoma. The primary outcomes measured were the severity and frequency of adverse events. RESULTS: Adverse events were seen in 6 of the 12 patients in the N group and 8 of the 10 in the R group. There were significantly more adverse events in the R group (p=0.035), but no difference in Grade 3 or higher adverse events (p=0.781), indicating that the adverse events were controllable. There was no significant difference in treatment effect between the N and R groups. CONCLUSION: In this report, 50% of adverse events in the N group were grade 3-4, 25% of which were grade 4, as seen in previous reports. In the present study, the side effects were not enhanced by treatment with immune checkpoint inhibitors plus radiotherapy. Immune checkpoint inhibitors plus radiation therapy would be a relatively safe treatment and may become an option for esophageal cancer treatment in the future.

DOI： 10.21873/invivo.13264

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BACKGROUND/AIM: Gastrectomy with lymphadenectomy is a standard treatment for gastric cancer. Anastomotic leakage remains a potentially fatal complication of gastrectomy. Forceful stapler extraction may cause anastomotic complications. We focused on the duodenal peristalsis, as we hypothesized that it might cause forceful stapler extraction. We then retrospectively investigated duodenal peristalsis and reviewed videos of Da Vinci system cases to clarify the relationship between peristalsis and anastomotic complications. PATIENTS AND METHODS: Forty-nine cases with stored videos of laparoscopic surgery using the Da Vinci system from 2015 to March 2021 were included. Peristalsis was defined by repeated contraction and expansion that was clearly visible three or more times in a row. The duodenum was investigated because it is frequently observed during gastrectomy. Suture failure was evaluated in cases with and without peristalsis. RESULTS: The study population included 49 patients [male, n=32; female, n=17; median age, 71 (42-82) years]. Duodenal peristalsis was observed in 14 (28.6%) cases. Three patients experienced complications. A comparative study of cases with and without complications showed significant peristalsis in cases with complications (p=0.0198). CONCLUSION: A new definition to evaluate duodenal peristalsis was established. Anastomotic complications were significantly more frequent in cases with peristalsis (p=0.0198). Our results suggest the utility of manual over-sewing or the use of reinforcement material.

DOI： 10.21873/invivo.13281

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BACKGROUND/AIM: The present study evaluated the clinical impact of other metachronous or synchronous primary cancer (OPC) in patients who received curative treatment for esophageal cancer. PATIENTS AND METHODS: The present study included 168 patients who underwent curative treatment for esophageal cancer between 2005 and 2018. Prognosis and differences between the OPC status (metachronous/synchronous) and clinic pathological parameters was analyzed. RESULTS: A total of 168 patients were included in this study. Forty patients were diagnosed with metachronous/synchronous OPC. When comparing the clinicopathological factors between the patients with and without OPC, the patients' background and postoperative clinical courses were very similar between the two groups. The 3- and 5-year overall survival rates in patients with esophageal cancer with OPC were 66.0% and 54.5%, respectively, while those in patients without OPC were 50.1% and 41.4%, respectively. There was no statistically significant difference in these rates (p=0.156). The OPC status was not included in the final multivariate analysis model. CONCLUSION: The OPC status was not found to be a prognostic factor for patients who received curative treatment for esophageal cancer. Therefore, it is not necessary to avoid performing curative treatment for esophageal cancer because of a patient's OPC status.

DOI： 10.21873/anticanres.16072

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The standard treatment for gastric cancer is surgical resection and perioperative adjuvant treatment. Multidisciplinary treatment for gastric cancer leads to nutritional and inflammatory changes. Nutritional and inflammatory changes during multidisciplinary treatment can lead to poor physical activity, severe toxicity in patients receiving chemotherapy or radiation therapy, and poor oncological outcomes. Evaluation of the perioperative nutritional and inflammatory status during treatment is necessary in order to utilize and optimize multidisciplinary therapy for gastric cancer. If physicians were able to detect the perioperative nutritional and inflammatory status before and during gastric cancer treatment, they would be able to select the optimal treatment and perioperative nutritional treatment. Recently, various types of nutrition and inflammation assessment tools were developed and reported for gastric cancer. These nutrition and inflammation assessment tools have some clinical advantages, such as ease of implementation, perioperative accessibility, and low cost. On the other hand, each tool has its own clinical characteristics, which must be understood before using it in the clinical practice. This review summarizes the background, current status, and future perspectives on the application of nutrition and inflammation assessment tools in gastric cancer treatment.

DOI： 10.21873/anticanres.16023

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BACKGROUND/AIM: Preoperative sarcopenia is associated with various cancers and affects the long-term prognosis of patients. After gastrectomy for gastric cancer, dynamic changes in body composition occur, and sarcopenia becomes more apparent after surgery than before surgery. However, the relationship between sarcopenia in the early postoperative period and long-term survival is not fully understood. The aim of this study was to determine the effects of surgical sarcopenia on long-term outcomes of patents with gastric cancer. PATIENTS AND METHODS: We included 408 patients who underwent curative gastrectomy (distal or total gastrectomy) for gastric cancer at the Kanagawa Cancer Center from December 2013 to November 2017. Sarcopenia was defined using the skeletal muscle index (SMI), using computed tomography (CT) one month after gastrectomy. We compared the long-term outcomes between patients with and without sarcopenia. RESULTS: The 5-year overall survival (OS) rates were 83.2% and 91.4% in the surgical and non-surgical sarcopenia groups, respectively. The hazard ratio (HR) of surgical sarcopenia for OS was 2.410 (95% confidence interval (CI)=1.321-4.396). In addition, surgical sarcopenia was associated with non-cancer-related deaths and deaths from other cancers. CONCLUSION: Patients with surgical sarcopenia after gastrectomy should be carefully monitored not only for gastric cancer recurrence but also for the occurrence of other diseases, including other cancers.

DOI： 10.21873/anticanres.15957

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BACKGROUND/AIM: This prospective multi-central randomized phase II trial evaluated the efficacy and safety of oral Vitamin B12 500 μg/day replacement compared with oral Vitamin B12 1,500 μg/day in patients with Vitamin B12 deficiency after total gastrectomy for gastric cancer. PATIENTS AND METHODS: Patients were randomly assigned to receive oral Vitamin B12 500 μg/day or Vitamin B12 1,500 μg/day in a 1:1 ratio with a minimization method. The primary endpoint was the incidence of a normal serum Vitamin B12 level at three months after treatment. RESULTS: From January 2018 to December 2021, 3 institutions collaborated with the present study, and 74 patients were registered from these 3 institutions. The study was prematurely closed due to poor accrual after reaching almost 50% of its goal. Among the 74 recruited patients, 36 were allocated to the Vitamin B12 500 μg/day arm and 38 to Vitamin B12 1,500 μg/day arm. The incidences of patients with a normal Vitamin B12 level at 3 months (serum Vitamin B12 level >200 pg/ml) were 91.7% (33/36) in the Vitamin B12 500 μg/day arm and 100% (38/38) in the Vitamin B12 1,500 μg/day arm (p=0.3587). The types of clinical symptoms with Vitamin B12 deficiency that improved with Vitamin B12 treatment and the degree of improvement were also similar. CONCLUSION: Although the primary endpoint of the present study was not met, it was found that oral Vitamin B12 500 μg/day replacement is as effective and safe as oral Vitamin B12 1,500 μg/day replacement for Vitamin B12 deficiency.

DOI： 10.21873/anticanres.15891

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BACKGROUND/AIM: The albumin-bilirubin (ALBI) score is a promising tool for the evaluation of the perioperative hepatic function. The present study aimed to evaluate the clinical impact of the preoperative ALBI status in patients with gastric cancer (GC) who received curative treatment. PATIENTS AND METHODS: The present study included 244 patients who underwent curative treatment for GC between 2005 and 2018. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Based on the 3- and 5-year OS rates, we set the cut-off value for the ALBI score at -2.7849. The 3- and 5-year OS rates were 87.3% and 80.9%, respectively, in the ALBI-low group, and 66.9% and 60.6% in the ALBI-high group; these differences were statistically significant (p<0.001). The ALBI score was included in the final multivariate analysis model [Hazard ratio (HR)=2.120, 95% confidence interval (CI)=1.177-3.818, p=0.012]. Similar results were observed for RFS. In addition, the ALBI score correlated with the introduction of postoperative adjuvant chemotherapy. CONCLUSION: The preoperative ALBI score correlated with both the OS and RFS of GC patients as well as the clinical course of adjuvant chemotherapy. Taken together, the ALBI score is a promising prognostic factor for GC.

DOI： 10.21873/anticanres.15887

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BACKGROUND: Laparoscopic/robotic distal gastrectomy (LDG/RDG) as a treatment for early gastric cancer has become increasingly and widely accepted for its minimal invasiveness and proportionate outcomes. Over the years, in addition to the LDG/RDG technique and the lymphadenectomy and gastrectomy procedures, various reconstruction methods have been developed and further improved upon. In particular, the number of minimally invasive intracorporeal anastomosis reconstruction techniques has been increasing. MATERIALS AND METHODS: The medical records of 445 patients with gastric cancer who underwent reconstruction following LDG/RDG via either trapezoidal-shaped gastroduodenostomy (TAPESTRY; n=126) or delta-shaped anastomosis (DSA; n=319) at our hospital between April 2012 and May 2021 were retrospectively reviewed. Short-term surgical outcomes, including the operation time, blood loss, length of hospital stay, and complications, were compared between the 2 groups. Anastomosis-related complications, namely leakage, bleeding, stricture, and delayed gastric emptying, were monitored and graded using the Clavien-Dindo classification. RESULTS: All operations were either performed or supervised by qualified surgeons. Patients' characteristics in the TAPESTRY group and the DSA group were biased in terms of the surgical approach, but they were well-balanced after propensity score matching. Overall anastomosis-related complications (Clavien-Dindo grade II or above) within 30 days after surgery in the TAPESTRY group were comparable with those in the DSA group, either all patients (1.5% vs. 5.0%, P=0.115) or after propensity score-matching analysis (2.1% vs. 6.5%, P=0.134). There were no records of reoperation or mortality during hospitalization in either group. CONCLUSIONS: TAPESTRY was performed safely, with a low rate of anastomosis-related complications. These findings suggest that trapezoidal-shaped gastroduodenostomy could be a feasible option for reconstruction in patients undergoing LDG/RDG.

DOI： 10.1097/SLE.0000000000001032

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BACKGROUND: The current expectancy of long-term survival of patients with pathological stage (pStage) III gastric cancer (GC) is not satisfactory. However, neoadjuvant chemotherapy (NAC) is expected to improve survival rates in these patients. An appropriate pretherapeutic diagnostic strategy is necessary for selecting patients who are eligible for NAC. Surgical findings can often identify serosal invasion or metastatic lymphadenopathy, thereby facilitating the selection of candidates for NAC. Therefore, we aimed to evaluate the accuracy and potential of surgical staging in improving the management and survival of patients with GC. PATIENTS AND METHODS: We assessed the accuracy of surgical staging in comparison to preoperative staging using data from patients who underwent gastrectomy for GC. In addition, differences in survival after using the surgical staging criterion were assessed. RESULTS: A total of 915 patients were evaluated in this study. The sensitivity of surgical staging in detecting pStage III in the surgical T4N0-3 plus surgical T3N1-3 group was satisfactory (79.3%). The proportion of patients with pStage I using the surgical staging criterion was 7.8%. CONCLUSION: Surgical staging using laparoscopy or laparotomy may assist in selecting candidates for enrollment in clinical trials for NAC.

DOI： 10.21873/anticanres.15750

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BACKGROUND/AIM: Perioperative systemic inflammation affects the long-term oncological outcomes in cases of malignancies. We evaluated the clinical impact of the preoperative systemic inflammation score (SIS) in resectable esophageal cancer patients who received curative treatment. PATIENTS AND METHODS: This study included 168 patients who underwent curative surgery followed by perioperative adjuvant chemotherapy for esophageal cancer between 2005 and 2018. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Based on the 3- and 5-year OS rate, we set the cut-off value for SIS at 2 in the preset study. Among the 168 total patients, 119 were categorized as the Low-SIS group, and 49 were categorized as the High-SIS group. The respective 3- and 5-year OS rates were 61.9% and 52.4% in the Low-SIS group and 33.3% and 26.6% in the High-SIS group. There were significant differences in OS (p<0.001). The SIS was therefore selected for the final multivariate analysis model (hazard ratio=2.094, 95% confidence interval=1.355-3.234, p<0.001). On comparing the perioperative clinical course between the High- and Low-SIS groups, there were significant differences in the rate of postoperative anastomosis leakage of grade ≥2 between the groups (61.5% in the High-SIS group vs. 30.3% in the Low-SIS group; p=0.021). CONCLUSION: The systemic inflammation score had a clinical effect on the long-term oncological outcomes in esophageal cancer patients, suggesting that it might be a promising prognostic factor for esophageal cancer patients.

DOI： 10.21873/anticanres.15749

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Language：English   Publisher：(一社)日本胃癌学会  

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BACKGROUND/AIM: We investigated the association of the preoperative lymphocyte-to-C-reactive-protein ratio (LCR) with gastric cancer survival and recurrence after curative treatment. PATIENTS AND METHODS: This study included 480 patients who underwent curative surgery followed by adjuvant treatment for gastric cancer between 2013 and 2017. The prognostic factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: A LCR of 7,000 was regarded as the optimal critical point of classification, considering the 1-, 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 84.4% and 73.9% in the low-LCR group, respectively, and 92.4% and 87.0% in the high-LCR group, respectively, and were statistically significantly different. The RFS rates at 3 and 5 years after surgery were 78.8% and 68.7% in the low-LCR group, respectively, and 89.3% and 86.6% in the high-LCR group, respectively, with a statistically significant difference. A multivariate analysis showed that the LCR was a significant independent prognostic factor for both OS and RFS. CONCLUSION: The LCR was a significant prognostic factor for survival in patients who underwent curative treatment for gastric cancer.

DOI： 10.21873/invivo.12728

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INTRODUCTION: Previous randomized controlled trials demonstrated similar oncological outcomes between laparoscopic-assisted (LA) and open (OP) colectomy; however, patients with transverse colon cancer were not analyzed. The aim of this study was to confirm the oncological safety and the advantages of the short- and long-term results of LA surgery for transverse colon cancer in comparison to OP surgery. MATERIALS AND METHODS: The study data were retrospectively collected from the databases of four hospitals. Patients with transverse colon cancer who underwent LA or OP R0 or R1 resection were registered. RESULTS: Among the 204 patients, 149 underwent OP colectomy and 55 underwent LA colectomy. The median follow-up period was 43 months. The rate of conversion to OP resection was 7.3%. The 5-year overall survival rate of the LA group was higher than that of the OP surgery group for all-stage patients (97.5% vs. 91.1%, P = 0.108), and it was similar in Stage II and Stage III patients (94.1% vs. 94.2%, P = 0.510). The LA group had significantly lower blood loss and a significantly longer operative time in comparison to the OP surgery group. Furthermore, the postoperative hospital stay was significantly shorter (9 vs. 13 days, P = 0.001) and the incidence of Grade ≥III complications was lower in the LA group (3.7% vs. 14.8%, P = 0.031). CONCLUSION: We concluded that LA surgery for transverse colon cancer is oncologically safe and yields better short-term results in comparison to OP surgery.

DOI： 10.4103/jcrt.JCRT_946_20

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BACKGROUND: We investigated the influence of the preoperative Controlling Nutritional Status (CONUT) score on survival and recurrence of gastric cancer in patients after curative treatment. PATIENTS AND METHODS: This study included 331 patients who underwent curative surgery followed by adjuvant treatment for gastric cancer between 2013 and 2017. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Based on the 1-, 3- and 5-year survival rates, a CONUT score of 2 was regarded as the optimal cut-off value for classification. The 3- and 5-year OS rates were 93.6% and 88.6%, respectively in the low-CONUT group, and 82.7% and 73.6% in high-CONUT group (p=0.022). The 3- and 5-year RFS rates were 78.8% and 68.7%, respectively, in the low-CONUT group, and 89.3% and 86.6%, respectively, in the high-CONUT group (p=0.05). A multivariate analysis showed that the CONUT score was a significant independent predictive factor for OS and RFS. CONCLUSION: The CONUT score was a predictive factor for survival in patients who underwent curative treatment for gastric cancer. It is necessary to develop an effective plan for perioperative care and surgical strategy according to the CONUT score.

DOI： 10.21873/invivo.12784

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Peritoneal metastasis (PM) is one of the most frequent forms of gastric cancer recurrence. In this study, we aimed to use computed tomography (CT) colonography (CTC) to detect signs of PM earlier in patients in whom PM was suspected but not yet diagnosed. CTC was used to evaluate patients with clinical symptoms or general CT findings that were suspicious but not sufficient to confirm PM. In total, 18 patients with suspected PM were enrolled. Ten patients (55.6%) had PM on CTC. Abnormal colonic deformities were identified at locations other than those of the lesions detected by general CT in seven patients. The sensitivity and specificity of CTC for the detection of PM were 83.3% and 100%, respectively. The median overall survival after CTC was 201 days in the CTC-positive group, which was significantly shorter than that in the CTC-negative group (945 days, p = 0.01). In the multivariate analysis, a positive CTC finding was the only factor independently associated with survival (p = 0.005). According to our experience with 18 patients, CTC can be an alternative to conventional imaging for early detection of PM. Further prospective studies with larger sample sizes are warranted to confirm and validate these findings. University hospital Medical Information Network Clinical Trials Registry (UMIN-CTR): Registration number: UMIN000044167.

DOI： 10.1371/journal.pone.0261527

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BACKGROUND/AIM: The albumin-bilirubin (ALBI) score, which evaluates the perioperative liver function, was developed, and had a clinical impact on both the short- and long-term oncological outcomes in some malignancies. We evaluated the clinical impact of preoperative albumin-bilirubin status in patients with resectable esophageal cancer who received curative treatment. PATIENTS AND METHODS: The study included 121 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2018. The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: Based on the 3- and 5-year OS rates, we set the cut-off value for the ALBI score at -2.7. Eighty patients were classified into the ALBI-low group (ALBI score <-2.7), 41 patients were categorized into the ALBI-high group (ALBI score >-2.7). The 3- and 5-year OS rates were 62.2% and 53.2%, respectively, in the ALBI-low group, and 42.2% and 35.2% in the ALBI-high group. There was a significant difference in OS (p=0.0113). The 3- and 5-year RFS rates were 43.1% and 40.3%, respectively, in the ALBI-low group and 37.7% and 26.1% in the ALBI-high group. There was a significant difference in RFS (p=0.048). When comparing the perioperative clinical course between the ALBI-high and ALBI-low groups, the incidence of postoperative anastomotic leakage was 46.3% (19/41) in the ALBI-high group, and 27.5% (22/80) in the ALBI-low group (p=0.038). CONCLUSION: The ALBI status had a clinical impact on both OS and RFS in esophageal cancer patients. Therefore, ALBI may have potential application as a prognostic factor for esophageal cancer patients.

