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ABSTRACT: BACKGROUND:: Completely laparoscopic gastrectomy with intracorporeal anastomosis was introduced to achieve safer anastomosis and smaller scars. Although several reports have shown the feasibility of linear-stapled anastomosis, there are no studies of a large number of patients assessing the long-term complications and functional outcomes. METHODS:: This retrospective study included 345 patients who had intended to undergo completely laparoscopic distal or total gastrectomy with linear-stapled anastomosis between September 2005 and January 2012. This study evaluated both the short- and long-term complications, as well as the endoscopic findings, changes in body weight and serum albumin. RESULTS:: Completely laparoscopic gastrectomy was successfully achieved in 342 patients (99.1%). Short-term complications occurred in 59 patients (17.3%). Reconstruction-related complications were observed in 19 patients (5.6%). Three patients with anastomotic leakage required reoperation. No patient experienced anastomotic stenosis over a mean follow-up period of 29.6 months. Two patients underwent an emergency operation for an internal hernia after total gastrectomy. Adhesive intestinal obstruction was observed in 5 patients (1.5%), but all were resolved without surgical intervention. Body weight loss at 2 years after distal and total gastrectomy was 7.2% and 13.9%, which were similar to previous reports of open surgery. CONCLUSIONS:: Completely laparoscopic gastrectomy with linear-stapled anastomosis is a feasible choice for gastric cancer patients with some potential long-term advantages such as less anastomotic stenosis and fewer adhesive intestinal obstructions.
Annals of surgery 04/2013; · 7.90 Impact Factor
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ABSTRACT: PURPOSE: The safety and feasibility of laparoscopic gastrectomy (LG) for patients who have undergone previous upper abdominal surgery (PUAS) remain unclear. A matched-pair analysis was conducted to compare the short-term outcomes of LG between patients with gastric cancer who had undergone PUAS and those who had not. METHODS: A matched-pair analysis was performed to compare the short-term outcomes of LG between 22 patients who had undergone PUAS and 66 who had not (control group). To compare the outcome to that of open gastrectomy (OG) following PUAS, a total of 143 consecutive OG patients treated during the same study period were also reviewed. RESULTS: Cholecystectomy was the most common type of PUAS, followed by gastrectomy. There were no significant differences between the groups in terms of the length of the operation, blood loss, and the number of retrieved lymph nodes or the rate of conversion to open surgery. The postoperative morbidity in the PUAS group (3/22, 13.6 %) was comparable to that of the control group (7/66, 10.6 %, P = 0.6981). There was no mortality within 30 days in either group. When compared to OG following PUAS (n = 23), LG was performed with significantly less blood loss with an equivalent postoperative outcome. CONCLUSIONS: LG following PUAS is considered to be a safe and feasible surgical modality. PUAS should therefore not be regarded as a contraindication for LG.
Surgery Today 03/2013; · 1.22 Impact Factor
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ABSTRACT: BACKGROUND: Minimally invasive esophagectomy (MIE) in the prone position typically includes thoracoscopic mediastinal dissection and laparoscopic gastric tube construction, followed by esophagogastric anastomosis in the neck. We introduced an intrathoracic esophagogastric anastomosis using linear staplers. TECHNIQUE: The lower mediastinal dissection and the gastric tube construction are done in the laparoscopic part of the operation. The esophagus is transected at the cranial level of the aortic arch after the completion of the upper mediastinal lymph node dissection in the prone position. The excess length of the gastric tube is sacrificed before making the anastomosis. Side-to-side esophagogastric anastomosis is performed using a 35-mm endoscopic linear stapler. The entry hole is closed with hand suturing using the posterior and the axillary port. RESULTS: Twenty-six patients with middle or lower esophageal tumor underwent MIE with an intrathoracic anastomosis. The mean thoracoscopic procedure time was 302 min. One patient had an anastomotic leakage, which was successfully managed with drainage. There has been no anastomotic stenosis. Pneumonia was observed in two patients. There was no mortality. CONCLUSIONS: MIE with an intrathoracic linear-stapled anastomosis with the patient in the prone position is safe and feasible.
