Language：English   Publisher：BMC Gastroenterology  

Purpose: This study aimed to investigate the efficacy of measuring lymph node size on preoperative CT imaging to predict pathological lymph node metastasis in patients with colon cancer to enhance diagnostic accuracy and improve treatment planning by establishing more reliable assessment methods for lymph node metastasis. Methods: We retrospectively analyzed 1,056 patients who underwent colorectal resection at our institution between January 2004 and March 2020. From this cohort, 694 patients with resectable colon cancer were included in the study. We analyzed the relationship between lymph node size on preoperative CT imaging and lymph node metastasis identified on postoperative pathological examination. Results: The optimal cutoff values for the maximum long diameter and short diameter of regional lymph nodes on preoperative CT were identified as 6.5 mm and 5.5 mm, respectively, with an AUC of 0.7794 and 0.7755, respectively. Notably, the predictive accuracy varied by tumor location. Higher cutoff values were observed in the right-sided colon (maximum long diameter: 7.7 mm, maximum short diameter: 5.9 mm) compared to the left-sided colon (maximum long diameter: 5.8 mm, maximum short diameter: 5.2 mm). Conclusion: Lymph node size on preoperative CT is a significant predictor of pathological lymph node metastasis in colon cancer. Notably, the optimal cutoff values for predicting lymph node metastasis vary depending on the specific region within the colon.

DOI： 10.1186/s12876-025-03602-x

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PubMed

Language：English   Publisher：International Journal of Surgery Case Reports  

Introduction and importance: Brunner's gland hamartoma is a rare benign duodenal tumor. Resection is recommended for large or symptomatic lesions, but conventional pancreaticoduodenectomy and other procedures can be overly invasive for the lesion. We report a case of Brunner's gland hamartoma resected using laparoscopic and endoscopic cooperative surgery (LECS). Case presentation: A 51-year-old woman was referred to our hospital with an asymptomatic duodenal tumor that had increased in size. A submucosal tumor was found on the anterior wall of the duodenal bulb during a detailed examination, and surgery was performed because the tumor was large (2 cm). In order to optimally resect the tumor, duodenal LECS (D-LECS) was selected. The resection line was determined while checking the base of the lesion with an intraoperative endoscope, and after the lesion was resected, the mucosal defect was closed using laparoscopic manipulation. Histopathological evaluation revealed Brunner's gland hyperplasia and mixed smooth muscle bundles, and the lesion was diagnosed as a Brunner's gland hamartoma. The surgery was completed without any problems, and the patient made a full recovery after the surgery with no complications such as stenosis, and no recurrence was observed. Clinical discussion: With D-LECS, the lesion can be resected without excess or deficiency, and the incision can be sutured with minimal invasiveness. D-LECS is an effective method as a treatment option for Brunner's gland hamartoma. Conclusion: We herein report a case of Brunner's gland hamartoma treated safely with a minimally invasive surgical technique: D-LECS.

DOI： 10.1016/j.ijscr.2024.110617

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Language：English  

DOI： 10.1186/s40792-024-02033-2

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PubMed

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

Language：English   Publisher：シュプリンガー・ジャパン(株)  

Language：English   Publisher：Surgery Today  

Purpose: Few studies have investigated the impact of the surgical proximal and distal margins on colon cancer recurrence. We conducted this study to investigate the effect of resection margins on the prognosis of resectable colon cancer. Methods: We analyzed data on 1458 patients who underwent colorectal resection in our institute between January, 2004 and March, 2020, including 579 patients with resectable colon cancer. The association between the resection margin and recurrence for each oncological status was assessed and the value of the resection length that influenced recurrence was analyzed. Results: Patients who had pT4 colon cancer with margins of more than 7 cm had a trend of fewer recurrences and longer relapse-free survival (RFS) than those with colon cancer of other stages (P = 0.033; hazard ratio [HR], 0.42; 95% confidence interval [CI], 0.20–0.89). Multivariate analysis identified a margin of < 7 cm as an independent risk factor for RFS in patients with pT4 colon cancer (P = 0.023; HR, 2.65; 95% CI 1.013–6.17). No correlation was found between resection margins and recurrence, depending on the extent of lymph node metastasis and tumor location. Conclusion: A resection margin of at least 7 cm should be maintained for patients with pT4 colon cancer.