DOI： 10.21873/invivo.12847

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BACKGROUND/AIM: The present study evaluated the clinical characteristics and prognostic factors of gastric cancer (GC) patients with synchronous and metachronous other primary cancer who received curative treatment for GC. PATIENTS AND METHODS: The study included 244 patients who underwent curative treatment for GC between 2005 and 2018. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: A total of 244 patients were included in this study. Among them, 58 patients were diagnosed with synchronous and metachronous other primary cancer. When comparing the patient background characteristics and clinical course between GC patients without and with synchronous and metachronous other primary cancer, the background, postoperative surgical complications, and details of adjuvant treatment were similar between the two groups. The 3- and 5-year OS rates in GC patients with synchronous and metachronous other primary cancer were 69.7% and 48.0%, respectively, while those in patients without synchronous and metachronous other primary cancer were 80.6% and 74.3%, respectively, showing a statistically significant difference (p<0.001) The synchronous and metachronous other primary cancer status was included in the final multivariate analysis model (hazard ratio=2.201; 95% confidence interval=1.229-3.942; p=0.008). CONCLUSION: Synchronous and metachronous other primary cancer status is a prognostic factor in GC patients. Therefore, synchronous and metachronous other primary cancer patients need both other primary cancer and GC follow-up to improve their survival.

DOI： 10.21873/invivo.12987

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BACKGROUND/AIM: The present study investigated the clinical impact of the lymph node ratio (LNR) on overall survival (OS) and recurrence-free survival (RFS) in cancer patients with lymph node metastasis who received curative treatment. PATIENTS AND METHODS: Eighty-six patients who received curative surgery for gastric cancer between 2000 and 2015, and in whom lymph node metastasis was pathologically confirmed, were included in this study. The LNR was defined as the ratio of the number of metastatic lymph nodes to the total number of harvested lymph nodes. RESULTS: A lymph node ratio of 0.23 was considered the optimal cutoff point for classification according to OS. Statistically significant differences were observed in the 3- and 5-year OS rates and 3- and 5-year RFS rates. The 3-year and 5-year OS rates in the LNR <0.23 group were 57.6% and 57.6%, respectively, whereas those in the LNR ≥0.23 group were 33.0% and 0% (p<0.001). The 3-year and 5-year RFS rates in the LNR <0.23 group were 45.9% and 43.6%, respectively, whereas those in the LNR >0.23 group were 25.2% and 0% (p=0.002). Regarding the site of first relapse, the incidence rates of peritoneal and lymph node metastasis in the LNR >0.23 group were significantly different in comparison to the LNR <0.23 group. CONCLUSION: A high LNR was associated with significantly worse OS and RFS in patients who received curative treatment for gastric cancer. The lymph node metastasis status should be utilized in the development of treatment strategies for gastric cancer.

DOI： 10.21873/invivo.12792

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BACKGROUND: We investigated the clinical influence of the prealbumin level on the gastric cancer survival and recurrence after curative treatment. METHODS: This study included 447 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: A prealbumin level of 20 mg/dl was regarded as the optimal point of classification, considering the 3- and 5-year survival rates. The OS rates at 3 and 5 years after surgery were 80.7% and 65.0% in the low-prealbumin group, respectively, and 93.1% and 87.9% in the high-prealbumin group, respectively, a statistically significant difference (p < 0.001). The RFS rates at 3 and 5 years after surgery were 71.7% and 68.0% in the low-prealbumin group, respectively, and 90.1% and 84.7% in the high-prealbumin group, respectively, a statistically significant difference (p = 0.031). A multivariate analysis demonstrated that the prealbumin level was a significant independent risk factor for the OS and RFS. In addition, the rate of introduction of adjuvant chemotherapy was significantly lower and the frequency of peritoneal recurrence and lymph node recurrence significantly higher in the low-prealbumin group than in the high-prealbumin group. CONCLUSION: Prealbumin is a risk factor for the survival in patients who undergo curative treatment for gastric cancer. It is necessary to develop an effective plan of perioperative care and surgical strategy according to the prealbumin level.

DOI： 10.1007/s12029-021-00777-w

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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BACKGROUND/AIM: The number of patients who have cardiovascular-morbidities and use antiplatelet and/or anticoagulation therapy is rapidly growing worldwide. The present study evaluated the safety and feasibility of gastrectomy for gastric cancer in patients who received antiplatelet and/or anticoagulation therapy in the perioperative period. PATIENTS AND METHODS: Cases were selected from the medical records of consecutive patients who were diagnosed with gastric cancer and underwent complete resection at the Kanagawa Cancer Center from 2013 to 2017. The patients were divided into the antiplatelet and/or anticoagulation treatment group and the non-antiplatelet and/or anticoagulation treatment group. RESULTS: Five hundred and six patients underwent gastrectomy for gastric cancer and were analyzed in the present study. Among them, 62 patients (12.3%) received anticoagulation therapy (anticoagulation group). When the anticoagulation and non-anticoagulation groups were compared, although there were some differences in patient background factors, the surgical findings, perioperative clinical course, and details of postoperative complications were similar. The incidence of postoperative bleeding was 0.8% (4/506) in all patients. The incidence of postoperative bleeding was 1.6% (1/62) in the anticoagulation group and 0.7% (3/446) in the non-anticoagulation group. Preoperative anticoagulation therapy was not identified as a significant independent risk factor for postoperative bleeding. CONCLUSION: These results suggest that curative gastrectomy for gastric cancer is safe and feasible, regardless of the perioperative use of antiplatelet and/or anticoagulation treatment. In addition, the perioperative use of antiplatelet and/or anticoagulation treatment was not a significant risk factor for postoperative bleeding after gastrectomy for gastric cancer.

DOI： 10.21873/anticanres.15375

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Language：Japanese   Publisher：日本臨床外科学会  

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BACKGROUND: Post-operative pneumonia is a major complication after general elective surgery in elderly patients and is often caused by aspiration associated with oesophageal reflux. The aim of this study was to identify the risk factors of post-operative pneumonia after gastrectomy in elderly patients with gastric cancer with two potential risk factors of ageing and oesophageal reflux. METHODS: We retrospectively examined the data of 251 patients ≥75 years old who underwent gastrectomy between January 2014 and December 2018 in our institution. The reconstruction methods were Billroth-I or Roux-Y after distal gastrectomy, jejunal interposition or double tract after proximal gastrectomy and Roux-Y after total gastrectomy. The severity of pneumonia was evaluated by the Clavien-Dindo classification. RESULTS: Post-operative pneumonia was identified in 15 patients (5.9%) and was significantly associated with an age ≥80 years old, poor performance status, history of smoking and cardia-non-preserving gastrectomy (total gastrectomy and proximal gastrectomy) in univariate analyses. Multivariate analyses showed that a poor performance status and cardia-non-preserving gastrectomy were independent risk factors for post-operative pneumonia. The patients who suffered post-operative pneumonia required a longer hospital stay than those without post-operative pneumonia (P = 0.002). CONCLUSION: We identified a poor performance status and cardia-non-preserving gastrectomy, which are likely to lead to oesophageal reflux, as risk factors for post-operative pneumonia in elderly patients with gastric cancer. These results warrant further prospective studies to evaluate their utility for reducing the rate of post-operative pneumonia in elderly patients through cardia-preserving gastrectomy or anti-reflux reconstruction.

DOI： 10.1093/jjco/hyab032

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Language：English   Publisher：(一社)日本胃癌学会  

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BACKGROUND: Most evidence regarding lateral lymph node dissection for rectal cancer is from expert settings. This study aimed to evaluate the safety and efficacy of this procedure in a practice-based cohort. METHODS: A total of 383 patients who were diagnosed with stage II-III mid-to-low rectal cancer between 2010 and 2019 and underwent primary resection with curative intent at a general surgery unit were retrospectively reviewed. After propensity matching, 144 patients were divided into the following groups for short- and long-term outcome evaluation: mesorectal excision with lateral lymph node dissection (n = 72) and mesorectal excision (n = 72). RESULTS: This practice-based cohort was characterized by a high pT4 (41.6%) and R1 resection (10.4%) rate. Although the operative time was longer in the lateral dissection group (349 min vs. 237 min, p < 0.001), postoperative complications (19.4% vs. 16.7%, p = 0.829), and hospital stay (18 days vs. 22 days, p = 0.059) did not significantly differ; 5-year relapse-free survival (62.5% vs. 66.4%, p = 0.378), and cumulative local recurrence (9.7% vs. 15.3%, p = 0.451) were also in the same range in both groups. In the seven locally recurrent cases in the lateral dissection group, four had undergone R1 resection. CONCLUSIONS: Lateral lymph node dissection was found to be safe in this practice-based cohort; however, the local control effect was not obvious. To maximize the potential merits of lateral lymph node dissection, strategies need to be urgently established to avoid R1 resection in clinical practice.

DOI： 10.1186/s12893-021-01053-1

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BACKGROUND: The lymph node (LN) ratio (LNR) and the log odds of positive LNs (LODDS) have been proposed as sensitive prognosticators in patients with primary gastric cancer, especially in patients with an insufficient number of harvested LNs. We investigated the association of LNR and LODDS with survival in patients with remnant gastric cancer (RGC) and explored whether these staging methods are prognostic factors in patients with an insufficient number of harvested LNs. METHODS: The present study retrospectively examined 95 patients with RGC who received gastrectomy between January 2000 and December 2018. The patients were classified according to the adjusted X-tile cutoff for LNR and LODDS. The association between survival rates and clinicopathological features was investigated. The predictive accuracy of the LNR and LODDS was compared with that of the Union for International Cancer Control pathological N factor. RESULTS: Multivariate analysis revealed that the LNR and LODDS were independent risk factors for recurrence-free survival (RFS) [hazard ratio (HR) 2.623, p = 0.020; HR 3.404, p = 0.004, respectively] and overall survival (OS) (HR 3.694, p = 0.003; HR 2.895, p = 0.022, respectively) in patients with RGC. Moreover, even in patients with 15 or fewer harvested LNs, only the LNR was a significant independent risk factor for RFS (HR 21.890, p < 0.001) and OS (HR 6.597, p = 0.002). The receiver operating characteristic curves revealed that the prognostic accuracy of the three methods was comparable (p > 0.05). CONCLUSION: LNR has significant prognostic value for patients with RGC, including those with an insufficient number of harvested LNs.

DOI： 10.1245/s10434-020-09433-2

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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Language：Japanese   Publisher：(公社)神奈川県医師会  

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BACKGROUND: We investigated the impact of the pre-surgical C-reactive protein-to-albumin ratio (CAR) on survival and recurrence after curative treatment for gastric cancer. PATIENTS AND METHODS: This study included 481 patients who underwent curative treatment for gastric cancer between 2013 and 2017. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: A CAR of 0.05 was regarded as the optimal critical point of classification considering the 3- and 5-year survival rates and patients were divided according to their CAR. The OS rates at 3 and 5 years after surgery were significantly higher at 92.5% and 87.9%, respectively, in the low-CAR group compared with 84.9% and 71.9%, respectively, in the high-CAR group. The corresponding RFS rates were 89.1% and 85.5%, and 81.0% and 72.2%, respectively, also a significant difference. A multivariate analysis demonstrated that the CAR was a significant independent risk factor for the OS and marginally significant independent risk factor for the RFS. In addition, the incidences of pancreatic fistula and abdominal abscess were significantly higher and the rate of introduction of adjuvant chemotherapy significantly lower in the high-CAR group. CONCLUSION: The CAR was a risk factor influencing survival in patients who underwent curative treatment for gastric cancer. An effective perioperative care plan and surgical strategy need to be developed according to the CAR.

DOI： 10.21873/invivo.12648

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BACKGROUND/AIM: Cancer stem cells (CSCs) are reported to associated with cancer metastasis, relapse, and chemoresistance. This study examined the clinical significance of the expression of two CSC markers, the transporter associated with antigen processing 1 (TAP1) and the Delta-like 4 (DLL4) protein, in patients with locally advanced GC. PATIENTS AND METHODS: This study was performed using samples obtained from 413 pathological stage II/III GC patients after curative gastrectomy. We examined TAP1 and DLL4 expression using immunohistochemical analysis with tissue microarray and examined the association between TAP1 or DLL4 expression, clinicopathological factors and survival. RESULTS: High TAP1 expression was associated with better overall survival compared to low TAP1 expression (p=0.004). Furthermore, in multivariate analysis, high TAP1 expression was defined as a predictive factor for good survival. There was no significant difference between DLL4 expression and clinicopathological features and overall survival. CONCLUSION: TAP1 expression may be a useful prognostic marker in patients with locally advanced GC.

DOI： 10.21873/invivo.12562

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Springer  

We investigated the impact of the neutrophil to lymphocyte ratio on esophageal cancer survival and recurrence after curative treatment. This study included 120 patients who underwent curative surgery followed by adjuvant treatment for esophageal cancer between 2008 and 2018. The risk factors for overall survival and recurrence-free survival (RFS) were identified. Neutrophil to lymphocyte ratio of 2.38 was regarded to be the optimal critical point of classification considering the 1-year, 3-year, and 5-year survival rate. The overall survival rates at 3 and 5 years after surgery were 70.5% and 63.0% in the neutrophil to lymphocyte ratio low group, respectively, and 41.0% and 29.7% in neutrophil to lymphocyte ratio high group, which amounted to a statistically significant difference (p=0.001). The recurrence-free survival rates at 3 and 5 years after surgery were 48.6% and 40.7% in the neutrophil to lymphocyte ratio low group, respectively, and 33.6% and 26.9% in neutrophil to lymphocyte ratio high group, which amounted to a statistically significant difference (p=0.046). A multivariate analysis demonstrated that the neutrophil to lymphocyte ratio was a significant independent risk factor for both the overall survival and recurrence-free survival. Neutrophil to lymphocyte ratio was a risk factor for survival in patients who underwent curative treatment for esophageal cancer. It is necessary to develop the effective plan of the perioperative care and the surgical strategy according to the neutrophil to lymphocyte ratio.

DOI： 10.1007/s12262-021-02830-1

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BACKGROUND: The aim of the present study was to determine the utility of the C-reactive protein-to-albumin ratio (CAR) for predicting the overall survival (OS) in locally advanced colorectal cancer (CRC) patients. PATIENTS AND METHODS: This retrospective multicenter study was performed using data from a prospectively maintained database of pathological Stage II or III patients undergoing CRC surgery at the Yokohama City University, Department of Surgery, and its affiliated institutions between April 2000 and March 2016. The risk factors for the OS were identified. RESULTS: A CAR of 0.03 was considered to be the optimal cutoff point for classification based on the 1-, 3-, and 5-year survival rates and receiver operating characteristic curve. The OS rates at 3 and 5 years after surgery were 92.4% and 85.7% in the CAR-low group, respectively, and 86.7% and 81.1% in the CAR-high group. A multivariate analysis showed that the CAR was a significant independent risk factor for the OS. When comparing the patients' demographic and clinical characteristics between the CAR ≤0.03 and >0.03 groups, the incidence of patients who received adjuvant chemotherapy and the incidence of postoperative complications were significantly different between the two groups. CONCLUSION: The present study showed that the preoperative CAR was a risk factor for the OS in patients who underwent surgery for CRC. To improve the patients' survival, CAR might be a useful tool for devising treatment strategies.

DOI： 10.4103/jcrt.JCRT_355_19

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BACKGROUND: A multi-institutional phase II study was conducted to evaluate the efficacy and safety of preoperative docetaxel, cisplatin and S-1 therapy in marginally resectable advanced gastric cancer. METHODS: Patients with macroscopic type 4, large macroscopic type 3 and bulky lymph node metastasis received two cycles of preoperative docetaxel, cisplatin and S-1 therapy (docetaxel 40 mg/m2 and cisplatin 60 mg/m2 on day 1, and S-1 80 mg/m2 for 14 days, every 4 weeks). The primary endpoint was the pathological response rate, with an expected value of 65%. RESULTS: Thirty-one patients were enrolled in this study. The pathological response rate was 54.8%, and it was higher than the threshold value but lower than the expected rate. The R0 resection rate was 93.5%. The frequencies of grade 3-4 toxicities during docetaxel, cisplatin and S-1 therapy were 41.9% for neutropenia, 6.5% for febrile neutropenia and 32.3% for nausea/vomiting. Grade 2 and 3 surgical morbidities occurred in 23.3 and 6.7% of the patients, respectively. CONCLUSIONS: Preoperative docetaxel, cisplatin and S-1 therapy was feasible in terms of chemotherapy-related toxicities and surgical morbidity, but the effect did not achieve the expected value. The association between the pathological response rate and survival will be evaluated in the final analysis of this clinical trial.

DOI： 10.1093/jjco/hyaa221

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Language：English   Publisher：(一社)日本消化器外科学会  

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BACKGROUND/AIM: Glioma-associated oncogene 1 (GLI1) is an important transcription factor in the hedgehog signalling pathway and tumour formation. We evaluated the clinical significance of GLI1 expression as a prognostic factor in patients with locally advanced gastric cancer (GC). PATIENTS AND METHODS: GLI1 expression levels were measured by quantitative real-time polymerase chain reaction analysis of cancerous and adjacent normal mucosa specimens obtained from 142 patients with Stage II/III GC administered adjuvant chemotherapy with S-1 after curative resection. The associations of GLI1 expression with clinicopathological features and survival were evaluated. RESULTS: Clinicopathological features and GLI1 expression showed no association. Overall survival was significantly poorer in the high compared to the low GLI1 expression group (p=0.04). Multivariate analysis revealed that GLI1 expression was a significant independent prognostic factor [p=0.019, hazard ratio (HR)=1.94, 95% confidence interval (CI)=1.70-3.38]. CONCLUSION: GLI1 expression may be a useful prognostic marker in patients with locally advanced GC.

DOI： 10.21873/anticanres.14599

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BACKGROUND: Lymph node ratio (LNR), defined as the ratio of metastatic nodes to the total number of examined lymph nodes, has been proposed as a sensitive prognostic factor in patients with gastric cancer (GC). We investigate its association with survival in pathological stage (pStage) II/III GC and explore whether this is a prognostic factor in each Union for International Cancer Control pStage (7th edition). PATIENTS AND METHODS: We retrospectively examined 838 patients with pStage II/III GC who underwent curative gastrectomy between June 2000 and December 2018. Patients were classified into low-LNR (L-LNR), middle-LNR (M-LNR), and high-LNR (H-LNR) groups according to adjusted X-tile cutoff values of 0.1 and 0.25 for LNR, and their clinicopathological characteristics and survival rates were compared. RESULTS: The 5-year recurrence-free survival (RFS) and overall survival (OS) rates postsurgery showed significant differences among the groups (P < 0.001). Multivariate analysis demonstrated that LNR was a significant predictor of poor RFS [M-LNR: hazard ratio (HR) 3.128, 95% confidence interval (CI) 2.254-4.342, P < 0.001; H-LNR: HR 5.148, 95% CI 3.546-7.474, P < 0.001] and OS (M-LNR: HR 2.749, 95% CI 2.038-3.708, P < 0.001; H-LNR: HR 4.654, 95% CI 3.288-6.588, P < 0.001). On subset analysis stratified by pStage, significant differences were observed between the groups in terms of the RFS curves of pStage II and III GC (P < 0.001 and < 0.001, respectively) and OS curves of pStage II and III GC (P = 0.001 and < 0.001, respectively). CONCLUSIONS: High LNR is a predictor of worse prognosis in pStage II/III GC, including each substage.