Journal of Gastrointestinal Surgery 08/2012; · 2.83 Impact Factor
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ABSTRACT: Proximal gastrectomy has been applied for selected patients with early upper gastric cancer, because of its potential advantages over total gastrectomy, such as preserving gastric capacity and entailing fewer hormonal and nutritional deficiencies. Esophago-gastric anastomosis is a simple reconstruction method with an excellent postoperative outcome provided that gastroesophageal reflux is properly prevented. Following open surgery, the esophagus is anastomosed to the anterior stomach wall with partial fundoplication to prevent esophageal reflux. We developed a novel laparoscopic hand-sewn method to reproduce the anti-reflux procedure that is used in open surgery. The esophagus is first fixed to the anterior stomach wall with a knifeless endoscopic linear stapler. This fixation contributes to maintaining a stable field for easier hand-sewn anastomosis, and allows us to complete the left side of the fundoplication at the same time. This novel technique was used to successfully perform complete laparoscopic proximal gastrectomy with a hand-sewn esophago-gastric anastomosis in ten patients, without any postoperative complications. No patient had symptoms of gastroesophageal reflux during a median follow-up period of 19.9 months. One patient developed anastomotic stenosis, and this was resolved with endoscopic dilatation. The mean percent body weight loss at 12 months after surgery, in comparison to the preoperative weight, was 10.4 %. Laparoscopic proximal gastrectomy with an esophago-gastric anastomosis using our novel technique would be a feasible choice would be a feasible choice and would show benefit for selected patients with early upper gastric cancer.
Gastric Cancer 07/2012; · 2.42 Impact Factor
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ABSTRACT: BACKGROUND: A recent randomized controlled trial (Trastuzumab for Gastric Cancer [ToGA] study) established standard scoring criteria of human epidermal growth factor receptor 2 (HER2) for gastric cancer and demonstrated the efficacy of trastuzumab for treating metastatic gastric cancer. The aim of the present study was to evaluate the frequency of HER2-positive cases by application of the standard criteria in patients with resectable gastric cancer and to examine the relationships between HER2 expression and prognosis, mucin phenotype, p53 status, and clinicopathological features. METHODS: A total of 213 patients were included in this retrospective study. All tumor samples were examined for HER2 expression by immunohistochemistry (IHC), HER2 amplification by in situ hybridization, and mucin and p53 expression by staining for CD10, MUC2, MUC5AC, MUC6, and p53. RESULTS: HER2-positive tumors were identified in 25 patients (11.7 %). HER2-positive cases were more frequently found in men, older patients, and in the intestinal histological type (P = 0.0048, 0.0309, and <0.0001, respectively). Although no association was found between HER2 overexpression and mucin phenotype, the expression of CD10 and p53 was significantly correlated with HER2 positivity (P = 0.0079 and 0.013). The overall survival of HER2-negative and -positive patients was not significantly different. However, in patients with stage III/IV, overall survival was worse in HER2-positive patients (P = 0.0149). In a comparison between dual-color in situ hybridization (DISH) and fluorescence in situ hybridization (FISH), four IHC2+/3+ cases that were DISH-positive were judged as negative by FISH. CONCLUSIONS: Our study indicated that HER2 expression was less frequent in resectable gastric cancer than in metastatic gastric cancer. The impact of HER2 expression on survival was limited. DISH was superior to FISH for evaluating cases with limited HER2 expression.
Gastric Cancer 03/2012; · 2.42 Impact Factor
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ABSTRACT: A 64-year-old man was admitted to our hospital with hematemesis. Emergency upper gastrointestinal endoscopy revealed bleeding from a submucosal tumor (SMT) in the antrum of the stomach, with two other SMTs at different sites. Based on his family history, we diagnosed familial multiple gastric gastrointestinal stromal tumors (GISTs) and performed laparoscopic total gastrectomy. Three distinct tumors were found: one in the fornix, one in the lesser curvature of the angle, and one in the antrum of the stomach. Microscopic examination of the resected specimens revealed different cytomorphologies, of the spindle and epithelioid type, as well as immunophenotypes in the tumors. Mutation analysis revealed different sites of mutation in c-kit and PDGFRA. No mutation was detected in the normal tissue of the stomach. These findings confirmed a diagnosis of multiple sporadic gastric GISTs. Thus, investigating germline mutation might assist in the preoperative diagnosis of multiple gastric GISTs.
Surgery Today 11/2011; 42(1):84-8. · 1.22 Impact Factor
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ABSTRACT: Although pneumoperitoneum has been suspected as a possible cause of transient elevation of liver function tests (LFTs) after laparoscopic surgery, liver damage by direct retraction could also influence postoperative LFTs. The aim of this study was to clarify whether laparoscopic gastrectomy (LG) using a Nathanson retractor was associated with the postoperative elevation of LFTs compared with open gastrectomy (OG).