DOI： 10.1007/s00595-024-02836-8

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PubMed

Language：Japanese   Publisher：The Japan Broncho-esophagological Society  

DOI： 10.2468/jbes.75.144

CiNii Research

Language：English   Publisher：Anticancer Research  

Background/Aim: The efficacy of neoadjuvant chemotherapy (NAC) for colon cancer remains unestablished. This study aimed to investigate the outcomes of NAC in patients with locally advanced T4b or obstructive T4a colon cancers (LACC). Patients and Methods: Data of patients with LACC who underwent colon surgery between 2010 and 2022 after NAC at our institution were retrospectively reviewed. Patient characteristics, surgical outcomes, tumor features, and prognosis were analyzed. Results: Among 800 patients with LACC who underwent radical resection, 11 received NAC because of cT4b or cT4a with mechanical obstruction. NAC, administered as a doublet regimen, had a median duration of three months, without grade ≥3 adverse events. R0 resection was achieved in all patients and downstaging was observed in eight patients. One patient developed a postoperative abdominal abscess, and adjuvant chemotherapy was administered to eight patients. Four patients experienced recurrence: liver metastasis in two, and local recurrence in two. Among these, three patients underwent resection of recurrent tumors. Median follow-up was 30 months. Conclusion: NAC is feasible for T4b or obstructive T4a colon cancer and may be a treatment option for LACC. Further large-scale studies are required to confirm the efficacy of NAC in these patients.

DOI： 10.21873/anticanres.16923

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

DOI： doi: 10.21873/cdp.10270.

Language：English   Publisher：Anticancer Research USA Inc.  

<jats:p>Background/Aim: High-output stomas (HOSs) are a complication that can cause dehydration or renal dysfunction and affect the quality of life of patients, causing water, sodium, and magnesium depletion with malnutrition. Preoperative factors that are useful for predicting HOS are not well defined. Patients and Methods: A total of nine patients developed HOS among 31 patients who underwent rectal cancer surgery with ileostomies during 2014-2021. Clinicopathological and surgical parameters were also analyzed. HOS was defined as maximum output of ≥2,000 ml/day. Results: The clinicopathological features did not differ between the HOS and non-HOS groups. Lower Hemoglobin (Hb) levels (<12 mg/dl) and longer operation times (≥300 min) were shown to be risk factors in the development of HOS. Conclusion: Low Hb levels on preoperative blood tests were predictors of HOS development in patients who underwent rectal cancer surgery and ileostomies simultaneously in our data set. Further studies are required to improve the robustness of these findings.</jats:p>

DOI： 10.21873/cdp.10270

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PubMed

CiNii Research

Publisher：Anticancer Research  

Background/Aim: Anastomotic leakage (AL) is a serious complication after esophagectomy, and the refractory fistula (RF) following AL is therapeutically challenging with no optimal management strategies known. Thus, new therapeutic options are required for treating RF. Case Report: A 67-year-old man who underwent endoscopic mucosal dissection was subjected to subtotal esophagectomy and reconstruction with a gastric tube through the retrosternal route with cervical anastomosis as additional therapy. On postoperative day 5, leakage from the esophagogastric anastomosis was detected. A refractory enterocutaneous fistula (4 cm in length) developed between the esophagogastric anastomosis (the fistula opening was 1 cm approximately) and cervical skin. The RF did not heal despite the drainage of saliva, enteral nutrition, oral administration of biperiden hydrochloride for orofacial dyskinesia to rest the esophagogastric anastomosis, coagulation factor XIII transvenously, and fibrin glue injection from the opening of the fistula, probably due to difficulty in maintaining the rest of the esophagogastric anastomosis caused by orofacial dyskinesia. On postoperative day 76, soft coagulation to the fistula opening at the esophagogastric anastomosis by an endoscopic approach and to the fistula via the fistula opening at the cervical site by a percutaneous approach was performed. The post-treatment course was uneventful. The RF completely closed immediately after soft coagulation. Conclusion: Soft coagulation using endoscopic and percutaneous approaches to RF is a minimally invasive procedure and may be a useful option if the fistula opening of the anastomotic site is small and accessible endoscopically, and there are no vital organs around the fistula.

