[Show abstract][Hide abstract] ABSTRACT: Laparoscopic surgery is a minimally invasive operation developed for treating gastrointestinal malignancies. We aimed to characterize the differences in the intra-abdominal environment following open and laparoscopic surgeries.
We investigated data of 48 patients who underwent gastrectomy between 2010 and 2012. We analyzed the mRNA expression of chemokines, indoleamine 2, 3-dioxygenase (IDO), and so on in peritoneal lavage fluid with real-time RT-PCR. We also determined the leukocyte population and calculated the granulocyte/lymphocyte (G/L) ratio in peritoneal lavage fluid using flow cytometry.
CCL3 mRNA was significantly upregulated, whereas IDO mRNA was significantly downregulated, in the open group compared to the laparoscopic surgery group. Flow cytometry revealed that the G/L ratio was significantly higher in the open group.
We suggest that the production of chemokines and neutrophil infiltration into the abdominal cavity may be suppressed in the laparoscopic surgery. Thus, laparoscopic surgery may be beneficial in preserving local immunity.
[Show abstract][Hide abstract] ABSTRACT: Lymph node metastasis is one of the most important prognostic factors in patients with esophageal squamous cell carcinoma (ESCC). Neoadjuvant treatment can reduce micrometastasis in lymph nodes to enable curative resection by down staging. The aim of this study was to evaluate the histological effect of neoadjuvant therapy on lymph node metastasis of ESCC by performing immunohistochemistry for cytokeratin staining.
A total of 3061 lymph nodes were examined from 62 patients who received neoadjuvant treatment followed by esophagectomy with lymphadenectomy.
We observed positive staining for cytokeratin in 276 (9.0%) lymph nodes, which included overt metastasis, micrometastasis and hyalinized cytokeratin particles (HCP). Patients with HCPs in lymph nodes had better outcomes than patients without HCPs in lymph node. A significant prognostic difference between the patients with HCPs and without HCPs was observed in a subgroup of patients with nodal metastasis.
Our findings suggest that HCP might reflect a degenerative change of cancer cells in lymph nodes and can predict the response to neoadjuvant therapy.
[Show abstract][Hide abstract] ABSTRACT: : Thoracoscopic esophagectomy (TE) in the prone position for patients with esophageal cancer has received a great deal of attention. We retrospectively compared clinical outcomes and surgical stress of TE in the prone position (TE-P) and in the lateral position (TE-L) at our institution.
A total of 58 consecutive patients (28 in the TE-L group and 30 in the TE-P group) were studied. Between the 2 groups, clinical outcomes and various parameters were compared.
There were no hospital deaths in both TEL and TEP groups. Blood loss during the thoracoscopic part of the surgery were significantly (P<0.01) lower in the TE-P group (118±72 mL) compared with the TE-L (245±203 mL) group. The incidence of respiratory complications tended to be lower (P=0.07) in the TE-P group (3.3%) than in the TE-L (17.8%) group. The duration of systemic inflammatory response syndrome condition was significantly (P=0.02) shorter in the TE-P group (1.5±2.5 d) than in TE-L (3.6±3.5 d) group. The levels of serum C-reactive protein on postoperative days 1 and 2 were significantly (P<0.01) lower in the TE-P group than in the TE-L group.
TE-P for patients with esophageal cancer was safe and feasible. TE-P might be a potentially less invasive procedure than TE-L.
[Show abstract][Hide abstract] ABSTRACT: We report a case of a 72-year-old woman with breast cancer who developed significant stenosis due to gastric cardia metastasis. The patient had undergone radical mastectomy for breast cancer when she was 53 years old and had developed postoperative recurrent diseases in the sternum and lung when she was 62 years old. Nineteen years after mastectomy, computed tomography (CT) scans showed gastric cardia metastasis. As symptoms of cardiac stenosis gradually developed, we performed proximal gastrectomy. The specimen was histologically diagnosed as estrogen receptor( ER)-positive scirrhous carcinoma that had metastasized from the breast cancer. The patient resumed oral intake of food after surgery. Surgical treatment might be useful to improve the quality of life of patients with metastatic gastric tumor.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2210-3.