DOI： 10.1245/s10434-020-08616-1

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BACKGROUND: The aim of this study was to evaluate the impact of postoperative infectious complications on long-term outcomes after curative resection of gastric cancer. PATIENTS AND METHODS: Patients who underwent curative gastrectomy with lymphadenectomy for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015 were retrospectively selected from medical records. Clinicopathological factors between patients with and without infectious complications were compared. Prognostic factors of long-term survival were analyzed by univariate and multivariate Cox proportional hazards analyses. RESULTS: A total of 2,254 patients were eligible for inclusion in the present study. Fifty-eight patients had postoperative infectious complications (IC group); 2,196 had no postoperative infectious complications (NC group). In the IC group, the median age (p=0.031), body mass index (p=0.004), American Society of Anesthesiologists physical status (p=0.006) and percentage of male patients (p<0.001) were higher in comparison to the NC group. The operation time was longer (p<0.001) and the incidence of intestinal-type histology was higher (p=0.017) in the IC group. The 5-year overall survival rates of the IC and NC groups were 59.8% and 83.2%, respectively (p<0.001). Univariate and multivariate analyses demonstrated that postoperative infectious complications were a significant risk factor for poorer overall survival (hazard ratio=2.38; 95% confidence interval=1.47-3.85, p<0.001). CONCLUSION: Perioperative management is necessary to reduce the incidence of postoperative infectious complications and improve the survival of patients after curative resection of gastric cancer.

DOI： 10.21873/anticanres.14404

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Language：Japanese   Publisher：(一社)日本大腸肛門病学会  

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Gastrojejunostomy has been performed as a palliative treatment for unresectable, advanced gastric cancer patients with gastric outlet obstruction (GOO). However, its role before neoadjuvant chemotherapy (NAC) has not been established. We present the case of a 72-year-old man with distal advanced gastric cancer with GOO. Computed tomography showed para-aortic lymph node (PAN) metastasis without other distal metastasis. We performed laparoscopic stomach-partitioning gastrojejunostomy (LSPGJ), which avoided new gastrojejunostomy reconstruction when performing distal gastrectomy after NAC. His oral intake improved after surgery and NAC was successfully administered on postoperative day 14, without surgical complications. After completion of NAC, the patient underwent radical distal gastrectomy with gastrojejunostomy reused as Billroth-II reconstruction. A histological examination revealed no residual cancer cells. LSPGJ, with partitioning on the expected resection line in distal gastrectomy after NAC, can be useful for treating advanced gastric cancer with GOO when NAC followed by curative gastrectomy is planned.

DOI： 10.1111/ases.12741

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BACKGROUND: Several immune-inflammatory markers are associated with cancer progression. The purpose of the present study was to clarify the influence of the preoperative C-reactive protein-to-albumin ratio (CRP/ALB ratio) on survival of patients with esophageal cancer and recurrence after curative resection. PATIENTS AND METHODS: The preoperative CRP/ALB ratio was evaluated in 122 patients who underwent radical resection for esophageal cancer from 2005 to 2018. The correlations between the CRP/ALB ratio and cancer-specific overall (OS), recurrence-free (RFS) survival and the clinicopathological status were analyzed. RESULTS: The optimal cut-off value of the CRP/ALB ratio determined using receiver operating characteristic curve analysis was 0.04. Patients were divided into two groups based on this cut-off value: the low CRP/ALB group (n=59) and the high CRP/ALB group (n=50). The OS rate at 5 years after surgery was significantly lower in the group with high CRP/ALB at 40.5% whilst it was 63.5% in the low CRP/ALB group (p=0.005). The corresponding RFS rates at 5 years after surgery were 32.5% and 48.3%, respectively, which was a statistically significant difference (p=0.007). A multivariate analysis showed that a high CRP/ALB ratio was a significant independent risk factor for poorer cancer-specific OS and RFS. CONCLUSION: The preoperative CRP/ALB ratio was a strong prognostic marker for patients with esophageal cancer. The surgical strategy, including procedure and perioperative care should be carefully planned for patients with a high CRP/ALB ratio.

DOI： 10.21873/anticanres.14205

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BACKGROUND: The aim of the present study was to evaluate the clinical impact of the perioperative use of antiplatelet/anticoagulation therapy for postoperative bleeding after esophagectomy for esophageal cancer. PATIENTS AND METHODS: Patients were selected from the medical records of consecutive patients who were diagnosed with primary esophageal adenocarcinoma or squamous cell carcinoma and who underwent complete resection at Yokohama City University from January 2005 to September 2018. The patients were divided into the antiplatelet/anticoagulation treatment group and the non-treatment group. We compared the safety and feasibility of esophagectomy between two groups. RESULTS: One hundred and twenty-two patients underwent esophagectomy for esophageal cancer and were analyzed in the present study. Among them, 18 (14.8%) received anti-thrombotic therapy (anticoagulation group). The incidence of postoperative bleeding in patients overall was 8.2% (10/122). The incidence of postoperative bleeding in the anticoagulation group was 22.2% (4/18), while that in the non-anticoagulation group was 5.8% (6/104). Preoperative anticoagulation therapy was identified as a significant independent risk factor for postoperative bleeding (hazard ratio=4.673, 95% confidence interval=1.170-18.519; p=0.029). CONCLUSION: The perioperative use of anti-thrombotic therapy was a significant risk factor for postoperative bleeding after esophagectomy for esophageal cancer. Thus, when patients receive perioperative antiplatelet/anticoagulation treatment, careful attention is required after esophagectomy due to their increased risk of postoperative bleeding.

DOI： 10.21873/anticanres.14204

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BACKGROUND: This study aimed to investigate the impact of postoperative complications (PCs) in patients with pathological stage (pStage) II or III gastric cancer (GC) who received adjuvant chemotherapy with S-1 after curative surgery. PATIENTS AND METHODS: Altogether, data for 226 patients were examined retrospectively. The relationship between PCs and clinicopathological features and survival were examined. RESULTS: Recurrence-free survival was significantly worse in the group with PCs than in the PC-negative group. On multivariate analysis, having PCs of grade 2 or more was an independent risk factor for recurrence (hazard ratio=1.721; 95% confidence intervaI=1.014-2.920; p=0.044). In addition, for each pStage analysis, having PCs of grade 2 or more was a risk factor for recurrence even in patients with pStage II GC. CONCLUSION: PC of grade 2 or more was an independent risk factor for recurrence in patients with pStage II GC who received adjuvant chemotherapy with S-1 after curative gastrectomy. Thus, for patients with PCs, even for those with pStage II GC, more effective adjuvant chemotherapy, such as S-1 plus docetaxel, may be needed.

DOI： 10.21873/anticanres.14120

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Language：English   Publisher：(一社)日本胃癌学会  

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The effectiveness of lymph node dissection tends to be reduced clinically in elderly patients with colorectal cancer because of physical limitations, such as comorbidities and organ dysfunction. We investigated the influence of the level of lymph node dissection on the prognosis of elderly patients with colorectal cancer. A total of 137 patients with pT2 or more-advanced tumors or lymph node metastasis were retrospectively studied. The 5-year overall survival(OS)andrelapse free survival(RFS) rates were 74.1% and 63.9%, respectively. Lymph node dissection was an independent prognostic factor in the examination of prognostic factors of OS. In the propensity-matchedcohort, the 5-year OS rates were 87.2% and5 8.2%(p=0.02), and the 5-year RFS rates were 77.8% and4 6.4%(p=0.03)in the D3 andred ucedgroups, respectively. The D3 group hada significantly better prognosis than the reduced group. D3 lymph node dissection might contribute to the improvement of prognosis in elderly people with colorectal cancer.

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Language：Japanese   Publisher：(株)癌と化学療法社  

高齢者大腸癌症例では併存疾患や臓器機能低下など身体的制限から、臨床的にリンパ節郭清を縮小する傾向にある。高齢者大腸癌手術におけるリンパ節郭清度が予後に与える影響について検討を行った。pT2以深またはリンパ節転移陽性であった137例を対象とした。5年全生存率(overall survival:OS)、5年無再発生存率(relapse free survival:RFS)はそれぞれ74.1%、63.9%であった。OSに対する予後因子の検討では、リンパ節郭清度が独立した予後因子であった。傾向スコアマッチングによる43例ずつでの長期成績の検討では、5年OS(D3群87.2% vs縮小群58.2%、p=0.02)、5年RFS(77.8% vs 46.4%、p=0.03)で、いずれもD3群が縮小群よりも有意に予後良好であった。高齢者大腸癌手術においてD3リンパ節郭清は予後の向上に寄与する可能性が示唆された。(著者抄録)

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BACKGROUND: The short- and long-term outcomes of esophagectomy for esophageal cancer were fully evaluated in patients older than 75 years of age. PATIENTS AND METHODS: The present study selected patients who received esophagectomy for esophageal cancer. Patients were divided into non-elderly patients [age <75 years (non-elderly group)] and elderly patients [age ≥75 years (elderly group)]. The postoperative surgical morbidity, postoperative 30-days mortality, recurrence-free survival (RFS), and overall survival (OS) rates were evaluated between the non-elderly group and elderly group. RESULTS: One hundred twenty-two patients were evaluated in this study. Ninety-eight patients and 24 patients were classified into the non-elderly group and elderly group, respectively. The postoperative surgical complication rates in the non-elderly and elderly groups were 71.4% and 75.0%. There was not a statistically significant difference between the two groups (p=0.710). Mortality was observed in 1 patient in the elderly group (4.2%) due to cardiovascular disease. Significant differences were observed in the five-year OS and RFS rates of the elderly and non-elderly groups (55.4% vs. 29.7%, p=0.0017 and 42.2% vs. 21.2%, p=0.0334, respectively). CONCLUSION: Although the rate of postoperative surgical complications after esophagectomy for esophageal cancer was almost equal in the elderly and the non-elderly patients, significant differences were observed in the mortality and long-term outcomes of the two groups. Thus, the surgical strategy and perioperative care must be carefully planned for esophageal cancer patients older than 75 years of age.

DOI： 10.21873/anticanres.14047

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Language：Japanese   Publisher：(株)癌と化学療法社  

高齢者大腸癌症例では併存疾患や臓器機能低下など身体的制限から、臨床的にリンパ節郭清を縮小する傾向にある。高齢者大腸癌手術におけるリンパ節郭清度が予後に与える影響について検討を行った。pT2以深またはリンパ節転移陽性であった137例を対象とした。5年全生存率(overall survival:OS)、5年無再発生存率(relapse free survival:RFS)はそれぞれ74.1%、63.9%であった。OSに対する予後因子の検討では、リンパ節郭清度が独立した予後因子であった。傾向スコアマッチングによる43例ずつでの長期成績の検討では、5年OS(D3群87.2% vs縮小群58.2%、p=0.02)、5年RFS(77.8% vs 46.4%、p=0.03)で、いずれもD3群が縮小群よりも有意に予後良好であった。高齢者大腸癌手術においてD3リンパ節郭清は予後の向上に寄与する可能性が示唆された。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J00296&link_issn=&doc_id=20200220310013&doc_link_id=%2Fab8gtkrc%2F2020%2F004702%2F014%2F0259-0261%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2020%2F004702%2F014%2F0259-0261%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: To evaluate the outcomes of curative resection for Borrmann type IV gastric cancer through an analysis of the clinical, surgical and pathological data and through identifying which of these prognostic factors are associated with survival. PATIENTS AND METHODS: We retrospectively analyzed 2798 patients who had undergone excision of the primary lesion and 122 patients with type IV gastric cancer undergoing curative resection (R0 or 1) at Yokohama City University Hospital and Kanagawa Cancer Center between November 1995 and May 2016. RESULTS: Borrmann type IV gastric cancer had more advanced and unfavorable clinicopathological factors compared to other types. The 5-year overall survival rate was 28%, and the median survival was 21.8 months. The overall survival rate was influenced by the depth of invasion, lymph node metastasis, peritoneal lavage cytology (CY), stage and intraoperative blood loss. Of these, independent prognostic factors were intraoperative blood loss (<400 vs. ≥400 ml, risk ratio 1.64; p=0.045) and CY (0 vs. 1, risk ratio 2.25; p=0.004). CONCLUSION: The control of intraoperative bleeding had a positive impact on the survival of patients receiving curative resection for Borrmann type IV gastric cancer.

DOI： 10.21873/anticanres.13967

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BACKGROUND: We investigated the clinical influence of anastomotic leak (AL) on esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into those with AL and those without. The risk factors for overall (OS) and recurrence-free (RFS) survival were identified. RESULTS: AL was found in 44 out of the 122 patients (36.1%). The respective OS rates at 3 and 5 years after surgery were 43.9% and 40.2% in the AL group and 63.9% and 53.2% in the non-AL group, which were significantly different (p=0.0049). In contrast, the respective RFS rates at 3 and 5 years after surgery were 44.8% and 29.8%, and 44.9% and 42.4%, which were not significantly different (p=0.2306). A multivariate analysis showed that AL was a significant independent risk factor for both poorer OS and RFS in patients who underwent curative surgery for esophageal cancer. CONCLUSION: To improve survival of patients with esophageal cancer, the surgical procedure, perioperative care and surgical strategy must be carefully planned in order to prevent AL.

DOI： 10.21873/anticanres.13972

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BACKGROUND/AIM: Endothelial cell-specific molecule-1 (ESM-1) is a soluble proteoglycan which has important role in various biological events. We investigated the impact of the ESM-1 expression in cancer tissues on outcomes in stage II/III gastric cancer patients who received adjuvant S-1 chemotherapy. PATIENTS AND METHODS: The ESM-1 mRNA expression in cancerous tissues and adjacent normal mucosa from 253 patients was measured. The associations between the ESM-1 gene expression and the survival and clinicopathological features were investigated. RESULTS: A significant association was observed between high ESM-1 expression and undifferentiated adenocarcinoma. The overall survival curve was significantly lower in patients with high ESM-1 expression than in those with low expression (p=0.005). High ESM-1 expression was a significant independent prognosticator (HR=2.291, p=0.007). CONCLUSION: ESM-1 gene expression in cancerous tissues is an important prognosticator in stage II/III gastric cancer patients who received adjuvant S-1 chemotherapy.

DOI： 10.21873/invivo.11796

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PURPOSE: The enzymes gamma-glutamyl hydrolase (GGH) and folylpolyglutamate synthetase (FPGS) regulate intracellular folate concentrations needed for cell proliferation, DNA synthesis, and repair. High GGH expression affects 5-FU thymidylate synthase (TS) inhibition and is a risk factor for various malignancies. Here, the clinical significance of GGH and FPGS expression was investigated in Stage II/III gastric cancer patients undergoing postoperative adjuvant chemotherapy with S-1. METHODS: Surgical specimens of cancer tissue and adjacent normal mucosa, obtained from 253 patients with previously untreated gastric cancer, were examined. GGH and FPGS mRNA expression was measured by qPCR to evaluate their clinicopathological significance in gastric cancer patients after curative resection. RESULTS: While FPGS expression showed no significant differences between the cancerous and normal samples, GGH expression was higher in cancer tissue than in adjacent normal mucosa. High GGH expression was correlated with age, histological type, and vascular invasion. Overall survival (OS) of patients with high GGH mRNA expression was significantly poorer than of patients with low GGH expression. Multivariate analysis showed that high GGH expression was an independent prognostic factor of OS (HR: 2.58, 95% CI 1.29-5.16). Patients who received S-1 adjuvant treatment showed a significantly poor OS between high GGH/low FPGS and low GGH/high FPGS. Patients without adjuvant treatment showed no significant difference. CONCLUSION: GGH expression was significantly higher in gastric cancer tissue than in adjacent normal mucosa. High GGH and low FPGS expression is a useful independent predictor of poor outcomes in stage II/III gastric cancer patients undergoing postoperative adjuvant chemotherapy with S-1.

DOI： 10.1007/s00432-019-03087-8

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BACKGROUND: The short- and long-term outcomes of gastrectomy in elderly patients with gastric cancer have not been fully evaluated. PATIENTS AND METHODS: Patients who underwent gastrectomy were classified into two groups: Non-elderly patients (<80 years old) and elderly patients (≥80 years old). The surgical morbidity, overall and cancer-specific survival in the two groups were compared. RESULTS: A total of 411 patients were evaluated. The rate of overall complication was 29.4% in the non-elderly and 32.4% in the elderly (p=0.699). In the elderly, the overall and cancer-specific survival rates at 5 years after surgery were inferior to those of the younger group (59.8% vs. 66.7%, p=0.103 and 67.9% vs. 78.2%, p=0.028, respectively). CONCLUSION: The short-term outcomes after gastrectomy were almost equal for the two groups in the present study. The prognosis was poor in elderly patients, especially those with advanced gastric cancer.

DOI： 10.21873/invivo.12090

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© 2020 International Institute of Anticancer Research. All rights reserved. Background/Aim: Tumor microenvironments consist of many types of immune cells, in which regulatory T-cells (Tregs) are supposed to play important roles to suppress antitumor immunity. Regional lymph nodes are essential for antitumor immunity in colorectal cancer (CRC). In this study, we compared the diversity of phenotypes of T-cells in normal tissue and regional lymph nodes in order to determine the immunosuppressive mechanism of lymph node metastasis of CRC. Patients and Methods: Fifty patients were enrolled in this study, and paired samples (tumor tissue, normal tissue, and three regional lymph node samples and as well as non-regional lymph node samples) were obtained from each patient. In each paired-sample set, the proportions of different immune cell types and T-cells expressing immune checkpoint molecules were compared using flow cytometry. Results: Higher proportions of Tregs [7.58% (4.94%-13.87%) vs. 1.79% (0.03%-5.36%), p<0.001] and lower proportions of INFγ- producing CD4-positive T (iCD4+) cells [21.49% (12.08%- 27.35%) vs. 26.55% (15.65%-37.63%), p<0.001] were observed in tumor tissue than in normal mucosa. Parts of regional lymph nodes nearest the tumor had a greater proportion of Tregs [5.86% (4.18%-7.69%)] and lower proportions of iCD4+ [5.94% (3.51%-9.04%)] and INFγ- producing CD8-positive T (iCD8+) cells [21.93% (14.92%- 35.90%)] than distant parts of regional lymph nodes and nonregional lymph nodes. Both immune-suppressing molecules (CTLA-4 and PD-1) and immune-promoting molecules (OX-40 and ICOS) tended to be highly expressed in tumor tissue and local lymph nodes. Conclusion: In patients with CRC, regional lymph nodes, especially the parts nearest the tumor, had a higher proportion of Tregs and other suppressive immunophenotypes of T-cells than those located more distantly.