A retrospective cohort study of 199 LG and 120 OG patients was conducted. Serum aspartate aminotransferase (AST), alanine aminotransferase (ALT), and total bilirubin were measured before operation and at postoperative days 1, 3, and 7. Abnormal elevation of LFTs was defined as a grade 2 or greater elevation in any parameter. To assess the possible effect of pneumoperitoneum, patients who underwent laparoscopic (n = 324) and open (n = 56) colectomy for colorectal cancer were also compared.
In both LG and OG groups, LFTs were significantly elevated postoperatively compared with baseline values. Mean ALT and total bilirubin levels on days 1, 3, and 7 were significantly higher in the LG than OG group. Abnormal elevation of LFTs was more frequent in the LG than OG group (50 vs. 12%). In multivariate analysis, LG was significantly associated with postoperative liver dysfunction (odds ratio [OR] = 7.99; 95% confidence interval [95% CI] = 3.69-18.85). No significant difference in the elevation of the LFTs was observed between laparoscopic and open colectomy (6% and 9%, respectively).
LG resulted in frequent elevation of LFTs. Care should be taken to minimize intraoperative liver damage when performing LG using a Nathanson retractor.
World Journal of Surgery 09/2011; 35(12):2730-8. · 2.36 Impact Factor
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ABSTRACT: During esophagectomy, laparoscopy can be used together with thoracoscopy, but it is not known whether a combined thoracoscopic-laparoscopic procedure is associated with fewer postoperative complications than open esophagectomy, and without compromising oncological outcome.
This was a longitudinal cohort study that included 185 esophageal cancer patients, including 72 who underwent combined thoracoscopic-laparoscopic esophagectomy (TLE), 34 who underwent thoracoscopic esophagectomy (TE), and 79 who underwent open esophagectomy (OE) between January 2002 and May 2010. The main outcome measures were postoperative respiratory and overall complications. The secondary outcome was 2-year relapse-free survival (RFS).
Respiratory complications occurred in 9 patients who underwent TLE, 13 who underwent TE, and 31 who underwent OE. TLE was associated with fewer respiratory complications (TLE vs. OE: odds ratio [OR], 0.22; 95% confidence interval [CI], 0.09-0.53 and TE vs. OE: OR, 0.71; 95% CI 0.29-1.76). Overall complications occurred in 34 patients who underwent TLE, 20 who underwent TE, and 54 who underwent OE. TLE was associated with fewer overall complications (TLE vs. OE: OR, 0.47; 95% CI 0.23-0.94 and TE vs. OE: OR, 0.51; 95% CI 0.21-1.25). The 2-year RFS rates were similar among the three groups: 71.6% for TLE, 57.7% for TE, and 58.3% for OE (TLE vs. OE: hazard ratio, 0.65; 95% CI 0.35-1.20 and TE vs. OE: hazard ratio, 0.91; 95% CI 0.45-1.82).
Unlike TE, TLE was associated with fewer postoperative complications than was OE, with no compromise of 2-year RFS. A randomized controlled trial with longer follow-up is needed.
Surgical Endoscopy 09/2011; 26(2):381-90. · 4.01 Impact Factor
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ABSTRACT: To improve the poor prognosis in patients with stage IV (StIV) gastric cancer (GC), we conducted a multicenter phase II study of preoperative S-1 plus cisplatin followed by gastrectomy and postoperative S-1 for StIV GC (the protocol is registered at the clinical trial site of the National Cancer Institute; KYUH-UHA-GC03-01, NCT00088816).
Eligibility criteria included histologically proven StIVGC. Patients received S-1 (80 mg/m(2)/day, days 1-21) plus cisplatin (60 mg/m(2) on day 8) for 2 courses. After preoperative chemotherapy (CTx), radical gastrectomy was performed. Postoperative S-1 (80 mg/m(2)/day, days 1-14) was administered every 3 weeks for 1 year.