DOI： 10.21873/anticanres.16457

Scopus

Publisher：Anticancer Research  

Background/Aim: Laparoscopic gastrectomy (LG) may have greater clinical benefits as a less invasive surgery for elderly patients with gastric cancer (GC). Therefore, we aimed to evaluate the survival benefit of LG in elderly patients with GC, especially focusing on preoperative comorbidities, and nutritional and inflammatory status. Patients and Methods: Data collected from 115 patients aged ≥75 years with primary GC who underwent curative gastrectomy, comprising 58 patients who underwent open gastrectomy (OG) and 57 patients who underwent LG, were retrospectively reviewed (total cohort), and 72 propensity-matched patients (matched cohort) were selected for survival analysis. The aim of the study was to determine short- and long-term outcomes, and the clinical markers to identify a population who may benefit from LG in elderly patients. Results: The complication and mortality rates as a short-term outcome in the total cohort and overall survival (OS) as a long-term outcome in the matched cohort did not differ significantly between the groups. In the total cohort, advanced tumor stage and ≥3 comorbidities were independent factors for poor prognosis in terms of OS [hazard ratio (HR)=3.73, 95% confidence interval (CI)=1.78-7.78, p<0.001 and HR=2.50, 95% CI=1.35-4.61, p<0.01, respectively]. The surgical approach was not an independent risk factor for postoperative complications (grade ≥III) and OS. In subgroup analysis of the total cohort, patients with a neutrophil-lymphocyte ratio (NLR) ≥3 in the LG group demonstrated a trend toward greater OS (HR=0.26, 95% CI=0.10-0.64, interaction p<0.05). Conclusion: LG might offer greater survival benefits than OG in frail patients such as those with high NLR.

DOI： 10.21873/anticanres.16366

Scopus

Language：English   Publisher：International Journal of Clinical Oncology  

Prof. Setsuro Fujii achieved significant results in the field of drug discovery research in Japan. He developed nine well-known drugs: FT, UFT, S-1 and FTD/TPI are anticancer drugs, while cetraxate hydrochloride, camostat mesilate, nafamostat mesilate, gabexate mesilate and pravastatin sodium are therapeutic drugs for various other diseases. He delivered hope to patients with various diseases across the world to improve their condition. Even now, drug discovery research based on Dr. Fujii’s ideas is continuing.

DOI： 10.1007/s10147-023-02326-w

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Language：English   Publisher：Springer Berlin Heidelberg  

症例は80歳女性。嚥下困難を主訴に来院した。上部消化管内視鏡検査で胸部下部食道に潰瘍性病変を認め、生検で中分化型扁平上皮癌と診断した。CTで胃周囲リンパ節に加え、鎖骨上リンパ節と傍下大静脈リンパ節の腫大を認めた。PET-CTで上記のリンパ節でFDGの異常集積を認めた。以上の所見から、ステージIVB期食道扁平上皮癌(cT3N2M1 cStageIVB)と診断し、ペムブロリズマブと標準化学療法の併用療法を開始した。レジメンは3週ごとのコースで、5-FU(800mg/m2)、シスプラチン(80mg/m2)、ペムブロリズマブ(200mg)を静注した。2コース終了後に好中球減少症が発現したため、5-FUとシスプラチンの投与量を減量した。4コース終了後に原発巣と転移巣の縮小を認め、PET-CTでFDGの異常集積は見られなかった。診断をycT2N0M0 ycStageIIに変更し、コンバージョン手術の方針となった。胸腔鏡下食道亜全摘術、リンパ節郭清術、胃管再建術を施行した。術後に腫瘍細胞の遺残を認めず、組織学的完全奏効と判定した。16日後に無事退院となった。10ヵ月後の再診で再発は見られなかった。