DOI： 10.21873/invivo.11848

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: Minimally invasive esophagectomy theoretically has advantages over open esophagectomy. The purpose of the present study was to compare the short-and long-term outcomes of patients who underwent video-assisted thoracoscopic esophagectomy (VATE) or conventional open esophagectomy (OE) for esophageal carcinoma. Methods: A total of 122 patients who underwent radical esophagectomy via VATE (VATE group, N = 87) and OE (OE group, N = 35) for esophageal carcinoma between 2005 and 2018 were retrospectively enrolled in this study, and the postoperative outcomes were compared. Results: The OE group had younger patients and more patients who received neo-adjuvant therapy that the VATE group. The procedure time in the OE group was also shorter than that in the VATE group (8.22 vs. 10.28 h, P &lt
0.001). Intraoperative blood loss was similar between the groups (P = 0.775). There were no significant differences in the total number of dissected lymph nodes between the groups (OE: 33, VATE: 37, P = 0.482). The incidence of severe complications was lower in the VATE group than in the OE group (44.8% vs. 65.7%, P = 0.037). With a median follow-up of 26 months, the 3-year overall survival and disease-free survival were similar between the two groups. Conclusion: VATE for esophageal carcinoma is associated with more favorable short-term outcomes and equal oncological outcomes compared with OE.

DOI： 10.4993/acrt.28.97

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BACKGROUND/AIM: The aim of the present study was to evaluate the optimal number of harvested LNs (LNs) in patients who were LN metastasis-negative after curative esophagectomy for esophageal cancer. PATIENTS AND METHODS: Sixty-one patients who underwent curative surgery for esophageal cancer between 2005 and 2017 and diagnosed as lymph node metastasis-negative were included in this study. RESULTS: The 5-year overall survival rates were 27.8% for 0-20 harvested LNs, 35.7% for 21-30 harvested LNs, 79.4% for 31-40 harvested LNs, and 85.2% for ≥41 harvested LNs. Thirty harvested LNs was regarded as the optimal critical point of classification, considering the 5-year OS rate. The number of harvested LNs was selected as a significant prognostic factor in both univariate and multivariate analyses. The respective 3- and 5-year OS rates were 50.3% and 36.7% for <30 harvested LNs and 82.4% and 82.4% for ≥30 harvested LNs (p=0.003). CONCLUSION: Thirty or more harvested LNs was a significant prognostic factor in patients with metastasis-negative LNs after curative esophagectomy for esophageal cancer. Therefore, the number of harvested LNs might be useful for predicting the LN metastasis status in esophageal cancer.

DOI： 10.21873/invivo.12001

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BACKGROUND/AIM: We investigated the clinical impact of the lymph node ratio (LNR) on overall survival (OS) and recurrence-free survival (RFS) in esophageal cancer patients who underwent curative surgery. PATIENTS AND METHODS: One hundred twenty patients who underwent curative surgery for esophageal cancer between 2005 and 2017 were included in this study. The LNR was defined as the ratio of the number of metastatic lymph nodes (LNs) to the total number of harvested LNs. RESULTS: A lymph node ratio of 10% was regarded as the optimal critical point for classification based on the overall survival rate. The 3-year and 5-year OS rates were 65.5% and 57.0%, respectively, in the LNR<10% group, and 11.8% and 0% in the LNR≥10% group; the difference was statistically significant (p<0.001). The 3-year and 5-year RFS rates were 52.6% and 44.6%, respectively, in the LNR<10% group, and 0% and 0% in the LNR>10% group; the difference was also statistically significant (p<0.001). When comparing the sites of first relapse, the incidence of distant lymph node metastasis in the LNR>10% group was significantly higher than that in the LNR<10% group. CONCLUSION: The LNR was a risk factor for both OS and RFS in patients who underwent curative surgery for esophageal cancer.

DOI： 10.21873/invivo.12012

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BACKGROUND/AIM: We investigated the impact of the age-adjusted Charlson comorbidity index (ACCI) on esophageal cancer survival and recurrence after curative treatment. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery followed by adjuvant chemotherapy for esophageal cancer between 2005 and 2017. The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: An ACCI of 5 was regarded as the optimal critical point of classification considering the survival rates. The OS rates at 3 and 5 years after surgery were 64.2% and 54.4% in the low-ACCI group, respectively, and 42.3% and 29.2% in high-ACCI group, respectively (p=0.035). The RFS rates at 3 and 5 years after surgery were 50.2% and 43.6% in the low-ACCI group, respectively, and 28.5% and 21.3% in high-ACCI group, respectively (p=0.021). A multivariate analysis demonstrated that ACCI was a significant independent risk factor for both the OS and RFS. CONCLUSION: ACCI is a risk factor for survival in patients who undergo curative treatment for esophageal cancer. An effective plan for the perioperative care and surgical strategy should be developed according to ACCI.

DOI： 10.21873/invivo.12103

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BACKGROUND/AIM: We performed a retrospective multi-center cohort analysis to compare the outcomes of laparoscopic surgery vs. open surgery for obstructive colon cancer. PATIENTS AND METHODS: A total of 455 patients with colon cancer with ileus underwent surgery at Yokohama City University Hospital and four related institutions from April 2000 to March 2016. RESULTS: There were 414 cases in the open surgery group and 41 cases in the laparoscopic surgery group with no marked differences in the gender or age. The postoperative complication rate, according to the Clavien-Dindo classification, was lower in the laparoscopic group compared to the open surgery group. The postoperative hospital stay was 16 days in the open surgery group and 9 days in the laparoscopic surgery group (p=0.004). Among the various factors examined, the operation approach was identified as a statistically significant independent risk factor for postoperative complications (p=0.015). CONCLUSION: Preoperative treatment for colon cancer with ileus and elective laparoscopic surgery are thought to be useful for achieving curative treatment, avoiding colostomy, and shortening the length of hospital stay.

DOI： 10.21873/invivo.12105

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BACKGROUND/AIM: The present study aimed to identify risk factors for anastomosis leak (AL) after esophagectomy for esophageal cancer. PATIENTS AND METHODS: One-hundred twenty-two patients who underwent esophagectomy for esophageal cancer between 2008 and 2018 were included. The rate of AL was measured based on the definition of leak as adapted from the Surgical Infection Study Group. To identify the risk factors for AL, logistic regression analysis was used. RESULTS: AL was found in 44 of the 122 patients (36.1%). Among the factors examined, the lymph node dissection status (p=0.007) and preoperative serum albumin level (p=0.022) were significant independent risk factors for AL. The incidence of AL was 26.7% (20 of 75) among patients who received 2-field lymph node dissection and 51.1% (24 of 47) among those who received 3-field lymph node dissection. The incidence of AL was 29.9% (23 of 77) in the preoperative serum albumin levels ≥4.0 g/dl group and 46.7% (21 of 45) in the serum albumin levels <4.0 g/dl group. CONCLUSION: Lymph node dissection status and preoperative serum albumin levels were risk factors for AL in patients who received esophagectomy for esophageal cancer.

DOI： 10.21873/invivo.11849

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BACKGROUND/AIM: The KIAA1199 gene has been associated with cancer-cell proliferation, but its functions remain poorly studied. Here, we examined the clinical significance of the KIAA1199 mRNA levels in locally advanced gastric cancer (GC). Materials and Methods/Results: Using samples from 254 patients with stage II/III GC, we found significantly higher KIAA1199 levels in cancerous tissues compared to adjacent normal mucosa (ANM). There was no significant relationship between KIAA1199 expression and clinical features. Although overall survival rates (OSR) of patients, who underwent surgery did not correlate with KIAA1199 expression, patients who underwent adjuvant chemotherapy with S-1 and had high KIAA1199 levels displayed significantly lower OSR. KIAA1199 knock down (KIAA1199-KD) suppressed proliferation, invasiveness, and sensitivity of GC cells to 5-fluorouracil (5-FU). CONCLUSION: KIAA1199 expression appears to be a promising prognostic marker in patients with locally advanced GC, who underwent postoperative adjuvant chemotherapy with S-1. KIAA1199 may represent a novel target for GC pharmacotherapy.

DOI： 10.21873/anticanres.13872

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Appendiceal mucinous neoplasm has a risk for pseudomyxoma peritonei caused by appendiceal perforation.It has been reported that laparoscopic surgery is more risky than open surgery.We investigated 4 patients who underwent laparoscopic surgery for appendiceal mucinous neoplasm.The median age was 69.5(49-85).There were 3 males and 1 female.Three cases of partial laparoscopic resection of the cecum and 1 case of ileocecal resection with lymph node dissection were performed. The pathology was low-grade mucinous neoplasm in all cases.The median hospital stay was 6 days, and there were no postoperative complications(CD Grade 3 or higher)or hospital death.As for long-term results, peritoneal pseudomyxoma developed in 1 case, which had already ruptured at the time of surgery.There were no recurrences in other cases.This result suggests that laparoscopic surgery for appendiceal mucinous neoplasm is safe with optimal selection of the procedure and a protective technique.

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A 52-year-old man whose fecal occult blood test was positive was found to have type 2 sigmoid colon cancer by colonoscopy. On enhanced barium enema study, the cecum was in the pelvis, and the ascending colon was running medially in the abdomen. Enhanced CT scan of the abdomen revealed rotation of the superior mesenteric vein(SMV). We diagnosed the case as sigmoid colon cancer(cT3N0M0, StageⅡA)with non rotation-type intestinal malrotation, and performed laparoscopic surgery. We confirmed the small intestine to be located on the right side of the abdomen, the cecum to be located in the pelvis, and the ascending colon to be running medially in the abdomen. The ascending mesocolon was adherent to the right of the sigmoid mesocolon. Following dissections of the ascending mesocolon from the sigmoid mesocolon, we performed surgery via the inside approach as usual. We dissected the root of the inferior mesenteric artery(IMA), and the operation was completed. In laparoscopic surgery for colorectal cancer with intestinal malrotation, there are some reports that it could be performed safely if attention is paid to adhesion of the mesenteries and vascular variation in the course of preoperative imaging diagnosis. We report a case of laparoscopic surgery that could be safely performed for sigmoid colon cancer with non rotation-type intestinal malrotation.

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BACKGROUND: Laparoscopic surgery in patients with retroperitoneal fibrosis has been reported to be difficult due to mesenteric and retroperitoneal fibrotic thickening. Here, we report a case of laparoscopic surgery with IgG4-related disease. CASE PRESENTATION: A 60-year-old man with IgG4-related kidney disease and autoimmune pancreatitis was diagnosed with cecal cancer. Laparoscopic ileocecal resection was performed. Preoperative CT showed no evidence of retroperitoneal fibrosis but showed a localized fibro-inflammatory lesion between the retroperitoneum and mesentery in front of the right kidney due to interstitial nephritis. Intraoperative findings revealed focal adhesions in the duodenal front within the range consistent with CT findings. CONCLUSIONS: This report shows that the degree and extent of fibrosis were similar between preoperative CT and actual surgical findings. Thus, it is possible that tissue fibrosis in patients with IgG4-related disease could be predicted by preoperative CT.

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腎機能障害を併存した再発大腸癌患者に対するFOLFIRI+bevacizumab療法により高アンモニア血症および意識障害を来した症例を経験したので報告する。症例は76歳、男性。直腸癌術後、左縦隔リンパ節転移に対するthird-lineの化学療法として治療を開始した。投与当日帰宅後より下痢を認め、3日目に意識障害があり当院に救急受診となった。来院時のJCSは200であり、血中アンモニア値は800μg/dL以上と異常高値を認め、高アンモニア血症に伴う意識障害と診断した。ICUに入室し人工呼吸器管理を行い、高アンモニア血症に対して分枝鎖アミノ酸製剤、ラクツロース投与および高度代謝性アシドーシスに対して血液透析を開始した。透析後、血中アンモニア値は37μg/dLと速やかに改善を認めた。翌日にはJCS10まで意識レベルは改善し、第19日目に自宅退院となった。腎機能障害を伴う症例に対して5-fluorouracil併用療法は慎重に投与すべきと考えられ文献的考察を併せ報告する。(著者抄録)

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虫垂粘液産生腫瘍は良性腫瘍に分類されるが、穿破を契機に腹膜偽粘液腫を来すリスクがあり、腹腔鏡下手術の安全性は確立されていない。当科関連施設で虫垂粘液産生腫瘍に対して腹腔鏡下手術を行った4例を後ろ向きに調査した。年齢の中央値は69.5(49〜85)歳、男性3例、女性1例であった。術式は盲腸部分切除3例、リンパ節郭清を伴う回盲部切除が1例。1例で腹腔内観察時、すでに穿破および周囲への腹膜偽粘液腫を認めたが、その他の症例において術中操作による穿破はなかった。病理診断は全例で低異型度虫垂粘液性腫瘍(low-grade mucinous neoplasm)であった。術後合併症(Clavien-Dindo分類Grade 3以上)は認めず、在院日数の中央値は6日であった。長期成績は、手術時すでに穿破していた1例を除き再発を認めなかった(観察期間中央値14.8ヵ月)。虫垂粘液産生腫瘍に対する腹腔鏡下手術は、選択肢の一つになり得ると考えられる。さらなる症例集積が必要である。(著者抄録)

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症例は76歳、男性。既往歴および家族歴に特記事項はない。現病歴は、2017年11月に検診目的の上部消化管内視鏡検査で胃前庭部後壁に半周性の隆起病変を認め、生検で胃癌が検出された。胃癌、cT1aN0M0の診断で、12月に内視鏡的粘膜下層剥離術(ESD)を施行した。ESD施行後の病理結果では粘膜下層への浸潤を認め非治癒切除であった。このため、2018年3月に追加切除として腹腔鏡下幽門側胃切除(D1郭清)およびBillroth I再建を施行した。経過良好にて術後10病日に自宅退院、以降外来フォローの方針となった。術後14病日に上腹部痛、炎症増悪で再入院となった。抗菌薬投与などの内科的治療を行ったが、炎症反応高値遷延、腎機能障害、尿潜血を認めた。血管炎関連の腎炎などを疑い精査の結果、抗GBM抗体型急速進行性腎炎の診断となった。今回、早期胃癌に対して腹腔鏡下幽門側胃切除術後に急速進行性糸球体腎炎を発症した1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Language：English   Publisher：(一社)日本癌治療学会  

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BACKGROUND/AIM: The PRKCI gene encodes Protein kinase C iota. The overexpression of protein kinase C iota is associated with poor outcomes in patients with gastric and other cancers, but the role of the PRKCI gene in gastric cancer is not fully understood. Thus, we evaluated the clinical significance of PRKCI gene expression in gastric cancer. MATERIALS AND METHODS: PRKCI mRNA expression levels in cancerous tissues and adjacent normal mucosa from 398 patients with gastric cancer were measured. Relationships between PRKCI gene expression and clinicopathological characteristics and outcomes were examined. RESULTS: Overall survival was lower in patients with a high expression of PRKCI than in those with low expression (p=0.016). No other relationships were observed. A high PRKCI expression was found to be an independent prognostic factor (p=0.036, HR=1.44, 95%CI=1.02-2.02). CONCLUSION: PRKCI gene expression in cancerous tissue might be a useful prognostic factor in patients with gastric cancer after gastrectomy.

DOI： 10.21873/anticanres.13771

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は42歳、女性。既往歴に特記事項はない。今回、検診で施行した上部消化管造影検査で胃体部前壁に潰瘍性病変を指摘された。上部消化管内視鏡検査を施行し、胃体下部前壁に潰瘍病変を伴う最大径50mmの粘膜下腫瘍を認めた。内視鏡下穿刺吸引細胞診で神経鞘腫の診断となり、手術目的に当科紹介受診となった。手術は、腹腔鏡下胃部分切除術および胃小彎のリンパ節を摘出した。術後経過良好で7日目に退院した。術後病理所見は神経鞘腫の診断で核分裂像や異型性を認めず、リンパ節転移も認めなかった。胃神経鞘腫は胃壁筋層のアウエルバッハ神経叢のシュワン細胞から生じ、全胃腫瘍の0.1〜0.2%とまれな疾患である。術前診断が極めて困難な場合が多くまた悪性の報告もあり、治療、手術方式は慎重に検討すべきである。今回、胃原発の巨大神経鞘腫を腹腔鏡下手術で切除した1例を経験したので、若干の文献的考察を加え報告する。(著者抄録)

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Language：English   Publisher：(一社)日本癌治療学会  

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This is a case of a 76-year-old man who had no significant past medical or family history. In the current medical history, in November 2017, upper gastrointestinal endoscopy showed a semicircular protruding lesion in the posterior wall of the gastric antrum, and gastric cancer was diagnosed following biopsy. Endoscopic submucosal dissection(ESD)was performed in the same year for the treatment of gastric cancer(cT1aN0M0). Pathological findings after ESD treatment showed invasion into the submucosa requiring non-curative resection. For this reason, laparoscopic pylorus side gastrectomy(D1 dissection)and Billroth Ⅰ reconstruction were performed as additional procedures in March 2018. The patient was discharged on the 10th postoperative day and was followed-up on an outpatient basis. On the postoperative day 14, he was re-admitted with complaints of upper abdominal pain and exacerbation of inflammation. Medical treatment, such as antibiotic administration was followed, however, a high degree of inflammatory response, renal dysfunction, and occult blood in urine were observed. Because of suspicion of vasculitis-related nephritis, the case was diagnosed as anti-GBM antibody type rapid progressive nephritis. We came across a case of rapidly progressive glomerulonephritis after laparoscopic pylorus side gastrectomy performed for early gastric cancer, and hence, We will review the related literature.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

This case involved a 42-year-old woman who had no remarkable findings in terms of case history and family history. Upper gastrointestinal series performed during a medical examination revealed ulcerative lesions in the anterior wall of the stomach body. Upper gastrointestinal endoscopy was performed, and a submucosal tumor with a maximum diameter of 50mm accompanied by an ulcerative lesion was found in the anterior wall of the lower part of the stomach. She was diagnosed with a schwannoma based on endoscopic ultrasonography-guided fine needle aspiration, and we received consultation for surgical purpose. Surgery was performed with laparoscopic partial resection of the stomach and lymph nodes in the lesser curvature of the stomach. She was discharged on the 7th day after the surgery. The postoperative pathologic findings showed no nuclear fissure or atypia with a diagnosis of a schwannoma and no lymph node metastasis. Gastric schwannoma is a rare disease that arises from Schwann cells of the Auerbach's plexus of the gastric wall muscularis and comprises 0.1-0.2% of all stomach tumors. Preoperative diagnosis is often extremely difficult, and there are reports of malignancy. Treatments and surgical methods should be carefully considered. Herein, we encountered a case of a resected giant gastric schwannoma by laparoscopic surgery, which is reported with a literature review.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

We report a case of altered consciousness related to hyperammonemia due to FOLFIRI plus bevacizumab therapy in a patient with recurrent colorectal cancer and renal dysfunction.A 76-year-old man received third-line chemotherapy for left mediastinal lymph node metastasis.He complained of diarrhea on the evening of the same day, and mental confusion on day 3 of the first FOLFIRI therapy.He had a JCS of Ⅲ(200).The laboratory results revealed a marked hyperammonemia.5 - fluorouracil(5-FU)-induced hyperammonemia was diagnosed and the patient was ventilated and managed with branchedchain amino acid solutions, lactulose, and hemodialysis in the ICU.After hemodialysis, the blood ammonia level reduced to the normal limits, and the symptoms of encephalopathy resolved on the following day.He was discharged home on the 19th day of hospitalization.5 -FU-containing therapy should be carefully administered in patients with renal dysfunction.Herein, we report a case of 5-FU-induced hyperammonemia with literature considerations.