Fifty-one patients were enrolled and all patients were followed for more than 2 years. The 2-year overall survival and progression-free survival rates were 43.1% (95% confidence interval [CI] 29.4-56.1%) and 33.3% (95% CI 20.9-46.2%), respectively. Preoperative chemotherapy was accomplished in 44 patients (86.3%). These 44 patients underwent surgery and R0 resection was achieved in 26. The rate of R0 resection for GC with a single StIV factor (n = 24) was 79.2% and that for GC with multiple StIV factors (n = 27) was 25.9%. All patients with cancer cells in peritoneal washings (cytology [Cy] 1) alone (n = 12) became Cy0 after preoperative chemotherapy. Postoperative chemotherapy was completed in 11 patients, including 8 with Cy1 alone. No treatment-related death was recorded. Recurrences were observed in 14 patients after R0 resection. The most frequent recurrence site was the peritoneum. Patients who underwent R0 resection and those with Cy1 alone had a better survival.
This perioperative treatment was safe and feasible for StIVGC but failed to show a survival benefit. In patients with StIVGC with Cy1 alone this treatment resulted in a better prognosis.
Gastric Cancer 06/2011; 15(1):61-9. · 2.42 Impact Factor
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Annals of Surgical Oncology 04/2011; 18 Suppl 3:S211-2; author reply S213-4. · 4.17 Impact Factor
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ABSTRACT: There is little evidence for the technical feasibility of laparoscopic gastrectomy (LG) with peripancreatic lymphadenectomy in terms of postoperative complications. To evaluate the technical feasibility of LG with radical lymphadenectomy, we focused on pancreas-related complications in LG and open gastrectomy (OG), and then investigated whether such complications increased in LG.
We reviewed the surgical outcomes of 138 consecutive patients with gastric cancer who underwent LG with peripancreatic lymphadenectomy in our hospital between July 2005 and February 2009. As a control group, we used 95 consecutive OG cases with peripancreatic lymphadenectomy without splenectomy or para-aortic lymphadenectomy. LG and OG were compared for clinicopathologic characteristics, operative outcomes, postoperative morbidities and mortalities, and amylase concentration of drainage fluid (d-AMY).
The overall operative morbidity rates were 15% in the LG and 20% in the OG group. Rates of postoperative pancreatic fistula (POPF), Grade B and C in the International Study Group on Pancreatic Fistula definition, were 7% in the LG group and 2% in the OG group, indicating no statistical difference (P = .149). There were no in-hospital deaths. The median value of d-AMY in LG was 934.5 IU/L, while that in OG was 349 IU/L; d-AMY after LG was significantly higher than that after OG (P < .01).
Considering low morbidity and mortality rates, LG with peripancreatic lymphadenectomy is technically feasible. Although POPF after LG was infrequent, d-AMY level was higher than after OG. We should pay attention to the potential risk of pancreatic leakage when carrying out LG with peripancreatic lymphadenectomy.
Surgery 01/2011; 149(1):15-21. · 3.10 Impact Factor
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ABSTRACT: It is well-known that the amphiphilic solutes are surface-active and can accumulate at the oil-water interface. Here, we have investigated the water and a light-oil model interface by using molecular dynamic simulations. It was found that aromatics concentrated in the interfacial region, whereas the other hydrocarbons were uniformly distributed throughout the oil phase. Similar to previous studies, such concentrations were not observed at pure aromatics-water interfaces. We show that the self-accumulation of aromatics at the oil-water interface is driven by differences in the interfacial tension, which is lower for aromatics-water than between the others. The weak hydrogen bonding between the aromatic rings and the water protons provides the mechanism for lowering the interfacial tension.
Journal of the American Chemical Society 12/2010; 132(51):18281-6. · 9.91 Impact Factor
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Journal of the American College of Surgeons 07/2010; 211(1):e1-6. · 4.55 Impact Factor
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ABSTRACT: A 77-year-old man presented with a 2-month history of an enlarged right inguinal lymph node. Diagnostic excisional biopsy of the inguinal lymph node proved it to be a poorly differentiated neuroendocrine carcinoma by histological and immunohistological analyses. We diagnosed a poorly differentiated neuroendocrine carcinoma by histological examination and immunohistological analysis of the resected inguinal lymph node. We performed computed tomographic examination and positron emission tomography, which identified lymph node involvement without any signs of other tumors. Because these tumors had grown expandingly and had been encapsulated locally, we performed an operation to dissect all of the involved lymph nodes. Direct invasion to the right external iliac artery was not detected, and two of the enlarged lymph nodes were successfully resected without any complications. Pathologically, the resected specimen was diagnosed as a neuroendocrine carcinoma with a negative surgical margin and it was similar to the histology of the inguinal lymph node previously resected. The patient had no recurrence for 3 years without receiving any adjuvant treatment. There have been no reports describing a case of poorly differentiated neuroendocrine carcinoma, of unknown origin, which metastasized to other lymph nodes. Although further studies are required, complete resection of the involved lymph nodes should be considered as a choice for localized, expanding growth-pattern disease even if it is undifferentiated type.