[Show abstract][Hide abstract] ABSTRACT: A 77-year-old woman with Stage IV gastric cancer was admitted to our hospital because of high fever, poor appetite, and abdominal pain during combined chemotherapy with S-1 and cisplatin( CDDP). Abdominal computed tomography (CT) revealed the presence of gas in the submucosal layer on the basis of which emphysematous cholecystitis (EC) was diagnosed. We performed cholecystectomy and were able to proceed with the chemotherapy 1 month after surgery. Destruction of the gallbladder mucosa by ischemia has been reported to be a possible cause of emphysematous cholecystitis. Moreover, underlying systemic diseases such as arterial sclerosis and diabetes mellitus could be risk factors for EC. Our case suggested that chemotherapeutic agents might trigger ischemic changes in the gallbladder and thus result in EC.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2316-8.
[Show abstract][Hide abstract] ABSTRACT: The patient was a 68-year-old man who complained of hoarseness and dyspnea. Upper gastrointestinal endoscopy revealed a type 3 tumor located in the middle thoracic esophagus at 30 cm from the incisor tooth that involved one-fourth of the circumference of the esophagus. Histopathological examination revealed moderately differentiated squamous cell carcinoma. Chest computed tomography( CT) revealed severe tracheal stenosis due to compression by a metastatic lymph node along the left recurrent laryngeal nerve. The patient was diagnosed as having cT4( 106recL-trachea), N2( 101L, 106recL, 106recR), M0, Stage IVa unresectable esophageal carcinoma. After insertion of a tracheal stent tube( spiral Z stent: diameter, 18 mm; length, 80 mm) to improve dyspnea, combination chemotherapy with 5-fluorouracil( 5-FU) plus nedaplatin was administered. Subsequent CT and endoscopy showed that the main tumor and the metastatic lymph node had significantly reduced in size and that complete response (CR) had been achieved. Thirty months after the initial treatment, the patient showed no sign of disease recurrence, after completion of 19 cycles of chemotherapy. The patient did not experience any severe adverse events. We report a case of a patient with locally advanced squamous cell carcinoma of the esophagus successfully treated with 5-FU/nedaplatin combination chemotherapy following tracheal stent tube placement.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2013; 40(12):2112-4.
[Show abstract][Hide abstract] ABSTRACT: Abstract This report describes a case of port site metastasis after laparoscopic gastrectomy for gastric cancer. A 57-year-old man with clinical cTNM stage II (T2 N0 M0) gastric cancer was admitted to our hospital. After administration of an oral fluoropyrimidine drug (S-1) for 2 weeks, he underwent laparoscopy-assisted distal gastrectomy (LADG). On hematoxylin and eosin staining, the pTNM stage was IA (T1b N0 M0). Eighteen months later, the patient developed a subcutaneous metastasis at the trocar site. A second operation was performed, and the abdominal wall mass was resected. The histological finding confirmed a diagnosis of metastatic gastric carcinoma. Immunohistochemical analysis revealed micrometastasis in fat tissue adjacent to the lymph node near the left gastric artery. Surgeons should be aware that port site metastasis can occur in patients undergoing LADG for gastric cancer with lymphatic micrometastasis, which is undetectable on routine hematoxylin and eosin staining.