PubMed

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Postoperative pneumonia after esophageal cancer can lead to additional pain, prolonged hospital stay, and respiratory failure. These adverse events might lead to early recurrence and/or death. We investigated the influence of postoperative pneumonia on the esophageal cancer survival and recurrence after curative surgery. PATIENTS AND METHODS: This study included 122 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The patients were classified into: i) those with postoperative pneumonia (pneumonia group) and ii) those without postoperative pneumonia (non-pneumonia group). The risk factors for the overall survival (OS) and recurrence-free survival (RFS) were identified. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. RESULTS: Postoperative complications were found in 34 of the 122 patients (27.9%). The OS rate at 5 years following surgery was 28.2% in the pneumonia group and 55.1% in the non-pneumonia group (p=0.006). The RFS rate at 5 years after surgery was 18.9% in the pneumonia group and 49.2% in the non-pneumonia group (p=0.061). A multivariate analysis showed that postoperative pneumonia was a significant independent risk factor for OS. CONCLUSION: The development of postoperative pneumonia was a risk factor for a decreased overall survival in patients who underwent curative surgery for esophageal cancer. The surgical procedure, perioperative care and surgical strategy should be carefully planned in order to avoid postoperative pneumonia.

DOI： 10.21873/anticanres.13392

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Language：Japanese   Publisher：横浜市立大学医学会  

症例は67歳、男性。アルコール性肝障害の精査目的で腹部CT施行したところ、2ヶ所の巨大未破裂脾動脈瘤を指摘され手術目的に当科紹介受診となった。精査の結果、脾動脈瘤は2ヶ所あり、それぞれの瘤径は57×40mmと50×50mmといずれも50mmを超える巨大な未破裂脾動脈瘤であった。動脈瘤が複数個あり、かつ各々の瘤径から血管内治療ではなく外科的治療を選択した。手術は開腹脾臓摘出術および脾動静脈瘤切除を施行した。術後は経過良好で6日目に退院した。脾動脈瘤は比較的まれな疾患で、多くの症例が無症状で発見されることが多い。一方で、脾動脈瘤の大きさは20mm程度の報告が多く、50mmを超える症例の報告は少ない。今回、2ヶ所で50mm大を超える巨大未破裂脾動脈瘤の一例を経験したので、若干の文献的考察を加え報告する。(著者抄録)

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。身長159cm、体重59kg。肺癌術後で外来経過観察中に貧血を認め、精査目的に上部消化管内視鏡検査を施行し、胃癌の診断となった。幽門側胃切除、D2郭清、Billroth I(B-I)再建術を施行した。術後診断は胃癌、ML、Less、Type 2、67×55×15mm、muc>sig>por、pT4a(SE)N2M0、fStage IIIBであった。術後S-1補助化学療法施行中の外来通院時に逆流症状を認め、食事摂取不良であった。術後3ヵ月、5ヵ月での体重はそれぞれ51kg、52.5kgおよび血清Alb値が3.2g/dL、2.7g/dLであり、低栄養となっていた。術後7ヵ月で逆流症状の改善を認めなかったため、アコチアミド塩酸塩の内服を開始した。内服開始後、逆流症状と食事摂取量が改善し、術後11ヵ月、15ヵ月での体重はそれぞれ54kg、57kgおよび血清Alb値が3.0g/dL、2.7g/dLとなった。術後23ヵ月目で腹膜播種再発を来し食事摂取不良となったが、逆流症状の再燃は認めなかった。胃切除術B-I再建後の逆流症状に対して、アコチアミド塩酸塩が治療選択肢となる可能性が示唆された。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

In a 65-year-old woman, anemia was observed during outpatient follow-up after right lung cancer surgery, and upper gastrointestinal endoscopy was performed for examination.Gastrointestinal endoscopy revealed a Type 2 tumor on the small curvature in the middle part of the stomach, and she was diagnosed with gastric cancer.Distal gastrectomy with D2 lymph node dissection and BillrothⅠ reconstruction was performed for the gastric cancer.There were no postoperative complications, and she was discharged on the ninth day after surgery.The pathological diagnosis was gastric cancer, ML, Less, Type 2, 67×55×15 mm, muc>sig>por, pT4a(SE)N2M0, fStage ⅢB.S -1 adjuvant chemotherapy was administered, but then discontinued in the second course due to the development of adverse events.Reflux symptoms appeared after the surgery, and her dietary intake was poor.Her body weight and serum albumin level at 3 and 5 months after surgery were 51 kg and 52.5 kg, respectively, and 3.2 g/dL and 2.7 g/dL, respectively.Because there was no improvement in the reflux symptom, oral administration of acotiamide hydrochloride was initiated 7 months after the surgery.After initiating oral intake of acotiamide hydrochloride, her dietary intake improved, and her body weight and serum albumin level at 11 and 15 months after surgery were 54 kg and 57 kg, respectively, and 3.0 g/dL and 2.7 g/dL, respectively.Peritoneal recurrence was observed 23 months after surgery, and her oral intake decreased, but the recurrence of reflux symptoms was not observed.Acotiamide hydrochloride could be an option for the treatment of reflux symptoms after gastrectomy.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 66-year-old woman diagnosed with advanced Stage Ⅳ gastric cancer(T4aN3M1[LYM])received RAM plus wPTX as third-line chemotherapy(ramucirumab 8mg/kg on the 1st and 15th day, paclitaxel 80mg/m2 on the 1st, 8th, and 15th day).After receiving 3 courses of this treatment, para-aortic lymphadenopathy had diminished but anemia had progressed because of tumor hemorrhage.Six weeks after the last administration of RAM, an open distal gastrectomy with D1 plus lymph node dissection and Billroth Ⅰ reconstruction was performed.The patient was discharged on the 9th day after surgery without complications such as postoperative bleeding and delayed wound healing.RAM plus wPTX therapy was restarted 6 weeks after the operation.Postoperative late complication there is no adverse event including adenocarcinoma and continues the same therapy at present.The perioperative treatment under the use of angiogenesis inhibitor has risk of postoperative bleeding and wound healing delay and includes surgery timing of treatment may be difficult.In our case, surgery was performed 6 weeks after the final administration of RAM.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Body weight, especially lean body mass, significantly decreases after gastrectomy. Postoperative surgical complications are a major risk factor for changes in body weight and body composition after gastrectomy. However, the influence of postoperative surgical complications after gastrectomy on body weight and body composition changes remains unclear. PATIENTS AND METHODS: This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Their body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, and at 1 week, 1 month and 3 months after surgery. Patients were classified as those with surgical complications and those without. RESULTS: Eight hundred and eighty-eight patients (156 in the group with complications and 732 in the group without) were entered in the present study. When comparing the two groups, the patients' background and surgical factors significantly differed, while the pathological findings were similar. The body weight losses at 1 week, 1 month, and 3 months after surgery were 3.8%, 7.0%, and 10.4%, respectively, in those with complications, and 3.3%, 5.6%, and 6.8%, respectively, in the group without, with p-values of 0.001, 0.002, and 0.001, respectively. The corresponding lean body mass losses were 3.7%, 6.5%, and 6.8%, and 3.2%, 4.2%, and 3.5%, respectively, with p-values of 0.001, 0.001, and 0.001, respectively. CONCLUSION: Decreases in body weight and lean body mass after gastrectomy were more serious in the patients with surgical complications than in those without. To maintain body weight and lean body mass in patients with surgical complications, additional care or treatments are needed.

DOI： 10.21873/anticanres.13215

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Language：Japanese   Publisher：(一社)日本腹部救急医学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：神奈川県医師会  

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Language：Japanese   Publisher：横浜市立大学医学会  

症例は74歳男性。2010年2月に食道胃接合部腺癌(cT3N1M0、Stage IIB)に対して噴門側胃切除、D1+リンパ節郭清および下縦隔郭清、腸瘻造設術を施行した。術後よりプロトンポンプ阻害薬の内服を開始していたが、術後5ヵ月目から逆流性食道炎及び反復性の食道胃吻合部潰瘍を発症し、その後増悪と緩解を繰り返していた。今回、2018年3月に胸痛を主訴に近医を受診した。同院で施行したCT検査で心嚢内の液体貯留を認め、胃心嚢瘻が疑われたため当院へ緊急搬送となった。当院で施行したCT検査では食道胃残吻合部よりやや頭側に食道壁から心嚢への瘻孔を認めた。さらに、上部消化管内視鏡検査では食道胃吻合部潰瘍に6mmほどの瘻孔を認めた。反復性食道潰瘍に伴う食道心嚢瘻の診断で、内視鏡的経鼻心嚢ドレナージ・絶食・補液・抗菌薬等の保存的治療の方針となった。治療経過は良好で、第11病日に上部消化管造影検査で胃心嚢瘻を認めず、経鼻心嚢ドレナージチューブを抜去した。第18病日に上部消化管内視鏡検査では食道胃吻合部潰瘍は瘢痕化を認めた。第31病日に自宅退院軽快退院となった。今回、反復する食道胃吻合部潰瘍を契機に食道心嚢瘻を発症した症例に対して、内視鏡的経鼻心嚢ドレナージ術を主体とする保存的治療で救命できた1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Background: The aim of this study was to determine whether or not the short- and long-term outcomes were affected by the age-adjusted Charlson comorbidity index (ACCI) in patients who underwent curative resection for gastric cancer. Methods: The patients were retrospectively selected from among the medical records of consecutive patients who underwent curative gastrectomy with nodal dissection for gastric cancer at Yokohama City University and Kanagawa Cancer Center from January 2000 to August 2015. Results: A total of 2254 patients were eligible for inclusion in the present study. One thousand six hundred fifty-six patients had an ACCI of <6 points (ACCI low group), while 598 had a score of ≥6 points (ACCI high group). The median age (p<0.001) and American Society of Anesthesiologists physical status (ASA-PS) score (p<0.001) of the ACCI high group were higher in comparison to the ACCI low group. The incidence of surgical complications in the ACCI high group was significantly higher than that in the ACCI low group (12.0% vs. 7.2%, p<0.001). Univariate and multivariate analyses demonstrated that an ACCI high classification was a significant risk factor for postoperative complications. In addition, the 5-year OS rates of the ACCI low and ACCI high groups were 85.4% and 74.1%, respectively. The difference was statistically significant (p<0.001). The univariate and multivariate analyses demonstrated that an ACCI high classification was a significant prognostic factor for OS. Conclusions: Our results support that a high ACCI value is an independent risk factor for the short- and long-term outcomes of patients with gastric cancer. To improve the survival of patients with gastric cancer, it is necessary to carefully plan the perioperative care and the surgical strategy according to the ACCI.

DOI： 10.7150/jca.35465

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background: The present study explored whether or not the Oral Health Assessment tool (OHAT) score is a risk factor of postoperative pneumonia after esophagectomy for esophageal cancer. Methods: This study included 47 patients who underwent curative surgery for esophageal cancer between 2008 and 2018. The rate of postoperative pneumonia was measured by the revised Uniform Pneumonia Score. Univariate and multivariate logistic regression analyses were performed to identify the risk factors for postoperative pneumonia. Results: Postoperative pneumonia was found in 18 of the 47 patients (38.3%). Among the various factors examined (age, gender, preoperative chemotherapy status, operative type, operative duration, blood loss, lymph node dissection, alcohol habit, OHAT score), the OHAT score (p = 0.006) and age (p = 0.040) were identified as significant independent risk factors for postoperative pneumonia in univariate and multivariate analyses. The incidence of postoperative pneumonia was 5% (1 of 20) in the OHAT ≤2 group and 51.9% (14 of 27) in the OHAT ≥3 group. Conclusion: The OHAT score is a risk factor for postoperative pneumonia in patients who have undergone curative esophagectomy for esophageal cancer. To improve the oncological outcomes of patients with esophageal cancer, it is necessary to carefully plan perioperative oral/dental care using the OHAT score.

DOI： 10.4993/acrt.27.31

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Body weight, especially lean body mass, significantly decreases after gastrectomy for gastric cancer due to surgical invasion, reduced food intake, and reduced mobility, which can reduce the quality of life and induce associated toxicity or reduce compliance with adjuvant chemotherapy. Such risks can be particularly high in elderly patients with gastric cancer. However, whether or not changes in the weight and body composition differ between elderly and non-elderly patients remains unclear. PATIENTS AND METHODS: This retrospective study examined patients who underwent curative surgery for gastric cancer between May 2010 and February 2017. Body weight and composition were evaluated by a bioelectrical impedance analyzer within 1 week before surgery, at 1 week after surgery, and at 1 and at 3 months after surgery. Patients were classified as elderly (≥80 years) or non-elderly (<80 years). RESULTS: Eight-hundred and eighty-eight patients (84 elderly and 804 non-elderly) were entered into the present study. Patient background, surgical and clinicopathological factors, and surgical complications did not significantly differ between the two groups. Body weight loss at 1 week, and at 1 and 3 months after surgery, defined as the decrease from the preoperative value, were -2.8%, -6.5%, and -9.0%, respectively, in the elderly and -3.5%, -6.0%, and -8.1%, respectively, in the non-elderly patients (p=0.111, 0.125, and 0.153, respectively). The corresponding losses of lean body mass were -2.6%, -6.0%, and -6.4%, respectively, in the elderly and -3.5%, -4.9%, and -4.7%, respectively, in the non-elderly patients, with p-values of 0.056, 0.036, and 0.029, respectively. CONCLUSION: Decreases in lean body mass after gastrectomy were greater in elderly than in non-elderly patients. In order to maintain lean body mass among elderly patients, additional care and treatments are needed.

DOI： 10.21873/invivo.11463

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BACKGROUND: This study investigated the impact of postoperative C-reactive protein (CRP) level on survival in patients with esophageal cancer who received perioperative steroid therapy and enhanced recovery after surgery (ERAS) care. PATIENTS AND METHODS: Overall, 115 patients were retrospectively reviewed. The patients were classified into those with a high CRP level (≥4.0 mg/dl) on postoperative day 4 and those with low CRP level (<4.0 mg/dl). The risk factors for overall survival (OS) and recurrence-free survival (RFS) were identified. RESULTS: The OS and RFS rates at 5 years after surgery were significantly low in patients with high CRP level on postoperative day 4. The multivariate analysis demonstrated that high CRP level on postoperative day 4 was a significant independent risk factor for OS and RFS. CONCLUSION: The present results suggest that the postoperative CRP level can be a prognosticator in patients with esophageal cancer who have received perioperative steroid therapy and ERAS care.

DOI： 10.21873/invivo.11515

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Aims: We previously demonstrated that a loss of lean body mass loss at one month after gastrectomy was an independent risk factor for the continuation of adjuvant chemotherapy with S-1. However, it is unclear whether or not lean body mass loss after gastrectomy leads to a poor survival through poor compliance to adjuvant chemotherapy with S-1. Methods: The recurrence free survival (RFS) overall survival (OS) and were examined in 115 patients who underwent curative gastrectomy and were pathologically diagnosed with stage II or III gastric cancer and who received postoperative adjuvant chemotherapy with S-1 between May 2011 and September 2016. Results: The median follow-up period was 40.6 months. The RFS rates at 5 years after surgery were 57.8% in the lean body mass loss ≥5% group and 73.5% in the lean body mass loss <5% group. The univariate and multivariate analyses for the disease free survival (RFS) demonstrated that a lean body mass loss >5% was a significant risk factor. The OS rates at 5 years after surgery were 72.0% in the lean body mass loss ≥5% group and 77.3% in the lean body mass loss <5% group. The OS was slightly worse in the lean body mass loss ≥5% group than in the lean body mass loss <5% group (p=0.2062). Conclusions: The lean body mass loss at one month, which is closely associated with poor S-1 compliance, was an important risk factor for the RFS. A prospective cohort study is necessary to confirm whether or not the lean body mass loss affects the gastric cancer survival.

DOI： 10.7150/jca.30697

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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This is a case of a 70-year-old man. Two courses of docetaxel/cisplatin/S-1 combination therapy were administered after clinical trial registration with diagnosis of Stage Ⅳ gastric cancer(ypT3N3aM1). In June 2014, gastrectomy and splenectomy were performed. Postoperative S-1 adjuvant chemotherapy was administered; however, in September 2014, aorticl ymph node metastasis was diagnosed as recurrent. After recurrence, irinotecan/cisplatin therapy was administered. In February 2015, recurrent lymph node metastasis increased, and chemotherapy was changed to paclitaxel. In May 2015, numbness (Grade 2)of the fingers was observed, and treatment was changed to oxaliplatin/S-1. In February 2016, storage of ascites became remarkable; therefore, chemotherapy was discontinued as per policy. After that, we continued outpatient visit and observed increased recurrent lymph node metastasis on image evaluation; however, as the patient's general condition was good, chemotherapy was restarted. Ramucirumab/paclitaxel therapy started in February 2017. During the course of treatment, neutropenia(Grade 2)was observed as an adverse event, but therapy continuation was possible without loss of ramucirumab only with loss of paclitaxel. Thereafter, the recurrence of lymph node metastasis was reduced, and the ascites accumulation decreased. Until now, 1 year after the start of ramucirumab/paclitaxel therapy, the patient still visits the outpa- tient clinic.