International Journal of Clinical Oncology 03/2010; 15(5):493-6. · 1.41 Impact Factor
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ABSTRACT: The prognosis of gastric cancer patients with peritoneal dissemination is poor. Recently, chemotherapy with S-1 plus cisplatin has been shown to be highly effective for advanced gastric cancer.
In 41 patients diagnosed with either macro- or microscopic peritoneal dissemination by staging laparoscopy, and receiving induction chemotherapy with S-1 plus cisplatin between August 2002 and February 2008, response of peritoneal lesions to the induction chemotherapy and the outcome of the following surgery were retrospectively evaluated.
Of 41 patients identified, 38 patients (93%) completed two cycles. Among grade 3 or 4 adverse effects, neutropenia was most frequently observed (9 patients; 22%). After chemotherapy, 32 patients (78%) underwent surgery and R0 resection was accomplished in 22 patients. Although objective response by Response Evaluation Criteria in Solid Tumors (RECIST) was recorded in only four patients (10%), peritoneal dissemination disappeared in 19 patients (46%). Patients with limited peritoneal metastasis, negative peritoneal cytology, or response of the primary lesion were more likely to exhibit disappearance of the peritoneal dissemination. Median survival time of all patients was 20.4 months. Patients with R0 resection had median survival time of 43.2 months, which was significantly longer than for those with noncurative resection (12.6 months) or without surgery (10.3 months).
Limited peritoneal dissemination of gastric origin is highly sensitive to induction chemotherapy with S-1 plus cisplatin. Resection after disappearance of peritoneal metastasis could cure some patients.
Annals of Surgical Oncology 09/2009; 16(12):3227-36. · 4.17 Impact Factor
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Surgical Endoscopy 10/2008; 22(12):2741. · 4.01 Impact Factor
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ABSTRACT: Venous ports are mandatory for chemotherapy in cancer patients because prolonged infusions are required. The aim of this study was to assess the safety of peripheral arm ports for chemotherapy in patients with colorectal cancer.
A peripheral venous access port was placed in the upper arm in 113 consecutive patients with metastatic colorectal cancer (MCRC). All patients received modified FOLFOX (5-fluorouracil [5-FU]/l-leucovorin [LV]/oxaliplatin [L-OHP]) 6 or FOLFIRI (5-FU/LV/irinotecan hydrochloride [CPT-11]) regimens at least once via the venous access port. All patients were followed up at least once every 2 weeks.
Puncture of the basilic veins was successfully completed under real-time sonographic guidance or radiographic guidance in all patients. The median operative time was 30 min. The cumulative follow-up period was 29 886 catheter days (range, 9-560 days; mean, 264 days). No procedural complications, such as pneumothorax, hemothorax, arterial puncture, or cardiovascular problems, occurred in our series. A total of nine patients (8.0%) had complications. Port-site infection occurred in six patients (5.3%; 0.20 infections per 1000 catheter-days). One patient (0.9%) had an episode of ultrasound-documented deep vein thrombosis in the ipsilateral upper extremity (0.03/1000 catheter-days). Dislocation or migration of the catheter tip occurred in two patients (0.07/1000 catheter-days). A second port was placed in six patients (5.3%) after removal of the fi rst port.
Peripheral arm ports can be maintained with excellent short-and long-term outcomes. Peripheral arm ports are considered to be a good alternative to central venous ports implanted in the chest in patients with MCRC.
International Journal of Clinical Oncology 09/2008; 13(4):349-54. · 1.41 Impact Factor
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ABSTRACT: To facilitate acceptance of laparoscopic total gastrectomy (LTG) for patients with upper gastric cancer, a simple, secure technique of reconstruction is necessary. The authors developed a new technique for intracorporeal esophagojejunal anastomosis that does not require hand sewing.