International surgery 10/2013; 98(4):363-366. DOI:10.9738/INTSURG-D-13-00049.1 · 0.47 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The right aortic arch (RAA) forms a vascular ring, encircling both the esophagus and trachea. We herein report a case of thoracic esophageal cancer with RAA successfully resected using video-assited thoracoscopic surgery (VATS). A 64-year-old man who presented with a complaint of abdominal pain, was admitted to our hospital. Further examinations revealed gall stones and multiple superficial esophageal carcinomas. Three-dimensional computed tomographic images showed RAA and aortic diverticulum. The trachea and esophagus were completely encircled by the RAA, the aortic diverticulum and the pulmonary artery. We successfully and safely performed VATS esophagectomy for esophageal cancer accompanied with RAA. To the best of our knowledge, this report is the first case for which VATS esophagectomy for esophageal cancer, accompanied with RAA, was carried out. Marking of the left recurrent laryngeal nerve with colored tape at the cervical part of the surgery made it easy to identify it during the thoracoscopic part of the surgery.
Anticancer research 04/2013; 33(4):1635-40. · 1.83 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The patient was a 39-year-old man with type 3 gastric cancer with synchronous multiple liver and lung metastases, who was diagnosed as cStage IV(cT4aN1M1H1). He received induction chemotherapy with S-1 and CDDP. After chemotherapy, the liver and lung metastases had disappeared completely. He underwent total gastrectomy and splenectomy, with D2 nodal dissection. Anastomotic leakage occurred on postoperative day 6, and substantial inflammatory conditions continued for 2 weeks. He died 6 weeks after surgery with multiple liver metastases. This case suggests that elevated inflammatory conditions may cause tumor progression.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2012; 39(12):1773-5.
[Show abstract][Hide abstract] ABSTRACT: We report a case of pancreatic adenosquamous carcinoma arising from an intraductal papillary muci-nous neoplasm (IPMN). A 79-year-old woman treated as an outpatient for diabetes was diagnosed with pancreatic duct IPMN in 2004, but could not be followed up by imaging due to poor compliance. She de-veloped lower abdominal pain at the end of January 2008, and a 3-cm mass showing delayed intense staining was found in the tail of the pancreas. Based on a diagnosis of IPMN + caudal pancreatic cancer, we conducted distal pancreatectomy. A 20 × 24-mm lightgray solid tumor was found in the resected specimen, and the main pancreatic duct was dilated to 11mm in diameter and filled with jelly-like mu-cus. Postoperative histopathological examination yielded a diagnosis of pancreatic adenosquamous car-cinoma arising from IPMN. In immunostaining, adenocarcinoma was positive for CA19-9 and CEA, and the squamous region showed partial weak staining, indicating the presence of a common expression phenotype. Dysplasia continuous with the IPMN was noted in the main pancreatic ducts and the sur-rounding interstitium showed severe fibrosis, suggesting that IPMN had advanced to the periphery and progressed to invasive pancreatic duct cancer, causing squamous cell metaplasia.
[Show abstract][Hide abstract] ABSTRACT: The primary small intestinal cancer is rare in gastrointestinal cancer, and there are much advanced/recurrent cases. However, there were a few case reports about chemotherapy for advanced or recurrent small intestinal cancer, and a treatment resume was inconsistent. We reported that S-1 and UFT/LV therapy was effective with the two cases as an oral chemotherapy for the primary small intestinal cancer.
Gan to kagaku ryoho. Cancer & chemotherapy 11/2010; 37(12):2789-91.
[Show abstract][Hide abstract] ABSTRACT: We evaluated the efficacy and safety of chemotherapy with S-1/CDDP for advanced and recurrent gastric cancer at Fuchu Hospital.
The participants were 24 patients treated at our hospital. S-1 was given orally at 80 mg/m/2 for days 1-21, and 60 mg/m2 of CDDP was administered on day 8, followed by a 2-week rest period, within a 5-week course.
Results were rated as a partial response in 12 cases and a stable response in 4 cases. The response rate was 50% (12/24), and median survival time was 273 days. The total incidence of grade 3 or greater adverse reactions including leucopenia, neutropenia, anemia, general fatigue, and eruption, was 25% (6/24).
The combination of S-1/CDDP therapy appears to be highly efficacious and safe and showed promise as a useful treatment strategy, even in an outpatient clinic.
Gan to kagaku ryoho. Cancer & chemotherapy 07/2010; 37(7):1287-90.