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は70歳、男性。Stage IV(ypT3N3aM1)、胃癌の診断でドセタキセル/シスプラチン/S-1療法を2コース施行した。2014年6月、胃全摘および脾臓摘出術を施行、術後S-1補助化学療法を施行したが、9月に大動脈周囲リンパ節に再発を認めイリノテカン/シスプラチン療法を開始した。2015年2月、再発リンパ節の増大を認め、パクリタキセル療法に変更、5月に手指のしびれ(Grade 2)を認め、オキサリプラチン/S-1療法に変更した。2016年2月、腹水貯留が著明となり、化学療法を中止した。その後、外来通院を継続し再発リンパ節の増大を認めたが、全身状態は良好であったため再度化学療法施行の方針とした。2017年2月からラムシルマブ/パクリタキセル療法を開始し、経過中に有害事象として好中球減少(Grade 2)を認めたが、パクリタキセルの減量のみでラムシルマブの減量は行わず治療継続できた。その後、再発リンパ節の縮小および腹水の減少を認めた。ラムシルマブ/パクリタキセル療法開始後1年経過した現在も外来通院中である。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は32歳、女性。上部消化管穿孔術後、2015年から不全型ベーチェット病の診断でプレドニゾロンを内服中であった。2017年3月、穿孔後経過観察中の上部消化管内視鏡で胃前庭部大穹後壁に径15mmの0-IIc病変を認め、生検で印環細胞癌が検出された。胃癌、cT1aN0M0の診断で、適応拡大病変として4月に内視鏡的粘膜下層剥離術(ESD)を施行した。病理結果で粘膜下層への浸潤を認め非治癒切除であったため、6月に追加切除として腹腔鏡下幽門側胃切除(D1+郭清)およびBillroth I再建を施行した。本症例の術前の留意点としては、カプセル内視鏡検査を含め全腸管の潰瘍病変の検索を行ったこと、術中の留意点としては金属ステープラーによる器械刺激で潰瘍形成や縫合不全のリスクが高くなるため再建を手縫い吻合で行ったことである。(著者抄録)

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症例は59歳、女性。健康診断で異常所見を指摘され施行した上部消化管内視鏡で胃前庭小彎側に2型腫瘤を認め、当院へ紹介受診となった。精査で進行胃癌[L、less、type 2、tub1、cT3N2H0P0M1(LYM:#16、Virchow)、Stage IV]と診断した。S-1(80mg/m2、day 1〜21)/CDDP(60mg/m2、day 8)(3週投与2週休薬)を開始し、4コース施行後の評価でcT3N1H0P0M0、Stage IIIAと判断した。開腹幽門側胃切除(D2郭清)およびB-I再建+#16サンプリング(#16b1lat、#16a2int)を施行した。病理結果はL、less、type 1、por1/2、pT2N2H0P0M0CY0(#16b1lat、#16a2intにも転移を示す所見なし)、pStage IIIBであった。補助化学療法としてS-1(80mg/m2、day 1〜28)(4週投与2週休薬)を開始した。術後6ヵ月(S-1 3コース施行後)のcomputed tomography(CT)で#16b1int腫大あり、リンパ節再発の診断でweekly paclitaxel(80mg/m2、day 1、8、15)(3週投与1週休薬)に変更した。術後1年3ヵ月(weekly paclitaxel 9コース施行後)の画像評価で腫大リンパ節は消失し、complete responseと判断した。術後5年9ヵ月(weekly paclitaxel 54コース)まで施行し化学療法を中止した。術後6年0ヵ月現在、無再発で外来通院中である。今回、傍大動脈リンパ節転移を伴う進行胃癌に対して集学的治療が奏効し長期生存を得られた1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Language：Japanese   Publisher：日本臨床外科学会  

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Although chemotherapy is the standard treatment for unresectable advanced gastric cancer, its prognosis is poor and the median survival time is only around 10 months. With some literature consideration, we report that ovarian metastasis triggered the diagnosis of unresectable advanced gastric cancer with long-term survival through multidisciplinary treatment. This is the case of a 69-year-old woman, who was diagnosed with ovarian tumor and underwent right extracorporectomy and omentum resection in 2011. Pathological diagnosis suspected adenocarcinoma. In February 2012, EGD found a type 4 tumor in the upper portion of the pyloric area of the stomach. She was diagnosed with gastric cancer with Stage IV(T4aN0M1 [ovary])ovarian metastasis. Because the primary tumor was HER2 positive, XP plus HER therapy(capecitabine 1,000mg/m2 twice a day for 14 days, CDDP 80mg/m2 every 3 weeks on the first day, and trastuzumab 8 mg/kg every 3 weeks on the first day)was administered since March 2012. No metastasis was found in the imaging examination after 8 courses of chemotherapy, and we also confirmed the reduction of the primary tumor in the EGD. Based on the images, primary resection was already possible. In December 2012, after a diagnostic laparoscopy, total gastrectomy with D2 lymph node dissection was performed. Postoperative pathology was diagnosed as Stage IV(pT4aN0M1). To control postoperative micrometastasis, capecitabine therapy(1,000mg/m2 twice a day for 14 days)was administered for 12 months starting from February 2013. Then, recurrence and metastasis were not observed during follow-up. However, in January 2017, a circumstellar stenotic tumor was found in the rectum and was diagnosed as recurrence of peritoneal dissemination through images. In February 2017, artificial ostomy(in the sigmoid colon, double-mouth type)was made. Then, the patient underwent an outpatient chemotherapy, with hospital visits, and she survives.

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A 59-year-old woman was diagnosed with advanced gastric cancer with para-aortic and Virchow's lymph node metastases (L, Less, type 2, tub1, cT3N2H0P0M1[LYM: #16, Virchow's]). Four courses of S-1(80mg/m / 2, days 1-21)and CDDP(60mg/ m2, day 8)were administered. After the chemotherapy, CT showed that the primary tumor and para-aortic and Virchow's lymph nodes had reduced in size. The clinical stage was ycT3N1H0P0M0, stage III A. The patient underwent distalgastrectomy, D2 dissection, and sampling of the para-aortic lymph nodes(#16b1lat, #16a2int). The pathological diagnosis was L, less, type 1, por1/2, pT2N2H0P0M0CY0, pStage III B. The patient was treated with S-1(80mg/m2, days 1-28)as adjuvant chemotherapy. After 3 courses had been administered(6 months after the resection), swelling of a para-aortic lymph node (#16b1int)was detected using CT. Based on the diagnosis of recurrence in the lymph node, weekly paclitaxel(80mg/m2, days 1, 8, and 15)was administered. After receiving 9 courses of weekly paclitaxel, the swelling of the lymph node disappeared, and the response evaluation was complete response. She discontinued the chemotherapy 5 years and 9 months after the surgery. To date, she has survived more than 6 years after surgery without recurrence. We report a long-surviving patient with advanced gastric cancer with para-aortic lymph node metastasis who received combined modality therapy.

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A 74-year-old woman was found to have a hepatic mass based on CT findings. She was diagnosed as having cecum cancer, and it was difficult to distinguish whether the hepatic mass was liver metastasis or biliary cystadenocarcinoma. We proceeded with the surgery for cecum cancer, and laparoscopic ileocecal resection with D3 lymph node dissection was performed. The histopathological diagnosis was mucinous adenocarcinoma, and the pathological stage was T3N2H1P0M1a, Stage IV. After the surgery, her CEA level was elevated, and we diagnosed the hepatic mass as a liver metastasis. A CapeOX plus bevacizumab regimen was administered but was discontinued for 2 courses due to the development of adverse effects and her decision. Gd-EOB-DTPA-enhanced MRI revealed a multilocular and lobulated mass, which was a low-intensity area in T1WI and high-intensity area in T2WI, and the mass had no significant contrast effects. These images were unspecific for liver metastasis of colorectal cancer, and we performed segmental 6 hepatectomy for diagnosis and curative surgery. A histopathological diagnosis of liver metastasis of cecum cancer was made. Here, we report a case of liver metastasis of colorectal cancer that was undifferentiated from biliary cystadenocarcinoma.

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Language：Japanese   Publisher：(株)癌と化学療法社  

切除不能進行胃癌に対する標準治療は全身化学療法であるが、生存期間の中央値は10ヵ月程度で予後は不良である。今回、卵巣転移を契機に切除不能進行胃癌と診断し集学的治療を施行し長期生存が得られた1例を経験したので、若干の文献的考察を加えて報告する。症例は69歳、女性。2011年に卵巣腫瘍を指摘され、右付属器摘出術と大網切除術を施行した。病理結果は低分化腺癌および印環細胞癌で転移性が強く疑われた。2012年2月に上部消化管内視鏡で胃体上部から幽門部にかけて4型の腫瘍を認めた。胃癌卵巣転移Stage IV[T4aN0M1(ovary)]の診断となった。原発巣のHER2が陽性であったため、2012年3月からXP+HER(capecitabine 1,000mg/m21日2回14日間、CDDP 80mg/m21日目に3週毎、trastuzumab 8mg/kg 1日目に3週毎)を施行した。化学療法8コース施行後の画像検査で遠隔転移所見はなく、また上部消化管内視鏡検査も原発巣の縮小を認めた。画像所見から原発巣切除は可能と判断し、2012年12月に診断的腹腔鏡施行後に開腹胃全摘およびD2リンパ節郭清術を施行した。術後病理はStage IV(pT4aN0M1)の診断となった。術後2013年2月から微小転移の制御目的にcapecitabine(1,000mg/m21日2回14日間)療法を12ヵ月施行し、以後外来経過観察となった。その後、再発や転移所見を認めずに経過したが、2017年1月に直腸に全周性の狭窄病変を認め、画像上腹膜播種再発の診断となった。2017年2月に人工肛門造設術(S状結腸、双口式)を施行し、現在外来化学療法を施行し通院生存中である。(著者抄録)

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A 32-year-old woman with a history of undergoing upper gastrointestinal surgery was administered prednisolone for abortive Behçet's disease since 2015. In March 2017, upper gastrointestinal endoscopy revealed a 0-IIc type early stage gastric carcinoma at the posterior wall of the gastric antrum. The pathological diagnosis was signet-ring cell carcinoma. This gastric carcinoma was classified as cT1aN0M0; therefore, endoscopic submucosal dissection(ESD)was performed for the expanded indication lesion in April 2017. The pathological diagnosis after ESD indicated the need for non-curative resection; thus, laparoscopy-assisted distal gastrectomy and Billroth I anastomosis were performed in July 2017. A transient anastomotic structure was admitted after this surgery, but she was discharged from the hospital lighthearted. A preoperative important aspect was the careful examination of all intestinal tracts for ulcer lesions, and an intraoperative important aspect was hand-sewn anastomosis because using a metallic stapler conferred a high risk of ulcer lesions and suture failure. We encountered a case wherein laparoscopy-assisted distal gastrectomy was performed in a patient with abortive Behçet's disease, early stage gastric carcinoma, and a history of undergoing upper gastrointestinal surgery.

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症例は74歳、女性。検診のCTで肝腫瘤を指摘された。精査の結果、盲腸癌を認め、肝腫瘤は肝転移と肝嚢胞腺癌の鑑別が困難であった。原発巣に対する手術を先行する方針とし、腹腔鏡下回盲部切除術を施行した。病理診断で主組織型は粘液癌であり、病期はT3N2H1P0M1a、Stage IVであった。CEA上昇もあり、肝転移と考えCapeOX+bevacizumab療法を開始したが、Grade 2の有害事象を認め本人の希望により2コースで中止した。Gd-EOB-DTPA造影MRIでは、腫瘍はT1WI低信号、T2WI高信号の多房性分葉状の形態を示し、有意な造影増強効果はなかった。大腸癌肝転移としては非典型的な所見であり、診断加療目的に肝S6部分切除を施行した。病理の結果、原発巣と同様に粘液癌主体であり、大腸癌肝転移と診断した。今回われわれは、肝嚢胞腺癌との鑑別に難渋した大腸癌肝転移の1例を経験したので報告する。(著者抄録)

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Language：English   Publisher：日本癌学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

Background/Aim: Postoperative delirium is a common complication which is associated with increased postoperative mortality and morbidity. The aim of this study was to evaluate the incidence and predictors of postoperative delirium using data from a phase II clinical trial. Patients and Methods: We analyzed the cases that were enrolled in randomized clinical trial to evaluate TJ-54 (Yokukansan, a traditional Japanese medicine [Kampo]) for the prevention and/or treatment of postoperative delirium (UMIN000005423). The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) was used to diagnose postoperative delirium. Results: A total of 167 patients were registered, delirium was observed in 9% of them. High age over 80 and low MMSE less than 27 were identified as significant independent risk factors. Conclusion: Surgeon should pay attention to the possible development of postoperative delirium in patients aged over 80 with a low MMSE less than 27 in performing surgery for gastrointestinal malignancies.

DOI： 10.4993/acrt.26.95

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INTRODUCTION: We describe an easy technique to connect the anvil and center rod of the EEA™ OrVil™. MATERIALS AND SURGICAL TECHNIQUE: The bulb tip of EEA OrVil was orally inserted slowly until the valve tip reached the esophageal stump. The surgeon inserted forceps while grasping the anvil from the right abdomen trocar. The circular stapler (EEA XL) was inserted via the cut-off stump of the lifted jejunum or remnant stomach through the intraumbilical incision. Then, the circular stapler was held with the shaft convex. When the automated stapler and center rod were confirmed to be completely aligned, the anvil and the main unit were connected, and the device was fired. DISCUSSION: Although we only reversed the direction of the circular stapler's shaft, this method improved the ease of the operation.

DOI： 10.1111/ases.12446

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BACKGROUND: This study was designed to investigate whether postoperative infectious complications (ICs) are a risk factor for the prognosis in esophageal cancer patients who receive neoadjuvant chemotherapy by stratifying the response to neoadjuvant chemotherapy. METHODS: The present study retrospectively examined patients who received neoadjuvant chemotherapy followed by esophagectomy between January 2011 and September 2015. Risk factors for overall survival (OS) were examined by Cox proportional hazard analyses. Pathological responders to neoadjuvant chemotherapy were defined as those with a tumor disappearance of more than one-third of the initial tumor. Postoperative ICs were defined using the Clavien-Dindo classification. RESULTS: Of the 111 patients examined, 45 (40.5%) developed postoperative ICs. A pathological response to neoadjuvant chemotherapy was observed in 54 (48.6%) patients. The multivariate analysis demonstrated that postoperative ICs were a significant independent risk factor for the OS (hazard ratio [HR] 2.359; 95% confidence interval [CI] 1.057-5.263, p = 0.036). In the subset analysis, postoperative ICs were a marginally significant independent risk factor for OS in the nonresponders (HR 2.862; 95% CI 0.942-8.696, p = 0.063) but not in the responders (HR 0.867; 95% CI 0.122-6.153, p = 0.886). CONCLUSIONS: These results suggested that the negative survival impact of postoperative ICs can be canceled out in esophageal cancer patients who respond to neoadjuvant chemotherapy.

DOI： 10.1245/s10434-018-6504-8

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Language：English   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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BACKGROUND: Body weight loss (BWL) is frequently observed in gastric cancer patients who undergo gastrectomy for gastric cancer. The risk factors for severe BWL after gastrectomy remain unclear. METHODS: The present study retrospectively examined patients who underwent curative gastrectomy for gastric cancer between January 2012 and June 2014 at Kanagawa Cancer Center. All patients received perioperative care based on the enhanced recovery after surgery protocol. The %BWL value was calculated based on the percentage of body weight at 1 month after surgery in comparison to the preoperative body weight. Severe BWL was defined as %BWL > 10%. The risk factors for severe BWL were determined by both univariate and multivariate logistic regression analyses. RESULTS: There were 278 patients examined. The median age of the patients was 68 years. The operative procedures included total gastrectomy [n=97; open (n=61) and laparoscopic {n=36)] and distal gastrectomy (n=181). Surgical complications of grade ≥ 2 (as defined by the Clavien-Dindo classification) were observed in 37 patients, these included: pancreatic fistula (n=9), anastomotic leakage (n=5), and abdominal abscess (n=3). There were no cases of surgery-associated mortality. Both univariate and multivariate logistic analyses demonstrated that surgical complications, and total gastrectomy were significant risk factors for severe BWL. CONCLUSIONS: Surgical complications and total gastrectomy were identified as being significant risk factors for severe BWL in the 1st month after gastrectomy. To maintain body weight after gastrectomy, physicians should pay careful attention to patients who undergo total gastrectomy and those who develop surgical complications.

DOI： 10.1016/j.asjsur.2017.02.005

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Previous studies have shown that laparoscopic colorectal cancer surgery is highly safe and effective compared to laparotomy. However, whether laparoscopic colorectal cancer surgery can be safely performed in patients with severe comorbidities remains unclear. The aim of this study was to evaluate the safety of laparoscopic colorectal cancer surgery in patients with severe comorbidities. PATIENTS AND METHODS: A total of 82 consecutive patients with colorectal cancer who underwent laparoscopic surgery were retrospectively divided into two groups according to whether they had severe comorbidity (50 patients) or non-severe comorbidity (32 patients). An age-adjusted Charlson comorbidity index of ≥6 was defined as severe comorbidity. RESULTS: Operative time, blood loss, and rate of conversion to laparotomy did not differ between the groups. Postoperative complications and the length of the postoperative hospital stay also did not differ significantly between the groups. CONCLUSION: Laparoscopic colorectal cancer surgery is feasible and safe, even in patients with severe comorbidities.

DOI： 10.21873/anticanres.12659

PubMed

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Language：Japanese   Publisher：(NPO)日本食道学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The therapeutic efficacy of dissection of the splenic hilar lymph nodes (#10) has not been fully evaluated in locally advanced proximal gastric cancer (LAGC) invading the greater curvature of the stomach. METHODS: Patients with LAGC invading the greater curvature who underwent D2 total gastrectomy with splenectomy between January 2000 and May 2015 were retrospectively examined. The therapeutic value index was calculated by multiplying the metastatic rate of a station and the 5-year survival of patients with metastasis to that station; the metastatic rate and the index of each lymph node station were then compared. RESULTS: In total, 82 patients were eligible for the present study. The most frequent metastatic node was #3, followed by #1, #4d and #7, #2, #4sa and #10, and #4sb and #9. These lymph nodes had a metastatic rate of more than 10%. The node station with the highest index was #3, followed by #7, #4d, #1, #4sb, #4sa, #2, and #9. The index of #10 was lower, but exceeded those of #8a and #11p. CONCLUSIONS: The metastatic rate of #10 was relatively high at 13%, and the therapeutic value index was as high as those of other suprapancreatic nodes. D2 dissection for proximal cancer located in the greater curvature should include removal of node #10.

DOI： 10.1007/s10120-017-0775-9

PubMed

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Language：Japanese   Publisher：横浜市立大学医学会  

症例は68歳、女性。2017年7月、右鼠径部腫瘤を主訴に当科受診した。現病歴は、2007年からの右鼠径部の膨隆を自覚していたが、経過観察していた。今回、2017年7月ごろから腫瘤の増大を認めたため受診となった。来院後の検査所見のComputed tomography(以下CT)で右鼠径部の嚢胞性病変を認めた。嚢胞は内部均一であり腹腔内との交通を認めないことからNuck管水腫の診断となった。本症例では腹腔内との連続を認めずヘルニアの合併も否定できないため前方アプローチによる手術を選択した。手術所見は外鼠径輪から突出する形で弾性軟な嚢胞性腫瘤を認め、嚢胞は腹腔内との連続性は認めなかった。子宮円索を高位結紮し切離して腫瘤を摘出、内ヘルニア門は1横指弱であり補強目的にmesh-plug法を施行した。病理組織学的所見でもNuck管水腫であり、子宮内膜症や癌の合併は認めなかった。Nuck管水腫はまれな疾患であり、その発生頻度は女児で0.1%と推定されている。またその多くは思春期までの小児期に診断されており成人での報告はさらに少ない。今回成人女性に発生したNuck管水腫は、きわめて珍しい症例であり、文献的考察と合わせて報告する。(著者抄録)

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Other Link： https://search-tp.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2018&ichushi_jid=J01499&link_issn=&doc_id=20180718460002&doc_link_id=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001339%2F&url=http%3A%2F%2Fid.nii.ac.jp%2F1246%2F00001339%2F&type=%89%A1%95l%8Es%97%A7%91%E5%8Aw%81F%89%A1%95l%8Es%97%A7%91%E5%8Aw%8Aw%8Fp%8B%40%8A%D6%83%8A%83%7C%83W%83g%83%8A&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F80205_3.gif

Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: To evaluate the safety of laparoscopic colorectal cancer surgery for patients with severe comorbidities. PATIENTS AND METHODS: A total of 203 consecutive patients with severe comorbidities who underwent resection for colorectal cancer were retrospectively divided into laparoscopic and open primary resection groups. An age-adjusted Charlson comorbidity index ≥6 was considered as severe comorbidity. RESULTS: Blood loss (31 g vs. 207 g, p<0.01) and total postoperative complications (10.0% vs. 27.5%, p<0.01) in the laparoscopic group were significantly decreased compared to the open group. Incidence of postoperative ileus (0.0% vs. 7.2%, p=0.06) and length of postoperative hospital stay (11 days vs. 14 days, p=0.08) in the laparoscopic group were improved, though not significantly, compared to the open group. CONCLUSION: Laparoscopic resection for patients with severe comorbidities is safe, and is associated with a lower rate of overall operative complications compared to open surgery.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.26.17

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：PJD Publications Ltd  

DOI： 10.4993/acrt.26.46

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Medical Association of Yokohama City University  

A 68-year-old woman presented to our department with a eomplaint of right inguinal swelling. She had a 10-year history of right inguinal swelling. She came to our hospital because the mass was increasing in size over the last month. Computed tomography showed a right inguinal, homogeneous, cystic mass without communication to the peritoneal cavity. Surgery was performed with a diagnosis of a hydrocele of the canal of Nuck. On intraoperative examination, the cystic mass did not connect to the peritoneal cavity. The mass was resected, and the internal inguinal ring was closed with a mesh-plug by the anterior approach. On histopathology, the diagnosis was a hydrocele of the canal of Nuck with no malignancy and no endometriosis. A hydrocele of the canal of Nuck is rare and occurs in children before adolescence, but it is much rarer in adults. A rare case of an adult hydrocele of the canal of Nuck is reported.