From September 2006 to January 2008, 16 patients (11 men and 5 women) with gastric cancer underwent LTG at the authors' institution. Laparoscopic esophagojejunal anastomosis using the following method was attempted for all patients. The esophagus was transected while being rotated by about 45 degrees counterclockwise to make the subsequent anastomosis easier. After the Y-anastomosis was created, an endoscopic linear stapler was applied to create a side-to-side anastomosis between the left dorsal side of the esophagus and the jejunal limb. The entry hole was first closed roughly with hernia staplers. Subsequently, an endoscopic linear stapler was applied so that all hernia staplers could be removed and the closure completed.
Laparoscopic esophagojejunal anastomosis was successfully performed for 15 patients. Intracorporeal anastomosis failed for one patient because a nasogastric tube was caught between the jaws of an endostapler, which resulted in a conversion to open procedure. No postoperative anastomotic complications occurred.
Using the new technique, intracorporeal linear-stapled esophagojejunal anastomosis can be performed easily and securely. This technique could become one of the standard methods for reconstruction after LTG, facilitating the acceptance of LTG as a surgical option for patients with upper gastric cancer.
Surgical Endoscopy 07/2008; 23(9):2167-71. · 4.01 Impact Factor
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ABSTRACT: Lymph node dissection is a crucial procedure for curative resection of gastric cancer [1]. To avoid portal vein injury during laparoscopic extended lymph node dissection for gastric cancer, taping of the common hepatic artery and subsequent confirmation of the portal vein have been recommended [2, 3]. This taping method, however, makes laparoscopic nodal dissection technically complicated. This study introduces a novel procedure for safe and simple laparoscopic suprapancreatic nodal dissection without taping of the common hepatic artery.
The authors' novel, simplified method consists of four steps: (1) dissection along the cranial edge of the pancreas from right to left, (2) dissection along the splenic artery with exposure of the left renal fascia, (3) dissection along the left gastric and the common hepatic arteries, and (4) retraction of the lymph nodes surrounding the common and proper hepatic arteries and their complete dissection from the portal vein. This procedure is reversely directed compared with conventional open gastrectomy (i.e., the nodal dissection is from left to right). For this study, the lymph node stations and groups were defined according to the 13th edition of the Japanese Classification for Gastric Carcinoma. The described procedures were performed for 58 consecutive patients with gastric cancer. The indication for this operation is primary T1/T2 gastric cancer without clinical nodal metastasis.
In all cases, safely extended suprapancreatic lymph node dissection was successfully accomplished using the described technique. A total of 43.5 +/- 18 lymph nodes were retrieved, including 14.4 +/- 6.3 second-tier lymph nodes. The overall number of retrieved lymph nodes in this study was similar to that reported previously [4]. Postoperative morbidity occurred at a rate of 22.3%, and the mortality rate was 0%. There was no conversion to open surgery. The mean blood loss was 127 ml (range, 0-490 ml), and the mean operative time was 289 min (range, 104-416 min) in the last 20 consecutive cases. To date, no tumor recurrence has been observed. The median postoperative observation period was 1.4 years (range, 0.4-2.4 years).
The described novel procedure would be sufficient and convenient for dissection of the suprapancreatic lymph nodes.
Surgical Endoscopy 07/2008; 23(2):436-7. · 4.01 Impact Factor
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ABSTRACT: LKB1 encodes a serine/threonine protein kinase that is defective in patients with Peutz-Jeghers syndrome (PJS), a hereditary disorder characterized by gastrointestinal hamartomatous polyposis and an increased risk of cancer development. Although a tentative molecular classification of PJS patients was recently made according to their LKB1 mutation status, it is difficult to clarify the genotype-phenotype relationship because of the rarity and genetic heterogeneity of this disease. Here we report on two probands with PJS whose intestinal hamartomatous polyposis was treated by laparoscopyassisted polypectomy. Direct sequencing analyses revealed a nonsense mutation at codon 240 in exon 5 in one patient, and a mutation at a splicing donor site in intron 5 in the other patient. No additional somatic mutations were detected in the resected hamartomas in either case. Immunohistochemical analysis revealed an elevated expression of cyclooxygenase-2, and almost complete loss of LKB1 expression in the polyps, suggesting that a biallelic inactivation of the LKB1 gene was responsible for the hamartoma formation. Methylation-specific polymerase chain reaction analysis revealed no hypermethylation of the LKB1 promoter. Mutation analysis is useful in making a precise diagnosis of PJS in candidate probands, and may in the near future provide valuable information for predicting cancer risk based on genotype-phenotype correlations.
Journal of Gastroenterology 02/2008; 43(6):492-7. · 4.16 Impact Factor