Publisher：International Journal of Surgery Case Reports  

Introduction and importance: Atraumatic splenic rupture (ASR) is a rare state that accounts for only <1 % of splenic ruptures. One of the causes of ASR is splenic neoplasm such as angiosarcoma. The treatment strategy for ASR is still unclear given the small number of cases reported in detail. Case presentation: A 75-year-old woman presenting with abdominal pain with shock was referred to our hospital. Emergency computed tomography revealed splenic rupture, and hemodynamic stabilization was obtained by emergent vascular embolization. Rebleeding occurred 27 days after the initial treatment, and splenectomy was performed. Pathologically, ASR was diagnosed as caused by splenic angiosarcoma. Clinical discussion: ASR is a very rare disease. The etiology of ASR has been reported as neoplastic, infectious, and so on. The treatment for ASR should be decided considering the etiology of ASR, hemodynamic stability, volume of blood transfusion, patient status, severity of the splenic injury, and volume of intraperitoneal bleeding. Conclusions: We experienced a very rare case of ASR, in which diagnosis was challenging and the timing of surgery was difficult to determine. When splenic rupture has an atraumatic cause, splenectomy should be considered because of the possibility of malignancy.

DOI： 10.1016/j.ijscr.2022.107708

Scopus

Publisher：Langenbeck's Archives of Surgery  

Purpose: Radical gastrectomy is considered the first choice of curative treatment for older patients with gastric cancer (GC). However, there is limited data on the survival benefits of gastrectomy for older patients with GC. Methods: This was a retrospective observational study where medical records of patients aged ≥ 75 years with clinically resectable primary GC, comprising 115 patients who underwent radical surgery (S group) and 33 patients who received conservative therapy (non-S group) (total cohort) and 44 propensity-matched patients (matched cohort), were reviewed. Survival and independent risk factors, including comorbidities and systemic nutritional and inflammatory statuses, were evaluated. Results: In the total cohort, the 5-year overall survival (OS) in the S group was significantly higher than that in the non-S group (53.7% vs 19.7%, P < 0.0001). In the matched cohort, the 3-year OS in the S group was significantly higher than that in the non-S group (59.4% vs 15.9%, P < 0.01). Multivariate analysis of the total cohort showed that no surgery was an independent prognostic factor for poor OS (hazard ratio (HR) 3.70, 95% confidence interval (CI) 1.91–7.20, P = 0.0001). In the S group in the total cohort, the multivariate analysis showed that renal disease (HR 2.51, 95% CI 1.23–5.12, P < 0.05) was an independent prognostic factor for poor OS. Conclusions: Gastrectomy for older patients improved the prognosis; however, careful patient selection is essential, especially among those with renal disease.

DOI： 10.1007/s00423-022-02511-x

Scopus

Language：English   Publisher：Annals of Surgery  

Objective:The aim of this study is to identify biomarkers that predict efficacy of preoperative therapy and survival for esophageal squamous cell carcinoma (ESCC).Background:It is essential to improve the accuracy of preoperative molecular diagnostics to identify specific patients who will benefit from the treatment; thus, this issue should be resolved with a large-cohort, retrospective observational study.Methods:A total of 656 patients with ESCC who received surgery after preoperative CDDP + 5-FU therapy, docetaxel + CDDP + 5-FU therapy or chemoradiotherapy (CRT) were enrolled. Immunohistochemical analysis of TP53, CDKN1A, RAD51, MutT-homolog 1, and programmed death-ligand 1 was performed with biopsy samples obtained before preoperative therapy, and expression was measured by immunohistochemistry.Results:In all therapy groups, overall survival was statistically separated by pathological effect (grade 3 > grade 2 > grade 0, 1, P < 0.0001). There was no correlation between TP53, CDKN1A, MutT-homolog 1, programmed death-ligand 1 expression, and pathological effect, whereas the proportion of positive RAD51 expression (≥50%) in cases with grade 3 was lower than that with grade 0, 1, and 2 (P = 0.022). In the CRT group, the survival of patients with RAD51-positive tumor was significantly worse than RAD51-negative expressors (P = 0.0119). Subgroup analysis of overall survival with respect to positive RAD51 expression indicated preoperative chemotherapy (CDDP + 5-FU or docetaxel + CDDP + 5-FU) was superior to CRT.Conclusions:In ESCC, positive RAD51 expression was identified as a useful biomarker to predict resistance to preoperative therapy and poor prognosis in patients who received preoperative CRT. Administration of preoperative chemotherapy may be warranted for patients with positive RAD51 expression.

DOI： 10.1097/SLA.0000000000003975

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