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND/AIM: Laparoscopy-assisted total gastrectomy (LATG) for gastric cancer may prevent the loss of body weight or lean body mass after surgery due to its reduced surgical stress compared with open total gastrectomy (OTG). PATIENTS AND METHODS: A total of 303 patients were examined in this study. All patients received the same perioperative care via fast-track surgery. The body weight and composition were evaluated using a bioelectrical impedance analyzer within 1 week before and at 1 week, 1 month, and 3 months after surgery. RESULTS: Two hundred and eight patients received OTG, and 95 received LATG. Although the clinical T factor and N factor were significantly different between these two groups, other clinical factors were similar. The respective body weight loss (1 week/1 month/3 months) was -4.7%/-8.0%/-11.9% in the OTG group and -4.7%/-8.2%/-11.6% in the LATG group, that were not significantly different between the two groups at any time point of measurement (p=0.698/0.528/0.534, respectively). The respective lean body mass loss (1 week/1 month/3 months) was -4.2%/-6.4%/-7.4% in the OTG group and -4.0%/-5.8%/-6.2% in the LATG group, that were not significantly different between the groups (p=0.503/0.588/0.946, respectively). CONCLUSION: The body composition changes were similar between the OTG and LATG groups using the same perioperative care of fast-track surgery. Adopting a laparoscopic approach would not help in reducing loss of body weight or lean body mass after gastric cancer surgery.

DOI： 10.21873/invivo.11408

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Serum C-reactive protein (CRP) level can be an indicator of the early stage of infectious complications. However, its utility in advanced esophageal cancer patients who receive radical esophagectomy with two- or three-field lymph node dissection with perioperative steroid therapy and enhanced recovery after surgery (ERAS) care is unclear. METHODS: The present study retrospectively examined 117 consecutive esophageal cancer patients who received neoadjuvant chemotherapy followed by radical esophagectomy. All patients received perioperative steroid therapy and ERAS care. The utility of the CRP value in the early detection of serious infectious complications (SICs) was evaluated based on the area under the receiver operating characteristic curve (AUC). Univariate and multivariate logistic regression analyses were performed to identify the risk factors for SICs. RESULTS: SICs were observed in 20 patients (17.1%). The CRP level on postoperative day (POD) 4 had superior diagnostic accuracy for SICs (AUC 0.778). The cut-off value for CRP was determined to be 4.0 mg/dl. A multivariate analysis identified CRP ≥ 4.0 mg/dl on POD 4 (odds ratio, 18.600; 95% confidence interval [CI], 4.610-75.200) and three-field lymph node dissection (odds ratio, 7.950; 95% CI, 1.900-33.400) as independent predictive factors. CONCLUSIONS: CRP value on POD 4 may be useful for predicting SICs in esophageal cancer patients who receive radical esophagectomy with perioperative steroid therapy and ERAS care. This result may encourage the performance of imaging studies to detect the focus and thereby lead to the early medical and/or surgical intervention to improve short-term outcomes.

DOI： 10.1186/s12885-017-3831-2

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(一社)日本内視鏡外科学会  

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Language：English   Publisher：(一社)日本内視鏡外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は63歳、男性。2001年9月に胃粘膜下腫瘍に対して、腹腔鏡補助下胃局所切除術を施行した。病理組織学的検査所見では腫瘍は11cm大で、強拡大10視野中10個の核分裂を認め、Fletcher分類において高リスクのGISTと診断した。外来にて経過観察としていたが、2004年11月に肝S5、S6の転移と多発腹膜転移が出現した。イマチニブを開始し、腹膜転移は消失し、肝転移も8年間増悪なく経過していたが、2012年12月に肝S6病変の増大を認めた。手術治療は希望しなかったため、2013年1月からスニチニブを50mg/day(4週投薬2週休薬)の投与で開始したところ、RECISTでSD、ChoicriteriaでPRが得られた。イマチニブ奏効病変も増悪なく、スニチニブ開始後4年経過した現在、無増悪で生存中である。(著者抄録)

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 65-year-old female received distal gastrectomy for gastric cancer.The pathological diagnosis was well differentiated adenocarcinoma(tub1), type 2, pT3, ly: 1, v: 1, N0, H0, P0, M0, CY0, pStage II A.She had been observed without adjuvant chemotherapy.Five years after the resection, umbilical tumor and intraperitoneal nodules were detected by computed tomography. Needle biopsy cytology of umbilical tumor revealed metastasis from gastric cancer.Based on the diagnosis of umbilical metastasis and peritoneal dissemination, S-1(80mg/m / 2, day 1-21)and CDDP(60mg/m2, day 8)were administered for 7 courses.Because of diarrhea(Grade 3), chemotherapy was changed to paclitaxel(80mg/m2, day 1, 8, 15).To date, the patient has undergone 33 courses of paclitaxel.The response evaluation is complete response and no other metastases are detected.She has survived more than 3 years from recurrence of gastric cancer.We report a long-surviving case of umbilical metastasis from post operative gastric cancer with chemotherapy.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 63-year-old man underwent a laparoscopic partial gastrectomy for GIST on September, 2001. Three years and 2 months after the gastrectomy, an abdominal CT showed multiple recurrences in S5 and S6 in the liver and peritoneum. After 4 months from the start of imatinib treatment(400mg/day), peritoneal tumors disappeared and the patient maintained stable disease by imatinib treatment for 8 years. However, on December, 2012, an abdominal CT scan revealed the regrowth of the tumor in S6 in the liver, and PET-CT showed focal progression of only the S6 lesion. Although the lesion was resectable, the patient did not request surgical intervention. So, we initiated sunitinib treatment(50mg/day), and the residual liver metastasis has been well controlled with favorable response of sunitinib for 4 years without severe side effects.

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、女性。胃癌(L.、less、type2、tub1、cT3、cN0、cH0、cP0、cM0、CY0、cStage IIA)の診断で、胃切除の治療方針となった。手術は幽門側胃切除術(D2郭清)およびBillroth I法再建を施行した。病理結果はML、less、type2、tub1、pT3、ly:1、v:1、N0、H0、P0、M0、CY0、pStage IIAであった。術後補助療法は施行せず、外来経過観察となった。術後5年目の腹部造影CT検査で臍部での再発を疑われ、生検の結果、胃癌臍転移の診断となった。再発後、S-1(80mg/m2、day 1〜21)/CDDP(60mg/m2、day 8、3週投与2週休薬)を7コース投与したが、有害事象(下痢:Garde 3)のため中止となった。その後、paclitaxel(80mg/m2、day 1、8、15:3週投与1週休薬)を33コース施行した。臍転移は画像上CRとなり、他臓器への転移もみられなかった。再発後3年以上経過した現在も外来通院中である。今回、化学療法が奏効し長期生存が得られた胃癌術後臍転移の1例を経験したので、若干の文献的考察を加えて報告する。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J00296&link_issn=&doc_id=20171221480115&doc_link_id=%2Fab8gtkrc%2F2017%2F004412%2F115%2F1393-1395%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2017%2F004412%2F115%2F1393-1395%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Upfront surgery and subsequent S-1 chemotherapy is frequently selected for peritoneal cytology-positive (CY1) gastric cancer patients without other distant metastases (CY1-only). The objective of this study was to confirm the efficacy of this strategy in clinical practice and to identify the risk factors associated with survival. METHODS: Overall survival (OS) and recurrence-free survival (RFS) were examined in 36 CY1-only patients who underwent macroscopic curative resection followed by postoperative S-1 chemotherapy between January 2000 and June 2015. Univariate and multivariate analyses were performed using a Cox proportional hazards model to identify risk factors. RESULTS: The median OS was 22.3 months (95% confidence interval 18.7-31.0). When the OS was compared by a log-rank test, significant differences were observed in the status of lymph node metastasis of pathological N3b (pN3b). Moreover, the univariate and multivariate analyses demonstrated that the status of pN3b was a significant independent risk factor for OS and RFS. The median OS in patients with pathological N0-N3a (pN0-N3a) was 31.0 months, while that in patients with pN3b was 18.2 months (P = 0.002). The median RFS in patients with pN0-N3a was 16.4 months, while that in patients with pN3b was 7.9 months (P = 0.007). CONCLUSIONS: The present study confirmed the efficacy of postoperative S-1 chemotherapy for CY1-only gastric cancer patients who received upfront surgery. This strategy might be recommended as clinical practice for patients with CY1 disease but a more effective treatment should be established for CY1-positive patients, especially for those who are diagnosed with CY1 and pN3b disease.

DOI： 10.1007/s10147-017-1128-8

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 53-year-old man underwentdistal gastrectomy with Roux-en-Y(R-Y)reconstruction for gastric cancer. An R-Y anastomosis was performed usinga 21mm circular stapler. Five years postoperatively, he visited our hospital with anorexia. An abdominal computed tomography scan showed dilatation of the afferent loop. He was diagnosed with afferent loop syndrome due to R-Y anastomotic stenosis that resulted in poor oral intake and malnutrition. A U-shaped bend created by an adhesion caused a bowel obstruction of the Y-anastomotic site for which the patient underwent R-Y loop reconstruction with an aboral pouch usinga 60mm linear stapler. He has been well without postoperative complaints. Here, we report a case of R-Y loop reconstruction with an aboral pouch for afferent loop obstruction complicated by stenosis of the Y-anastomotic site after distal gastrectomy.

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は53歳、男性。胃癌に対して、幽門側胃切除・Roux-en-Y再建術を施行した。Y脚はcircular stapler(21mm)による側側吻合を用いた。合併症や再発なく経過したが、術後5年3ヵ月、食思不振で来院。画像検査から、Y脚吻合部狭窄に伴う慢性輸入脚症候群と診断した。狭窄部解除目的に外科的治療の方針とした。開腹すると、挙上空腸、Y脚吻合部が一塊となり、挙上空腸が屈曲していた。癒着剥離を行うことで屈曲は解除されたが、再狭窄が危惧されたためY脚吻合部形成の方針とした。Y脚吻合部の肛門側で輸入脚と挙上空腸を側側吻合し、パウチ状形成を付加した。術後合併症なく退院し、栄養状態改善と体重増加を認めた。幽門側胃切除後のY脚通過障害に対してY脚パウチ状形成を行った1例を報告する。(著者抄録)

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は72歳、女性。胃癌に対して腹腔鏡補助下幽門側胃切除術、D1+郭清、前結腸経路Roux-en-Y(R-Y)再建を施行した。術後1年9ヵ月に左上腹部痛を主訴に当科外来を受診した。CTにて上腸間膜動静脈分枝の渦巻様サインを認めたため、内ヘルニアを疑い入院とした。絶飲食により腹部症状は軽快したが自然整復されなかったと判断し、腹腔鏡下手術を行った。腹腔鏡の観察では、ほぼ全小腸がPetersen's defectに入り込んでいた。虚血性変化を認めなかったため腹腔鏡下に整復し、間隙を縫縮した。内ヘルニアの再発はなく、外来通院中である。幽門側胃切除後の内ヘルニアは比較的まれであるが、R-Y法では挙上空腸と横行結腸間膜との間隙が生じることで内ヘルニアの危険性が高く、嵌頓壊死により重篤化し得る病態であり、内ヘルニアの発生を念頭に置く必要がある。確実なPetersen's defectの縫合閉鎖が内ヘルニアの発生を予防するために重要と考えられた。(著者抄録)

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: We previously demonstrated that body weight loss (BWL) at one month after gastrectomy, a common finding after surgery for gastric cancer, was an independent risk factor for the continuation of adjuvant chemotherapy with S-1. However, it is unclear whether BWL after gastrectomy leads to poor survival through poor compliance to adjuvant chemotherapy with S-1. METHODS: We conducted this follow-up study in the same cohort as our previous study. Overall survival (OS) and recurrence-free survival (RFS) were examined in 103 patients who underwent curative D2 surgery and were pathologically diagnosed with stage II or III gastric cancer, and who received postoperative adjuvant chemotherapy with S-1 between June 2002 and December 2011. RESULTS: The median follow-up period was 64.3 months. The 5-year OS rate in the patients with a BWL of <15% was 59.9%, while that in the patients with a BWL of ≥15% was 36.4% (p = 0.004). Univariate and multivariate analyses for OS demonstrated that pathological T factor and BWL were significant risk factors. On the other hand, the 5-year RFS rate was 56.4% in the BWL <15% group and 36.4% in the BWL ≥15% group (p = 0.016), while univariate and multivariate analyses for RFS demonstrated that BWL was a marginally significant risk factor. CONCLUSIONS: Severe postoperative BWL, which is closely related with poor S-1 compliance, is an important risk factor for survival. It merits testing if preventing BWL improves survival of gastric cancer patients who receive S-1 adjuvant chemotherapy.

DOI： 10.1007/s10147-017-1089-y

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

症例は60歳の男性で,早期胃癌と診断し腹腔鏡補助下幽門保存胃切除術を施行(D1郭清)した.術後6年5ヵ月のCTで総肝動脈周囲(No.8a)リンパ節に孤立性の腫大を認め胃癌再発が疑われた.遠隔転移を認めず開腹No.8aリンパ節郭清を施行した.病理組織学的検査でカルチノイドと診断,PETや上下部消化管・小腸内視鏡検査を行ったが原発巣は不明であった.半年毎に画像検索し,リンパ節郭清後2年6ヵ月の上部消化管内視鏡検査で十二指腸球部に粘膜下腫瘍を認め生検でカルチノイドと診断した.リンパ節郭清後2年7ヵ月で開腹幽門側胃切除・十二指腸球部切除術(No.5,12a,17リンパ節郭清)を施行した.病理組織学的検査でリンパ節転移は認めなかった.最大腫瘍径20mm,核分裂像1個/HPF(high power field),MIB-1 index 2%でneuroendocrine tumor(NET)G1と診断した.リンパ節転移切除後30ヵ月で原発巣が判明した症例を経験したので報告する.(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2017&ichushi_jid=J01117&link_issn=&doc_id=20170725270003&doc_link_id=10.5833%2Fjjgs.2014.0114&url=https%3A%2F%2Fdoi.org%2F10.5833%2Fjjgs.2014.0114&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publisher：日本外科代謝栄養学会  

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：English   Publisher：The Japanese Society of Strategies for Cancer Research and Therapy  

DOI： 10.4993/acrt.25.88

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Gastroenterological Surgery  

A 60-year-old man was treated with laparoscopy-assisted pylorus-preserving gastrectomy for early gastric cancer. After surgery, the lesion was diagnosed as T1a N0M0, Stage IA. Six years and five months after the operation, we detected lymph node swelling around the common hepatic artery (No. 8a) and diagnosed lymph node metastasis. We performed No. 8a lymph node dissection, on the grounds of the lack of distant metastasis and the isolated lymph node swelling. The pathological findings showed a neuroendocrine tumor (NET). Therefore, we performed wholebody PET, gastrointestinal fiberscopy (GIF), colonofiberscopy (CF) and enteroscopy
however, no primary lesion was identified. We continued to evaluate the patient using imaging performed every six months. A total of 30 months after the No. 8a lymph node dissection, we diagnosed NET of the duodenum based on an endoscopic biopsy and performed distal gastrectomy and duodenal bulb resection with No. 5, 12a and 17 lymph node dissection. A histopathological inspection showed no metastasis of the lymph nodes. We herein report an interesting case in which the site of the primary lesion became clear approximately 30 months after the dissection of isolated lymph node metastasis.

DOI： 10.5833/jjgs.2014.0114

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Recurrent esophageal cancer has a poor prognosis.However, we sometimes encounter cases with long-term survival after radical treatment for recurrent esophageal cancer.We perform radical chemoradiotherapy aggressively when recurrent esophageal cancer is present in a limited area and is sufficiently localized to be treated by radiation therapy.From June 2010 to December 2014, 150 patients underwent curative esophagectomy for esophageal cancer.Forty -one cases relapsed and we treated 13 of them with radical chemoradiotherapy.Complete response(CR), non-CR/non-PD, and progressive disease(PD) were observed in 5, 6, and 2 cases, respectively.The CR rate was 38.4%.The median survival time from recurrence was 500± 39.7 days, and the 1-year and 3-year survival rates were 84.6% and 28.7%, respectively. Four out of 5 CR cases were single site recurrences.The other case was multiple and regrowth of the cancer was identified 253 days after the CR.These results suggest that radical chemoradiotherapy for recurrent esophageal cancer after curative esophagectomy can achieve long time survival, especially in cases with single site lymph node recurrence.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 69-year-old woman who underwent laparoscopic assisted distal gastrectomy for early gastric cancer(pathological T1bN1M0)in June 2011was admitted to the hospital because of abdominal pain in May 2015.A n abdominal CT scan showed ileus caused by a transverse colon tumor and ascending colon perforation.We performed emergency right hemicolectomy and diverting ileostomy.The postoperative pathological findings revealed poorly differentiated adenocarcinoma and signetring cell carcinoma similar to the gastric cancer resected 4 years ago.Immunohistochemical findings showed that the colon tumor was positive for CK7, but negative for CK20 and expressed a gastric mucin phenotype.From these findings, the colon tumor was diagnosed as a metastasis from early gastric cancer.Colon metastasis from early gastric cancer is rare and the diagnosis is difficult in some cases.We herein report this case and discuss the clinical and pathologic features of colon metastasis from gastric cancer.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

There is a high rate of leakage after laparoscopic lower anterior resection(Lap-LAR).We examined the safety of Lap-LAR at community hospitals.We investigated 54 patients who underwent Lap-LAR at the 10 hospitals related to the Department of Surgery at Yokohama City University between April 2013 and March 2014.T he median patient age was 67 years, and 32 patients were men.Forty -eight(88%)cases were higher than pathological Grade T3, and 37(69%)patients had undergone D3 lymph node dissection.A diverting stoma(DS)was created in 13(24%)patients.An anus drain was placed in 23 (40%)patients.The clinical anastomotic leakage rate(13%)is comparable with the rate of the DS study(12.9%).The rate of anastomotic leakage was acceptable.Lap -LAR at a community hospital could be safely performed for rectal cancer by making appropriate case choices and implementing preventive measures against anastomotic leakage.

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Neoadjuvant chemotherapy(NAC)is thought to be effective to improve the outcomes in patients with adenocarcinoma of the esophago-gastric junction(AEG). We encountered 3 patients who were confirmed as having a pathological complete response following gastrectomy after NAC. The first patient had Siewert type II and clinical Stage III AEG, the second patient had Siewert type I and clinical Stage III AEG, while the third had Siewert type II and clinical Stage II AEG. Two patients received NAC with 2 courses of S-1 plus cisplatin, while the third patient received 2 courses of docetaxel, S-1, and cisplatin. All of the patients were treated with D2 gastrectomy after the NAC, and remain alive at more than 40 months after initial chemotherapy treatment without recurrence. We report the details of these 3 cases and review the literature.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

A 74-year-old man admitted with dysphagia was found to have advanced esophageal squamous cell carcinoma, clinical stage IV (T4N2M0). We initiated definitive chemoradiotherapy(dCRT)with combined 5-fluorouracil and cisplatin chemotherapy( FP therapy)and 50.4 Gy irradiation, followed by boost FP therapy, to which the patient showed confirmed complete response(CR). Local recurrence was detected in the scar of the primary lesion at 4 months after the boost FP therapy. Photodynamic therapy(PDT)for this lesion resulted in CR. Thirteen months later, right hilar and right pericardial lymph node metastases were found. The right hilar lymph node metastases were not visible on CT after triweekly docetaxel therapy, but the pericardial lesions remained. The patient underwent salvage lymphadenectomy without further chemotherapy, and at 5 months after surgery, he was alive and recurrence-free.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

BACKGROUND: The aim of this study was to evaluate the safety of laparoscopic-assisted colorectomy(LAC)for elderly patients more than 70 years old. METHODS: The outcomes of 131 patients more than 70 years old who underwent LAC between April 2013 and March 2014 were retrospectively analyzed.Morbidity and mortality were evaluated using the Clavien-Dindo classification. RESULTS: Postoperative complications exceeding Grade II in the Clavien-Dindo classification were found in 20 patients(15.3%).No mortalities were observed in this study. CONCLUSIONS: LAC can be performed safely for elderly patients older than 70 years.

PubMed

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は30歳、女性。胃癌の既往があり2009年3月に胃全摘脾合併切除術を施行され、病理組織学的診断はU、Less、Type 2、pap、ly0、v2、pT3(SE)N2、M0、fStage IIIBであった。腹膜播種再発に対し、weekly paclitaxel療法施行中の2010年2月に頭痛、悪心・嘔吐、めまいが出現した。精査の結果、左小脳半球に28mm大の転移性脳腫瘍と小脳腫脹、水頭症を認め、緊急後頭下開頭腫瘍摘出術を施行した。脳腫瘍の病理組織所見は、胃癌の転移として矛盾しなかった。術後biweekly CPT-11+cisplatin療法を開始したが、有害事象によるコンプライアンス低下と再発所見を認めないことから、2011年4月に化学療法を中止とした。現在、小脳転移術後6年無再発生存中である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00296&link_issn=&doc_id=20161104480036&doc_link_id=%2Fab8gtkrc%2F2016%2F004310%2F037%2F1286-1288%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2016%2F004310%2F037%2F1286-1288%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は65歳、男性。2010年8月からの嗄声を主訴に来院した。胸部中部食道と胃角部小彎側に1型病変を認め、生検でそれぞれ扁平上皮癌と腺癌であった。胸腹部CT検査では#101R、#106recL、#1、#3のリンパ節腫大を認め、リンパ節を介して両側反回神経浸潤が疑われた。遠隔転移はなく、同時性進行食道(cT4N2M0、cStage IV)・胃(cT3N1M0、cStage IIB)重複癌と診断した。両側反回神経浸潤が疑われることから根治切除は困難と判断し、全身化学療法として、2010年10月よりDCS療法を開始した。DCS療法後、食道および胃の原発巣はPRであったが、反回神経周囲のリンパ節は残存していた。食道癌の根治目的に2011年1月から化学放射線治療(FP療法+60Gy)を施行し、効果判定は食道癌はCR、胃癌はPRだった。2011年5月に残存する胃病変に対して幽門側胃切除術を施行した。術後は化学療法を施行せず、治療開始より5年6ヵ月無再発生存中である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2016&ichushi_jid=J00296&link_issn=&doc_id=20161104480028&doc_link_id=%2Fab8gtkrc%2F2016%2F004310%2F029%2F1262-1264%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2016%2F004310%2F029%2F1262-1264%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Lean body mass loss after surgery, which decreases the compliance of adjuvant chemotherapy, is frequently observed in gastric cancer patients who undergo gastrectomy for gastric cancer. However, the risk factors for loss of lean body mass remain unclear. METHODS: The current study retrospectively examined the patients who underwent curative gastrectomy for gastric cancer between June 2010 and March 2014 at Kanagawa Cancer Center. All the patients received perioperative care for enhanced recovery after surgery. The percentage of lean body mass loss was calculated by the percentile of lean body mass 1 month after surgery to preoperative lean body mass. Severe lean body mass loss was defined as a lean body mass loss greater than 5 %. Risk factors for severe lean body mass loss were determined by both uni- and multivariate logistic regression analyses. RESULTS: This study examined 485 patients. The median loss of lean body mass was 4.7 %. A lean body mass loss of 5 % or more occurred for 225 patients (46.4 %). Both uni- and multivariate logistic analyses demonstrated that the significant independent risk factors for severe lean body mass loss were surgical complications with infection or fasting (odds ratio [OR] 3.576; p = 0.001), total gastrectomy (OR 2.522; p = 0.0001), and gender (OR 1.928; p = 0.001). CONCLUSIONS: Nutritional intervention or control of surgical invasion should be tested in future clinical trials for gastric cancer patients with these risk factors to maintain lean body mass after gastrectomy.

DOI： 10.1245/s10434-015-5080-4

PubMed

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：Japanese   Publisher：(一社)日本外科学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：English   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：(株)ジェフコーポレーション  

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Language：Japanese   Publisher：The Japanese Society of Gastroenterological Surgery  

<p>A 77-year-old man with advanced gastric cancer (por, P1H0M0T4aN0, HER2 negative) started chemotherapy using a regimen containing S-1 plus cisplatin. Acute generalized peritonitis due to gastric perforation occurred at day 19 of the first course, and the patient received emergency surgery. A perforation 1 cm in diameter was observed at the ulceration at the bottom of the tumor at the anterior wall of the gastric body. Simple closure using an omental patch was selected. The peritoneal foci obtained during the surgery demonstrated HER2 IHC3+. After surgery, the chemotherapy regimen was changed to capecitabine (X)+CDDP+trastuzumab (H). Diagnostic laparoscopy after 11 courses of chemotherapy demonstrated P0CY0. The patient received curative surgery by spleen-preserving D2 total gastrectomy. The final diagnosis was gastric cancer (25×25 mm in size, type 2, por 1, ly0, and v1), yP0H0M0ypT3N0 (0/45), and ypStage IIA. The pathological response of the primary tumor was grade 1b. The patient, who received adjuvant chemotherapy with capecitabine and trastuzumab, has been alive for 7 months after surgery. We suggest that combination chemotherapy with trastuzumab is useful for stage IV gastric cancer where HER2 is negative for the primary tumor but is positive for the metastatic site.</p>

DOI： 10.5833/jjgs.2015.0195

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(株)癌と化学療法社  

症例は77歳、男性。2012年3月に胃癌、UME、cT4aN2M0、cStage IIIBの診断で胃全摘D1+郭清術を施行した。術中網嚢内に腹膜播種結節を認め、病理組織学的にUME、Less、pType 3、por1>tub2、pT4aN3b(21/41)M1(P1)、fStage IVと診断した。術後化学療法(S-1:80mg/m2)を6コース実施後、有害事象により化学療法を中止し、経過観察となっていた。術後2年の上部消化管内視鏡検査で、胸部中部食道に隆起性病変を認め、病理組織学的には管腔構造を有した腺癌細胞増殖として認め、胃癌の食道転移と診断し、少量weekly docetaxel(25mg/m2)/cisplatin(25mg/m2)療法(3週投与1週休薬)を開始した。5コース実施後の上部消化管内視鏡検査で隆起性病変は消失し、全身検索においても再発所見を認めなかった。現在、無再発経過観察中である。(著者抄録)

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2015&ichushi_jid=J00296&link_issn=&doc_id=20151027380045&doc_link_id=%2Fab8gtkrc%2F2015%2F004210%2F046%2F1304-1306%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fab8gtkrc%2F2015%2F004210%2F046%2F1304-1306%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：日本臨床外科学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本消化器外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

PURPOSE: Previous studies from Western countries have shown similar survival outcomes after both open and laparoscopic resections. In Japan, radical D3 dissections performed by open resection have been routinely performed for ≥T2- or ≥N1-stage cancers, and relatively favorable survival outcomes were obtained. This study compared the survival in patients with Stage I/II colon and upper rectal cancers undergoing laparoscopic and open resection. METHODS: A total of 145 patients were initially enrolled. Propensity score matching was applied to assemble a study cohort. D2 lymph node dissection for T1 cancer and D3 for ≥T2- and ≥N1-stage cancers were applied. The primary outcome measure was the disease-free survival; the cancer-specific and overall survival rates were secondary outcomes. RESULTS: A total of 64 patients were matched for the analysis. The length of hospitalization, postoperative complication rates, number of lymph nodes removed and surgical margins were similar between the groups. The disease-free survival following laparoscopic surgery was better than that following open surgery, but the difference was not statistically significant. Neither the cancer-specific nor overall survival rates following laparoscopic surgery were inferior to those associated with open surgery. CONCLUSIONS: The outcomes of the laparoscopic approach were comparable to those for open surgeries accompanied by radical lymph node dissection.

DOI： 10.1007/s00595-014-0954-9

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Language：Japanese   Publisher：日本外科系連合学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：(一社)日本胃癌学会  

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Language：Japanese   Publisher：日本胸部外科学会-関東甲信越地方会  

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Language：English   Publisher：(一社)日本呼吸器外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：Japanese   Publisher：(NPO)日本血管外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

INTRODUCTION: Chylorrhea is a form of lymphorrhea involving digested lipid products absorbed in the small intestine. Here we report a rare case of chylorrhea after laparoscopy-assisted distal gastrectomy (LADG) with D1+ dissection that resolved following administration of a low-fat diet. PRESENTATION OF CASE: A 35-year-old woman with early gastric cancer underwent LADG with D1+ dissection, and on postoperative day 4, the drain output increased and the fluid with a high triglyceride level (740mg/dL) changed from clear to milky. On postoperative day 6, oral intake of a low-fat diet was initiated after a 2-day fast, and the daily drain output decreased from postoperative day 9. The drain tube was withdrawn on postoperative day 15, and the patient was discharged on postoperative day 17. DISCUSSION: D1+ dissection does not typically cause injury to the lymphatic trunks, cisterna chyli, or thoracic duct. The maximum output of chylous ascites was minimal, and thus, we assumed that chylorrhea occurred from slightly injured lymphatics with anatomical variation. CONCLUSION: Chylorrhea after LADG with D1+ dissection is very rare. The fasting of our case followed by a low-fat diet without TPN would be an effective therapy. As a result, our case recovered favorably without further therapy.

DOI： 10.1016/j.ijscr.2013.10.006

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Language：Japanese   Publisher：Japanese College of Surgeons  

An 82-year-old man consulted to our hospital complaining sudden abdominal pain, and at once admitted with a diagnosis as panperitonitis. The abdominal CT scan revealed an abscess formation within the lateral portion of the liver, a small amount of ascites, but no free air. It detected no other lesion causing panperitonitis. So this patient was diagnosed with panperitonitis due to the rupture of abscess, and then soon had an emergency operation. The perforation and pus on the left lobe of the liver was demonstrated. Washing with drainage against the abscess and peritoneal cavity was performed. Klebsiella pneumoniae was cultured from the abscess. The patient fell into the septic shock immediately after the operation, but recovered gradually, and was discharged on the 35th day after the operation.<br>Panperitonitis caused by rupture of liver abscess is relatively rare cases, and especially, those showing no gas in the abscess and peritoneal cavity tend to decrease in numbers. Therefore, recently it is difficult to get an exact diagnosis preoperatively, and to judge whether or not, and when, to operate. On the other hand, the patients indicating the decline of total ability for defense mechanisms against infection and having complication with other disease such as diabetes mellitus tend to increase. Since the state of such patients have high risk to develop into a serious illness, we need to perform the best treatment in a suitable time without a delay.

DOI： 10.4030/jjcs.37.1185

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Other Link： http://search.jamas.or.jp/link/ui/2013248713

Language：Japanese   Publisher：Japanese College of Surgeons  

Background:Laparoscopy assisted distal gastrectomy (LADG) has been introduced for treatment of early gastric cancer in Japan. But, it is not popular in general hospitals because of its technical difficulties and a lack of established evidence. We compared short term outcomes of LADG with open distal gastretomy (ODG) in our institute. The aim of this study is to evaluate continuation of early gastric cancer therapy in our institute before and after introduction of LADG.Method:Between January 2008 and December 2011, distal gastrectomy was performed in 44 patients with gastric cancer (19 ODG and 25 LADG). Result:There was not different in operation time, anesthesia time and number of harvested lymph nodes. In LADG group, blood loss was significantly less than that in ODG group. The duration until first walk, first flatus, first defecation, recovery of oral intake, and postoperative hospitalization in LADG group were shorter than those in ODG group.Conclusion:The quality of early gastric cancer therapy after introduction of LADG in our institute was sufficient compared with ODG.

DOI： 10.4030/jjcs.37.673

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Other Link： http://search.jamas.or.jp/link/ui/2013018243

Language：Japanese   Publisher：Japanese College of Surgeons  

We report our clinical experience in a patient who had ileocecal obstruction due to endometriosis of the ileum. A 48-year-old female was admitted due to lower abdominal pain. Abdominal X-rays showed the dilated terminal intestine with some niveaus. Enterography showed a severe stenosis portion at the terminal ileum. An ileocecal resection was performed for a treatment. Operative findings revealed stenosis of the terminal ileum with thick intestinal wall. Endometriosis of the ileum was diagnosed according to the histopathological assessment.<br> No recurrence of the disease have been found at two years after the surgery. In young women with intestinal obstruction, the intestinal endometriosis should be considered as the differential diagnosis.

DOI： 10.4030/jjcs.37.280

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Other Link： http://search.jamas.or.jp/link/ui/2013030072

Language：Japanese   Publishing type：Research paper (scientific journal)  

A 59-year-old man who had visited our hospital regularly for hemodialysis, complained of abdominal pain. Ultrasonography revealed multiple diverticula in the appendix. Based on this result, the patient was diagnosed with appendiceal diverticulitis. Appendectomy was performed. His postoperative course was uneventful, and he was discharged the hospital on the fifth day after the operation. The pathological diagnosis was also appendiceal diverticulitis. It has been said that appendiceal diverticulitis is relatively rare, and that distinguishing the disease from acute appendicitis preoperatively is difficult. We think, however, that the possibility of preoperative diagnosis would increase, if ultrasonography is performed with greater awareness of appendiceal diverticulitis. © 2012 The Japanese Society of Gastroenterological Surgery.

DOI： 10.5833/jjgs.45.766

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Language：Japanese   Publishing type：Book review, literature introduction, etc.   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 30-year-old woman underwent total gastrectomy with D2 lymph node dissection after being diagnosed with clinical T3, N2, MO, Stage inB gastric cancer. The postoperative pathological findings revealed a T3 (SE), N2, MO, Stage DIB tumor. Headache, dizziness, and vomiting occurred during chemotherapy for peritoneal recurrence, using weekly paclitaxel on days 1, 8, and 15. Head CT showed a solitary tumor with a diameter of 28 mm in the cerebellum, as well as cerebellar swelling and hydrocephalus. She underwent an emergency craniotomy and tumor enucleation. Pathological examination revealed a metastatic brain tumor from the gastric cancer. She received 12 courses of CPT-11 plus cisplatin until discontinuation because of an adverse event. The patient is alive 6 years after the diagnosis of the cerebellar metastasis without recurrence.

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Language：Japanese   Publishing type：Book review, literature introduction, etc.   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

We report a case of advanced esophageal and gastric cancer that was successfully treated via multimodal therapy. A 65- year-old man with hoarseness was referred to our hospital. He was diagnosed with clinical T4aN2M0, Stage IV esophageal squamous cell carcinoma and clinical T3N1M0, Stage D B gastric adenocarcinoma. He was treated with 3 courses of chemotherapy, administered over 4 weeks, with S-1 (80 mg/m2: day 1-14), cisplatin (60 mg/m2: day 1), and docetaxel (40 mg/m2: day 1). Computed tomography (CT) revealed shrinkage of the primary esophageal tumor, gastric tumor, and lymph node metastases. Next, we selected definitive radiation chemotherapy (CRT), because lymph node metastases remained around the bilateral recurrent laryngeal nerves. After CRT with a total 60 Gy plus administration of 5-fluorouracil and cisplatin, CT showed that the primary esophageal tumor and lymph node metastases had disappeared. Then, distal gastrectomy was performed for the remaining gastric cancer, as part of the multimodal therapy. After gastrectomy, no systemic chemotherapy was performed. At a follow-up examination 5 years and 6 months after the start of chemotherapy, the patient is alive without recurrence.

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Language：Japanese   Publishing type：Book review, literature introduction, etc.   Publisher：Japanese Journal of Cancer and Chemotherapy Publishers Inc.  

A 63-year-old man with dysphagia was referred to our hospital. He was found to have a type 2 tumor extending from the lower thoracic esophagus to the esophagogastric junction via upper gastrointestinal endoscopy. A biopsy revealed adenocarcinoma with overexpression of the human epidermal growth factor type 2 (HER2). The tumor was type I according to Siewert's classification, as the epicenter of the tumor was 27 mm to the oral side from the esophago-gastric junction. The clinical diagnosis was T3N1M1, stage IV according to the Japanese Classification of Gastric Carcinoma, and T3N2M0, stage ID per the Japanese Classification of Esophageal Cancer. He was treated with neoadjuvant chemotherapy consisting of 6 courses of capecitabine (1,000 mg/m2: days 1-14) plus cisplatin (80mg/m2: day 1) and trastuzumab (8mg/kg: day 1 of the first course, 6mg/kg: day 1 after the second course). Computed tomography (CT) and upper gastrointestinal endoscopy showed shrinkage of the primary esophagogastric cancer and lymph node metastases. The patient had a partial response and underwent radical esophagectomy. The pathological findings revealed a T3N2M0, stage ID tumor
the tumor was determined to be Grade 1b owing to the chemotherapeutic effect. At a follow-up examination 1 year and 7 months after the start of chemotherapy, the patient is alive without recurrence.

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER SOC CLINICAL ONCOLOGY  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER SOC CLINICAL ONCOLOGY  

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Language：English   Publishing type：Research paper, summary (international conference)   Publisher：AMER SOC CLINICAL ONCOLOGY  

Web of Science

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